Germany's Social Long-term Care Insurance: Design, Implementation and Evaluation

Across all industrialized countries, issues surrounding population ageing have captured the attention of policymakers. Among its manifold ramifications, disability-related poverty and the projected growth in public funding of long-term care demand close attention. Comparative studies have revealed distinct policy approaches to long-term care across different countries, but a shared interest in market-oriented policy design and cost containment. In Germany, legislation on mandatory and universal dependency care insurance came into force recently. The 1994 Dependency Insurance Act responded to limited market insurance against the financial risk of long-term care, deficiencies in servicing long-term care dependants and the fiscal crisis of German communities, which had to provide social assistance to a growing number of destitute care clients. The new social long-term care insurance scheme adopts basic features of existing German social insurance schemes even as it challenges the country's social insurance legacy in terms of cost containment strategies and consumer-directed provision. After three years of operation, the new programme is technically in place and financially healthy. However, critics point to its tight screening procedures, persistent shortages in the supply of formal care, and fraud. Equity issues, quality of care and consumer direction have also drawn critical attention. A variety of scenarios for programme improvement are conceivable. Coverage could be extended and payments offered to family caregivers. A comprehensive "cash and counselling" concept should be developed. Finally, programme efficiency depends on public accountability and quality auditing. Choice should be informed by ongoing research into long-term care and the broader impacts of long-term care policy.