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Jasmin Häcker und Bernd Raffelhüschen

Jasmin Häcker und Bernd Raffelhüschen. University of Freiburg. On the Inclusion of Dementia Patients into Compulsory LTC-Insurance in Germany – A Sustainable Step?. Research Centre for Generational Contracts. European Conference on Long-Term Care, Mannheim 21.10. - 22.10.05.

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Jasmin Häcker und Bernd Raffelhüschen

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  1. Jasmin Häcker und Bernd Raffelhüschen University of Freiburg On the Inclusion of Dementia Patients into Compulsory LTC-Insurance in Germany – A Sustainable Step? Research Centre for Generational Contracts European Conference on Long-Term Care, Mannheim 21.10.-22.10.05

  2. 1 The Status quo of Long-term Care Insurance 2 Projection of Dementia Patients and Sustainability 3 Citizens‘ Insurance vs. Partial Funding Strategy 4 Conclusion

  3. revenues (contribution payments) expenditures (transfer receipts) sum sum 159,2 159,2 1. The Status quo of LTCI Method of Generational Accounting Age-specific net contribution payments National account budget for the base year Population projection Sustainability gap Generational accounts Euro age

  4. 1. The Status quo of LTCI Fig. 1: Age-specific contribution payments and transfer receipts of LTCI

  5. 1. The Status quo of LTCI Fig. 2: Sustainability gaps of LTCI in the status quo with an increase in LTC costs by 1,5% (scenario 1) and 2,5% (scenario 2) (base year 2003, r=3%, g=1,5%) Fig. 3: Development of the contribution rate of LTCI in scenario 1 and 2 (base year 2003, r=3%, g=1,5%)

  6. Age-group 65-69 70-74 75-89 80-84 85-89 Prevalence rate 1,2 % 2,8 % 6 % 13,3 % 23,9 % 34,6 % 2. Projection of Dementia Patients and Sustainability Age-specific prevalence rates of dementia patients (Bickel (2000)): over 90 According to the 5thvariant of the 10th coordinated population projection the number of dementia patients can be extrapolated for all years after 2003

  7. 2. Projection of Dementia Patients and Sustainability Fig. 4: Development of the number of dementia patients and „all otherbeneficiaries“ for the years 2005 to 2050 (in percent)

  8. 2. Projection of Dementia Patients and Sustainability Fig. 5: Sustainability gaps of LTCI in the status quo and in case of additional benefits for dementia patients (scenario 3) (base year 2003, r=3%, g=1,5%) Fig. 6: Development of the contribution rate of LTCI in the status quo and in case of additional benefits for dementia patients (scenario 3) (base year 2003, r=3%, g=1,5%)

  9. 3. Citizens‘ Insurance vs. Partial Funding Strategy Citizens‘ Insurance (Lauterbach/Nahles) Changes on the revenueside:  inclusion of all citizens in the pay-as-you-go scheme  increase in the assessment limit • increase in the assessment of contributions through including incomes other than wages Changes on the expenditure side:  Additional benefits for dementia patients • Increase in the outpatient in-kind transfers for the care levels 1 and 2: care level 1: 384 € 704 € care level 2: 921 € 1.100 €

  10. 3. Citizens‘ Insurance vs. Partial Funding Strategy Fig. 7: Sustainability gaps of LTCI in the status quo and in case of the citizens‘ insurance (base year 2003, r=3%, g=1,5%) Fig. 8: Development of the contribution rate of LTCI in the status quo and in case of the citizens‘ insurance (base year 2003, r=3%, g=1,5%)

  11. outpatient inpatient care level 1: 384 € 400 € 500 € 1.023 € care level 2: 921 € 1.000 € 1.279 € care level 3: 1.432 € 1.500 € 3. Citizens‘ Insurance vs. Partial Funding Strategy Partial Funding Strategy (Stewens) Changes on the revenueside:  supplementary funded LTCI, mandatory for all 60 year-olds and younger in 2006 Changes on the expenditure side:  Additional benefits for dementia patients • Adjustment of outpatient and inpatient in-kind transfers: 1.432€  Freezing of the nominal transfer level Supplementary Insurance: benefits are adjusted annually + Fig. 9

  12. 3. Citizens‘ Insurance vs. Partial Funding Strategy Fig. 9: Real term transfer level of the base year if the supplemetary insurance covers the loss in benefits of unfunded LTCI due to the freezing of the nominal transfer level

  13. 3. Citizens‘ Insurance vs. Partial Funding Strategy Fig. 10: Development of the contribution rate of LTCI in the status quo and in case of the partial funding strategy (base year 2003, r=3%, g=1,5%)

  14. Conclusion • Neither of the reform options can curtail the problems of the LTCI  partial funding strategy does not fully account for the development in expenditures citizens‘ insurance even aggravates the demographic burden • Without having solved existing problems, no new basis for claim should be created!

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