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Prof. Rothgang and Team at SOCIUM are Partners in Flagship Project “Long-Term Care 2030”

The kick-off event at Karlsfeld on 19th December 2022 marked the beginning of a pilot project on long-term care for tomorrow, a joint initiative of SOCIUM and the Fraunhofer Institute for Integrated Circuits (Fraunhofer IIS) together with the Korian Foundation for Long-Term Care and Aging with Dignity (Korian Stiftung für Pflege und würdevolles Altern) as well as Korian Deutschland GmbH.

The pilot project has been awarded a budget of approx. 7m euros, of which half is provided by the Bavarian State Ministry for Health and Long-Term Care. Korian Deutschland is funding not only the cost of building and reconstruction work to the tune of 2.5m euros, but is also giving a further 1m euros over a period of 3 years to increase staffing levels. With this funding it will be possible to implement and test a scientific method for the standardized calculation of staffing requirements in long-term care, developed in a major project conducted by the University of Bremen from 2017-2020, commissioned by the self-governing body of long-term care insurance providers.

The present project was inaugurated by Klaus Holetschek, Bavarian State Minister for Health and Long-Term Care. In his speech, he declared: “Improving long-term care is a key issue for the future. We need to ensure that people in need of care are treated with dignity, but also that working conditions for care workers are improved. We must set the course now to provide comprehensive, humanitarian long-term care for tomorrow. The Bavarian State Ministry for Health and Long-Term Care considers the Project ‘Long-Term Care 2030’ forward-looking, and it is hoped that it will bring us sustainable insights for the long-term improvement of residential care in and beyond Bavaria.”

Elisabeth Scharfenberg, Chair of the Korian Foundation, added: “We, the Korian Foundation, are delighted over the inauguration of the project ‘Long-Term Care 2030’ at the Korian nursing home in Karlsfeld. With scientific support, we shall over the next three years be implementing a modernized concept that will effectively facilitate the daily work of care workers, support them in their routines and hence also benefit those in need of care.”

For the 3-year duration of the project, quantitatively and qualitatively needs-based and digitalized long-term care will be implemented and tested in realtime at the nursing home in Karlsfeld. With a significantly higher proportion of care assistants in the staff mix, the modernization of the nursing home using digital care technology (such as sensors, AI, service robots or data-based process management) and an innovative staffing schedule will be tested and evaluated. “In this way, needs-based and skills-oriented, digitally supported processes can be developed in the daily routine to enhance both the life quality of the nursing home residents and work satisfaction among qualified carers”, emphasized Professor Heinz Rothgang, University of Bremen.

 “The development, implementation and integration of new processes and ‘smart’ technologies to ease the workload for care workers present considerable challenges both for the developers and the users”, stated Dr. Thomas Wittenberg from the Fraunhofer Institute. In order to identify and evaluate the appropriate technologies (such as intelligent beds, data glasses, voice recognition or robotic systems for reducing workloads in long-term care), researchers of the Fraunhofer Institute in Erlangen will contribute to the project with their expertise. In close cooperation with the careworkers, they aim to develop new procedures for recognizing, analysing and interpreting stress points in care processes by means of wearable sensors, and put solution approaches into practice.

 In view of the urgent need for reform in residential long-term care, the nursing home at Karlsfeld should serve as a best-practice model for skill-based care in a digitalized home, and deliver valuable, transferable findings not just for Bavaria, but also for the whole of Germany. “The interplay and the triad of additional staff, building infrastructure and the application of technology make ‘Long-Term Care 2030’ a holistic, future-oriented project. If we want to make long-term care sustainable and viable for the future, we must not think in inflexible categories,” said Dr. Marc-Alexander Burmeister, CEO of Korian Deutschland GmbH. The objective is rather to evaluate the whole project holistically in terms of quality of care, and to tailor modular guidelines that other nursing homes can use as implementation blueprints.

 

 

 

 


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Heinz Rothgang and Rolf Müller from SOCIUM Research Center on Inequality and Social Policy, University of Bremen, have drawn up the Long-Term Care Report 2022, commissioned by BARMER

 

On Tuesday, November 29, the 2022 BARMER Long-Term Care Report was presented in Berlin. Besides a general overview and an evaluation of long-term care policy over the past year, the focus chapter in this year’s Report analyzes the impact of Covid-19 on the nursing home sector. Not only are the effects on the residents and the homes themselves examined, but also the financial effects on long-term care insurance.

Promises made in the Coalition Agreement have so far not yet been fulfilled

The Coalition Agreement was signed just over a year ago, and it included a set of measures for ameliorating the long-term care situation. However, none of these measures have been implemented to this day. As the measures laid out in the Agreement are urgently needed for further development, it can only be hoped that their implementation begins as quickly as possible in the coming year. Otherwise there will not be enough time till the end of the parliamentary term for carrying out the urgently needed, major long-term care reform.

Long-term care dependents in nursing homes bear the brunt of the pandemic

Nursing home residents have been affected directly and indirectly by the pandemic.

In the first wave, to limit the spread of the infection, nursing homes imposed drastic contact restrictions on visitors, volunteers, and in some cases even doctors, therapists and podiatrists. This resulted not only in restricted medical care, but in particular – not least because of isolation and loneliness – in negative effects on the mental health of the residents.

Despite contact restrictions, the share of residents suffering from COVID-19 in the first and second waves was 7-8 times higher than in the whole population, according to extrapolations of the BARMER data. Moreover, as a consequence of the vulnerability of nursing home residents, more than half of those who died with COVID-19 in the first and second waves were nursing home residents. For the years 2020 and 2021 the cumulative share of nursing home residents who died with COVID-19 stood at 45%, while the share of all care dependents among those who died with COVID-19 was 75%. Fatalities with COVID-19 led to a corresponding excess mortality. Compared with the years 2017-2019 there was an excess mortality among nursing home residents of more than 150,000 persons.

At the end of the observation period, the number of affected residents is still very high. Preparations for new variants of the virus and even more waves are therefore indicated. In order to prevent negative indirect effects, however, contact restriction measures should be dispensed with as far as possible.

Nursing home careworkers are also particularly badly affected

Contact bans in nursing homes, essential hygienic measures – including the compulsory wearing of masks for staff members – as well as staff shortages due to the pandemic, have exacerbated the situation for careworkers. They also had to carry out emotional work – which is normally done by relatives – and under more difficult conditions. As there was initially not enough personal protective equipment available, and the nature of their work made it almost impossible for them to keep their distance, they were particularly affected by the pandemic.

Consequently, sick leave figures for care workers in nursing homes in the first two waves were about five times higher than for employees in other economic sectors. In the third and fourth waves, however, figures for sick leave in all sectors levelled out again.

In order to be prepared for further COVID-19 waves and future pandemics, it is essential to recruit more employees in nursing homes expeditiously and in line with the new procedure for the standardized calculation of staffing requirements in long-term care. Only in this way can a downwards spiral of excessive demands on staff and higher sick leave figures be avoided.

After steep declines in the first two waves, the utilization of formal long-term care services has normalized again.

During the first two pandemic waves, some care dependents and their relatives dispensed with the use of formal care services out of fear of infection. Nursing homes also had to reduce their services, especially as they lacked the staff. There was a heavy drop of around 50% in demand for short-term care in the first wave. In residential long-term care the effect was primarily noticeable in a decline of around 40% in moves from home care to residential care. As full-time home residents usually have no chance of moving back into their old domestic settings, the effect of the pandemic on nursing home residents was correspondingly smaller.

The introduction of vaccinations was likely a decisive factor in the return, in summer 2021, of new arrivals in full-time nursing homes and the use of day care to pre-pandemic figures. However, the downward trend until December 2021 indicates that new waves may again give rise to reduced utilization.

Social insurance is again misused for financing obligations that concern society as a whole

It was laid down in the Coalition Agreement that pandemic-related additional costs of long-term care insurance would be financed through taxes.

In actual fact, the additional costs for rescue packages for long-term care facilities, for the prescribed POC-Antigen tests and for the Corona nursing care premium, accrued to 9.2 billion euros by the end of the first quarter of 2022, but were only offset by federal subsidies, financed through taxes, to the amount of four billion euros. This leaves the long-term care insurance fund with a deficit of 5.2 billion euros, and that is without taking the corona-related extra expenditure for the remaining three quarters of 2022 into account. As yet, therefore, this promise, made in the Coalition Agreement, has not been fulfilled, and obligations that concern society as a whole are again being subsidized through contributions.

Other financial risks render a financial reform at the beginnning of 2023 inevitable. It is to be hoped, when it happens, that the obligation to pay back the above-named credits will be waived and that corona-related costs will be fully tax-financed – as laid out in the Coalition Agreement.

Downloads (all in German):

BARMER Long-Term Care Report 2022

Statement by Prof. Rothgang at the Press Conference

Slide presentation by Prof. Rothgang at the Press Conference


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Funded by the State of Bremen until 31.12.2025

This is a consortium project involving the High-Profile Area of Health Sciences of the University of Bremen, the City University of Applied Sciences, Bremen, and the Apollon University of Applied Sciences in Bremen, which entails the appointment of six doctoral students who will be supervised by professors from all three universities. SOCIUM will be represented by Professor Dr. Heinz Rothgang.

The overarching objective of this cluster is to make a local contribution to the implementation of the WHO’s objectives of the “Healthy Cities” conceptual framework in Europe. This conceptual framework embraces an international vision of good governance, the reduction of health inequalities and the integration of health, or health promotion measures, in all sectors of society. One key aspect of this is the establishment of interdepartmental cooperation within the local authorities to incorporate health promotion into urban development. An equally important aspect is the creation of an efficient system of healthcare provision in which different health occupations are integrated and work together on an equal footing.

For the duration of the funding period the research cluster will investigate and assess Bremen’s health profile, thereby taking into account Bremen’s particular characteristics and strengths relating to Health Sciences; participate and collaborate in drawing up proposals; and, finally, present a concept for the sustainable promotion and implementation of integrated healthcare structures in Bremen. The practical work is divided up into six doctoral positions, awarded in April 2022.

The coordination of the research cluster and the integration of results from all the projects will be carried out by a postdoctoral member of the project team. A concept will also be developed for integrated, small-scale monitoring that combines the areas of health, social and environmental policy, and tested using data from Bremen for decision-making support in cross-sector cooperation for sustainable, climate-friendly and healthy urban development.


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Research team at SOCIUM presents BARMER Long-Term Care Report 2021

The BARMER Long-Term Care Report was presented today in Berlin. It highlights in particular the effects of the most recent long-term care reforms, and draws conclusions for future developments in the numbers of care dependents, as future staffing and financial requirements are derived from the number and composition of people in need of care. By 2025 and in subsequent years the number of people in need of care will actually be around 1 million more than predicted using conventional analytical methods. The Report discusses current long-term care policy in terms of the issue of personnel requirements – especially in the light of scientific assessments on staffing needs in full-time institutional care facilities. The authors, Professor Dr. Heinz Rothgang and Dr. Rolf Müller, also provide more in-depth studies on case numbers, incidences, prevalences and care processes. The main data sources are the long-term care statistics of the German Federal Statistical Office and routine claims data provided by BARMER.

Sharp growth in numbers (oder: the number of LTC dependents)

The successive inclusion of cognitive impairments in entitlement claims for long-term care insurance benefits means that the number of beneficiaries has progressively increased since the 2010s. According to long-term care figures for 2017-2019, the number of people in need of long-term care grew by 713,000. This growth can be attributed to demographic developments in 145,000 of cases, and other effects in connection with the introduction of care grades in 568,000 cases. Projections for future growth were hitherto based on the extrapolation from current prevalences. Calculations of this kind have invariably unterestimated future figures for care dependents. Current projections, based on care prevalence figures for 2019, underestimated the number of care dependents for the year 2020 by over 6 per cent. The authors of the Long-Term Care Report anticipate that in the coming years there will be no further expansion of entitled beneficiaries by legislative means, but that the effect of the introduction of previous reforms will only gradually abate by 2025. From then on, there will be a total of around 1,000,000 more people in care of need than predicted by conventional estimates. More recent estimates point especially to more care-dependents with Care Grades 1-3, and more people in receipt of care allowances.

Demand for careworkers predicted to be three per cent higher than conventional estimates

In spite of the large number of care-dependents with low care grades, there will also be higher take-up rates in residential care than forecast by conventional means. The new figures reveal that three per cent more care workers will be needed than previously estimated. Altogether, for the year 2030, 510,000 long-term care specialists, 196,000 care assistants with a 1-2 year training programme, and 386,000 untrained care assistants will be required. That is 81,000, 87,000 and 14,000 more, respectively, than indicated for 2019 according to the long-term care statistics. In 2030, therefore, there 182,000 more care workers will be required than in 2019. One should note, however, that even today the current legal requirements for care workers in full-time residential facilities, as well as the proportionate numbers in outpatient and day-care facilities, are often inadequate.

Benefit payments in 2030 comparable to 59m. Euros at today’s prices

In the model calculation, assuming that prevalences remain constant, benefit payments (at today’s prices) will increase to 53 bn. euros by 2030 and to 70.6 bn. euros by 2050. However, as the assumption of a constant prevalence at the level of 2019 has already been disproved for the year 2020, it must be assumed that the introductory effects will level off. Under these conditions, benefit payments (at today’s prices) can be expected to grow to 59 bn. euros by 2030 and 77.4 bn. euros by 2050. These new predictions thus show a financial shortfall of a further 6 bn. Euros as early as 2030.

Training Offensive is needed

The main problem remains the recruitment of care personnel. The main challenge of care policy is to meet increased requirements. To this end, more training opportunities must be made available. Moreover, the profession must be made more attractive by offering improved working conditions and higher pay. In this way it might be possible to persuade carers to remain in employment as carers) and to gain more prospective trainees.

Download (all in German only):
BARMER Pflegereport 2021
Statement von Prof. Rothgang anlässlich der Pressekonferenz
Folienvortrag von Prof. Rothgang anlässlich der Pressekonferenz


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Dr. Özden Güdük will compare German and Turkish long-term care systems in her study


From mid-September until mid-March 2022, Dr. Özden Güdük will be a guest researcher at the Department of Health, Long-Term Care and Pensions. Özden Güdük is an assistant professor in the Health Science Faculty at Yuksek Ihtisas University in Ankara, Turkey. She has worked in the healthcare sector in different positions and organizations for more than 20 years. Lately, she has been working on the topic of home healthcare services in Turkey. This topic includes the patients who need long-term care and their caregivers/relatives and the organizational structure that provide the services for them.

As it is known, all countries – specially developed countries – have been facing the negative consequences of aging that cause intense demand for caregiving. When countries are compared according to their aged population, Turkey seems a little luckier than most developed countries such as Germany, Japan, and Italy. However, this picture is about to change dramatically. The elderly population and the number of dependent elderly have been increasing year by year in Turkey. Like other countries, Turkey makes an effort to provide such services both effectively and financially. One of the effective ways for this is considered "the long-term care insurance system".

Özden Güdük’s research project aims to examine the long-term care insurance used in Germany and compare it with the system in Turkey. She intends to be able contribute to the development of long-term care services in Turkey at the end of the project.

 


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Research team at SOCIUM presents BARMER Long-Term Care Report 2020

This year's BARMER Long-Term Care Report was presented today at the Conference Centre of the Federal Press Conference House in Berlin. The Report focuses this year on the analysis of stress and health status among care workers. The working time of 26,000 care workers was lost in the year 2017 due to an above-average disease burden. The Report discusses current long-term care policy with regard to the ongoing care crisis – particularly in the light of additional burdens brought on by the Corona pandemic. The authors – Professor Dr. Heinz Rothgang, Dr. Rolf Müller and Benedikt Preuß – carried out in-depth studies of case numbers, incidences, prevalences and long-term care trajectories. The figures are based primarily on the long-term care statistics for the year 2017 provided by the Federal Office of Statistics as well as routine claims data of the BARMER health insurance fund.

Workload considerably heavier in long-term care

Workloads have increased considerably in many respects for care workers. Around 92 per cent of geriatric care workers report that they often carry out their work standing up (cf. 47 per cent reported in other occupations). Seventy-six per cent of geriatric care workers report having to frequently lift and carry heavy weights (as against 15 per cent in other occupations). Working in forced postures is reported significantly more frequently (45 percent as compared to 11 per cent). Fifty-two per cent of geriatric carers report that they often have to comply with rules relating to minimum performance or stipulated times for carrying out specific tasks (as against 27 per cent in other occupations). Other pressures include frequent deadline and performance pressures (reported by 63 per cent compared to 50 per cent in other occupations); frequently having to work very quickly is reported by 53 per cent (cf. 39 per cent), and 31 per cent of geriatric care workers claim that they frequently reach the limits of their endurance (as against 16 per cent in other occupations). All these burdens are also reported to be stressful more frequently by care workers than by workers in other occupations.

Poorer Health Status among Care Workers

Correspondingly, care workers are found to be altogether in poorer health than workers in other occupations. This correlation is shown by all measurement methods used. Survey results, the analysis of outpatient diagnoses, absence rates, prescriptions and hospitalisation figures all show that care workers are more seriously affected by musculoskeletal, psychic and behavioural disorders. Though in many areas the workload is similar for qualified and for auxiliary geriatric care workers, the health status of auxiliary workers is poorer than among qualified care workers.

Very high absence rates through illness among care workers

Sickness rates stood at 7.2 per cent in 2017 among qualified geriatric care workers, and as high as 8.7 per cent among auxiliary carers; in other occupations, the sickness rate was 5.0 per cent.  The above-average working time lost through sickness is calculated by multiplying the difference in sickness rates by the number of care workers. This surplus work time lost amounts to the working time of well over 24,000 care workers in the year 2017.
On average, within the year 2017 3.9 out of 1,000 geriatric care workers and six out of 1,000 auxiliary workers are granted disability pensions, while the rate among other occupations is three per 1,000. The above-average early retirement rates led to a loss of almost 2,000 care workers in 2017. The aggregate of above-aberage sickness-related absence times and the above-average entry into disability retirement pensions corresponds to the working time of 26,000 care workers lost in 2017 alone.

There is no alternative but to hire more staff

Current employment figures in care work are inadequate to ensure both professional care and salubrious working conditions. The work intensification arising out of this leads to an excessive workload and negative health effects for employees. This situation generates increased absence through sickness, and more people changing occupations, which in turn aggravates the care crisis. The vicious circle is complete when the remaining care workers are burdened with an even greater workload. This vicious circle has to be broken to ensure sustainable, quality-assured care work – and it can only be broken by employing more staff.

Downloads (all in German only):
BARMER Care Report 2020
Statement by Prof. Rothgang at the Press Conference
PresentatIon given by Prof. Rothgang at the Press Conference



Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Heinz Rothgang als Sachverständiger bei Anhörung zum Gesetz zur Verbesserung der Gesundheitsversorgung und Pflege


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Authors from the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen present the BARMER Long-Term Care Report for 2019

This year's BARMER Long-Term Care Report was presented today at the Conference Centre of the Federal Press Conference House in Berlin. The analysis of new living arrangements with long-term care provision is the central focus of this year’s Report. It also includes a review of LTC insurance 25 years since its inception. As in previous years, the authors – Professor Dr. Heinz Rothgang and Dr. Rolf Müller – continue to deliver in-depth analyses of case numbers, incidences, prevalences and long-term care trajectories. The data used for the Report are primarily long-term care statistics for the year 2017 and claims data provided by the health insurance fund BARMER.

Downloads:
BARMER Long-Term Care Report 2019 (in German)
Statement prepared by Professor Rothgang for the Press Conference
Presentation given by Professor Rothgang at the Press Conference


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Dr. rer. pol. Rolf Müller
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58554
E-Mail: rmint@uni-bremen.de

Thomas Kalwitzki at an Expert Hearing of the Committee on Health Care of the German Federal Parliament

On 8 May 2019 the Committee on Health Care of the German Federal Parliament (Deutscher Bundestag) organized a hearing attended by 17 experts and representatives of interest groups. The subject were the motions of the Green Party, the Left Party and the Free Democratic Party on a reform of the financing of the nursing care insurance. Heinz Rothgang had written an expert opinion on the issue and Thomas Kalwitzki answered questions at the hearing itself.

Rothgang and Kalwitzki point to a significant amount of unfairness between the two branches of the statutory nursing care insurance: the private obligatory nursing care insurance and the public nursing care insurance. This effects an unequal burden of financing the insurance for the different memberships of the two branches. Since the privately insured members on average include both the lower risks as well as the higher incomes the premiums covering the costs would be only one fourth of the premiums in the public insurance. Privately insured members are, hence, considerably less financially burdened than publicly insured members. This, however, contradicts the judgement of the German Federal Constitutional Court which called for a balanced burden-sharing between the two branches of the nursing care insurance for the people.

In order to distribute the financial burden fairly Rothgang and Kalwitzki advocated the introduction of a so called Citizen Nursing Care Insurance. It not only integrates the two existing branches of insurance but also adds additional forms of income (for example rental revenues or profits from interest) to the roster of incomes from which compulsory insurance premiums have to be deducted. And it increases the assessment ceiling up to which premiums have to be deduced. This will lead to a financial relief for the members of the public insurance branch and for the low-income members of the private insurance branch.

Rothgang and Kalwitzki also pointed to the fact that such a citizen insurance system can be implemented more easily in the realm of nursing care than for example in the realm of the normal health care system. Both the private as well as the public branches of the nursing care insurance are already based on similar regulations concerning services and service delivery. This reduces greatly possible resistance and implementation problems compared for example to the health insurance system.


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de

Professor Heinz RothgangProfessor Heinz Rothgang
Policy brief by Heinz Rothgang for the State Parliament of Schleswig-Holstein

After Hamburg offered its public officials an allowance for the membership in the public health insurance other states in German also discuss that option. Among them is Schleswig-Holstein. Heinz Rothgang, Professor of Health Economics at SOCIUM, wrote a policy brief for a hearing on this issue in Schleswig-Holstein.

In his policy brief Rothgang underlines four elements: Such a policy increases the choice of the public officials. It also strengthens the solidarity in the health care system, since it brings better risks back into the public system. Furthermore, such a policy reduces the administrative overhead since in the current system two bills for each case have to be processed. And this policy saves public expenditures in the long run since the higher costs of health care for elder people are then fully carried by the insurance system.

Rothgang, thus, supports the proposed policy but wants it based on two principles: First, it has to be voluntary for the public officials. And second the decision, once made, should not be revocable in order to avoid the typical double free-riding: to opt for the cheaper private insurance in younger years and then, when the costs rise in later years, to move to the public system.


Contact:
Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
Mary-Somerville-Straße 3
28359 Bremen
Phone: +49 421 218-58557
E-Mail: rothgang@uni-bremen.de