The insurance of care in Germany, 2001-2007

In the period 2001-2007, social security and health care remained linked to each other through four social health insurances: Pflegeversicherung (long-term care insurance) as a limited contribution to the costs of nursing and disability, Unfallversicherung (accident insurance) for occupational health risks and Gesetzliche and Private Krankenversicherungen, compulsory and private insurance for income risk and costs incurred through illness.

As in the Netherlands and Belgium, the political and social debate on the reform of the health-insurance system was in full swing from 1997 onwards. In the Bundesrepublik, as in the Netherlands, the debate focused on government regulations, market forces and demanddriven care. The reform of the Pflegeversicherung system was regarded as a social necessity in terms of improving the insurance system and providing more extensive and higher-quality care, and reinforcing the position of consumers. Politicians were also in favour of modernising the structure of the Gesetzliche Unfallversicherung (compulsory accident insurance) system, but this met with public opposition. Market theory and regulated competition largely shaped the development of the GKV and PKV after the reforms of the Gesundheitsstrukturgesetz (Health Care Structure Act) of 1992 and the Neuordnungsgesetze (Reorganisation Acts) of 1997.1

a. Modernisation of the Pflegeversicherung

The Pflegeversicherung was introduced in 1994, after twenty years of intense discussion on how to provide compulsory insurance for the high financial risks in long-term care. The purpose of the insurance was das finanzielle Risiko der Pfl egebedürftigkeit abzusichern und Pfl egebedürftigen trotz ihrer Hilfbedarfs ein möglichst selbständiges und selbbestimmtes Leben zu ermöglichen (to insure the financial risks of care needs and to enable those in need of care to live an indepen dent life). The legislature assumed that home care would allow people to continue living independently for longer than if they were cared for in another household or in an extramural setting such as a home for the elderly. The introduction of this insurance lessened the burden on the municipal social funds and the GKV, which up until then had been the main financers of home care, elderly care and nursing-home care.