Health care system of the elderly in Germany

Last updated

The elderly population is one of the most vulnerable populations in the world of health care, mainly because of their susceptibility to contracting disease, limited access to health care insurance, limited or non-existent access to long-term care insurance, and/or reduced quality of life. In Germany, the majority of the population, including the elderly is funded by a public health care insurance system. Only employees who have an income above a cutoff point and certain other groups have the option of purchasing private insurance. (The option of not having any insurance coverage was dropped in 2009.) For the most part, Germany raises money for this health system through statutory welfare contributions.

Contents

Increase in elderly population

As a result of longevity and low fertility rates, the elderly population (age 75 and older) in Germany has increased dramatically over the years, and is predicted to increase from 7% of the total population in the last century to over 10% by 2020. [1] The population in need of care is expected to increase from over a million to over 2 million people in 2020, which is about 2% of the population in Germany. 70% of the people, who are elderly and in need of care, live in private households, with a family member being the main caregiver in 80% of these households; daughters and daughters in law being the main caregivers. [1] The continual increase in the elderly population in Germany signifies that there will be a greater need for health care services to be provided to the elderly, notably long-term care services. This increased need places the elderly in a vulnerable position because of the potential of funds not meeting all their needs.

Long-term care insurance

Long-term care insurance was established by the German welfare state in 1996 to give elderly financial resources for a caregiver. This insurance either provides care services or cash benefits to pay for a private caregiver, such as a family member. This provides families with more support from a public institution, now being responsible for financing care for the elderly, unlike formerly when the high expenses of institutional care caused most families to care for their elderly in their own households. [1] The emergence of care insurance has encouraged the growth of private home-care agencies and new residential arrangements for elderly. [2] If a family opted for long-term care insurance to provide care services, they could attain these services through these private agencies; otherwise, they would receive cash benefits that could be used to pay a family member or other individual for informal care services.

Care service recipients

There are significant differences in the use of the long-term care services in Germany, depending on social position, ethnic background, and gender. Those with a higher social position most often utilize home-based services provided by private institutions, while those in a lower social position most often utilize cash benefits. Additionally, German elderly minorities are underrepresented in professionalized home-based services and residential care. [3] This is attributed to the large number of people in informal family care and their different cultures leading to difficulties in adapting to the existing care services. There is also a discrepancy in the numbers of women and men that utilize the care services. 69% of service recipients are women, which is attributed to women constituting the majority of the elderly of over 80 years old, receiving lower pensions, and requiring more care dependency. [3]

Health care satisfaction

In a study conducted in 1992, Louis Harris interviewed 948 elderly people over the age of 65 from Germany in order to have a better understanding of their health care access satisfaction and quality of life. 29% of German elderly are satisfied with their health care. 54% report having fair or poor health; and 38% report having six or more physician contacts over the past six months. 6% of German elderly viewed out-of-pocket medical expenses as a serious issue, 15% viewed Germany's system of paying for medical care as “inadequate”. [4] Overall, a significant proportion of the elderly population are satisfied with their health care, and a very small amount view out-of-pocket medical expenses as a serious issue. Taking this into account along with the long-term care services the elderly are provided, the German elderly generally have good access to short-term and long-term care insurance.

Increase in health care expenditures

Despite their current access to short-term and long-term health insurance services, it is often concluded that the increasing elderly population in Germany will have negative consequences on health care expenditures, which may threaten these services. This is further emphasized by the bankruptcy of the German health insurance fund City BKK recently declared bankruptcy due to the rising number of members and costs, which exceeded its budget from the healthcare fund. [5] There appears to be a linear relationship between the increase of age and increase of health care costs. However, a study conducted by Hilke Brockmann in 2000, suggests that as a person ages, their health care expenses decrease. The study further shows that proximity to death is what increases health costs, not age itself. Furthermore, the decrease in health expenditures as a person ages can be attributed to elderly having less expensive diseases. However, when comparing medical treatment expenses of the same diseases in young and elderly people in Germany, it was discovered that elderly people are still receiving less expensive health care, which suggests that health care is being rationed in Germany based on age, rationing being illegal and potentially responsible for the elderly not receiving the best treatment possible, ultimately, decreasing their potential for survival. [6]

Depression in elderly population

One factor that largely contributes to the costs associated with old age is the presence of mental health issues, namely depression. A study was conducted on 451 primary care patients aged 75 and older. 63 out of the 451 patients were diagnosed with depression. [7] Depressed and non-depressed individuals had similar education levels and did not have significant differences in age and gender. It was found that 14% of depressed individuals used mental health specialist services, while 8% of non-depressed individuals used mental health specialist services were used by 2%; psychiatrists were used by 5% of the depressed elderly and 1% by the non-depressed; and psychologists were used by 2% depressed elderly and 0.5% non-depressed. Additionally, depressed elderly were admitted to hospitals for an average stay of 20.7 days while non-depressed individuals were admitted for an average of 13 days. The overall direct health care costs of depressed elderly were found to be 5422 Euros annually, and in non-depressed elderly 3624 Euros annually. [7] Ultimately, it is unknown how much of the direct health care costs can be attributed to diagnosed and undiagnosed depression, but what is clear that the presence of depression in elderly affects their quality of life, which can potentially be improved if depression is recognized and treated promptly. In addition, prompt treatment of depression may reduce direct health care costs in the elderly population. [7]

Multiple chronic conditions in elderly population

Elderly patients with multiple chronic conditions are also associated with higher health care use and cost. Studies conducted showed that the illness level of the elderly is what directly affects health care use and costs; the illness level was measured as the number of incidences of disease. [8]

Reduction of health care expenditures

In order to reduce some of the health care expenditures associated with the medical conditions of the German elderly, which is largely due to money spent on medications for mental health or chronic conditions, the German government is strictly regulating reimbursement and pricing policies of the pharmaceutical market using cost-effective analysis. [9] This along with the implementation of other policies may reduce health care expenditures related to the elderly, reducing the threat of eliminating some of these services, and helping them have good access to short-term and long-term health care services as well as leading a good quality of life.

Staffing

The demography of Germany makes finding care staff for the increasing proportion of elderly people difficult. Jens Spahn said in 2018 that "Inviting nursing care personnel from our neighboring countries is the nearest option." He is planning a draft law to recruit 8,000 extra staff, but it has been estimated that an extra 100,000 are needed to cover immediate needs. The German Foundation for Patient Rights says that turnover in the sector is high. The German Nurses Association say that commercial providers do not keep to employer-union agreed pay rates. [10]

Related Research Articles

<span class="mw-page-title-main">Home care in the United States</span>

Home care is supportive care provided in the home. Care may be provided by licensed healthcare professionals who provide medical treatment needs or by professional caregivers who provide daily assistance to ensure the activities of daily living (ADLs) are met. In-home medical care is often and more accurately referred to as home health care or formal care. Home health care is different non-medical care, custodial care, or private-duty care which refers to assistance and services provided by persons who are not nurses, doctors, or other licensed medical personnel. For patients recovering from surgery or illness, home care may include rehabilitative therapies. For terminally ill patients, home care may include hospice care.

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It includes the generation and commercialization of goods and services lending themselves to maintaining and re-establishing health. The modern healthcare industry includes three essential branches which are services, products, and finance and may be divided into many sectors and categories and depends on the interdisciplinary teams of trained professionals and paraprofessionals to meet health needs of individuals and populations.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

<span class="mw-page-title-main">Healthcare in Canada</span> Overview of healthcare

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."

Long-term care insurance is an insurance product, sold in the United States, United Kingdom and Canada that helps pay for the costs associated with long-term care. Long-term care insurance covers care generally not covered by health insurance, Medicare, or Medicaid.

<span class="mw-page-title-main">Elderly care</span> Care serving the needs and requirements of senior citizens

Elderly care, or simply eldercare, serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes, hospice care, and home care.

Social welfare, assistance for the ill or otherwise disabled and the old, has long been provided in Japan by both the government and private companies. Beginning in the 1920s, the Japanese government enacted a series of welfare programs, based mainly on European models, to provide medical care and financial support. During the post-war period, a comprehensive system of social security was gradually established.

<span class="mw-page-title-main">Long-term care</span> Services for the elderly or those with chronic illness or disability

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.

An out-of-pocket expense is the direct payment of money that may or may not be later reimbursed from a third-party source.

Health insurance in the United States is any program that helps pay for medical expenses, whether through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

<span class="mw-page-title-main">Healthcare in Germany</span> Overview of healthcare in the Federal Republic of Germany

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, the municipalities are responsible for providing healthcare to their residents.

The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world. In 2017, France spent 11.3% of GDP on health care, or US$5,370 per capita, a figure higher than the average spent by rich countries, though similar to Germany (10.6%) and Canada (10%), but much less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

The healthcare reform debate in the United States has been a political issue focusing upon increasing medical coverage, decreasing costs, insurance reform, and the philosophy of its provision, funding, and government involvement.

Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed on price and ability to pay. Those unable to afford a health insurance policy are unable to acquire a private plan except by employer-provided and other job-attached coverage, and insurance companies sometimes pre-screen applicants for pre-existing medical conditions. Applicants with such conditions may be declined cover or pay higher premiums and/or have extra conditions imposed such as a waiting period.

Healthcare in Slovenia is organised primarily through the Health Insurance Institute of Slovenia. In 2015, healthcare expenditures accounted for 8.10% of GDP. The Slovenian healthcare system was ranked 15th in the Euro health consumer index 2015. The country ranked second in the 2012 Euro Hepatitis Index.

Health care in the United States far outspends that of any other nation, measured both in per capita spending and as a percentage of GDP. Despite this, the country has significantly worse healthcare outcomes when compared to peer nations. The United States is the only developed nation without a system of universal health care, with a large proportion of its population not carrying health insurance, a substantial factor in the country's excess mortality.

Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.

<span class="mw-page-title-main">Healthcare in India</span> Overview of the health care system in India

India has a multi-payer universal health care model that is paid for by a combination of public and private health insurance funds along with the element of almost entirely tax-funded public hospitals. The public hospital system is essentially free for all Indian residents except for small, often symbolic co-payments in some services. At the federal level, a national publicly funded health insurance program was launched in 2018 by the Government of India, called Ayushman Bharat. This aimed to cover the bottom 50% of the country's population working in the unorganized sector and offers them free treatment at both public and private hospitals. For people working in the organized sector and earning a monthly salary of up to ₹21,000 are covered by the social insurance scheme of Employees' State Insurance which entirely funds their healthcare, both in public and private hospitals. People earning more than that amount are provided health insurance coverage by their employers through either one of the four main public health insurance funds which are the National Insurance Company, The Oriental Insurance Company, United India Insurance Company and New India Assurance or a private insurance provider. All employers in India are legally mandated to provide health insurance coverage to their employees and dependents as part of Social Security in India.

Health policy and management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.

References

  1. 1 2 3 Dallinger, Ursula. "Elderly care in the family in Germany". University of Jena, 2012
  2. ↑ Wegner, Eldon L. "Restructuring care for the elderly in Germany". Current Sociology, 2001, 49:175.
  3. 1 2 Hildergard, Theobald. "Care services for the elderly in Germany" Veröffentlichungsreihe der Arbeitsgruppe Public Health, 2004.
  4. ↑ Rowland, D. "A five-nation perspective on the elderly". Health Affairs, 1992, p.205-215.
  5. ↑ Steinert, Elisabeth. "German insurance bankruptcy threatens the elderly and sick". International Committee of the Fourth International, 2011.
  6. ↑ Brockmann, Hilke. "Why is less money spent on health care for the elderly than for the rest of the population? Health care rationing in German hospitals" Social Science and Medicine 55, 2002, p.593-608.
  7. 1 2 3 Luppa, Melanie, et al. "Direct costs associated with depression in old age in Germany". Journal of Affective Disorders 105, 2008, p.195-204.
  8. ↑ Lehnert, Thomas, et al. Review: Health care utilization and costs of elderly persons with multiple chronic conditions". Medical Care Research and Review, 2011, 68:387.
  9. ↑ Gunnam, Rajesh. "Healthcare, Regulatory and Reimbursement Landscape- Germany". Press Release Distribution, 2012.
  10. ↑ "Germany to recruit more elderly care workers abroad". DW. 31 March 2018. Retrieved 16 December 2019.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.