Paradoxical decisions in German long-term care: expansion of benefits as a cost-containment strategy MARGITTA MÄTZKE AND TOBIAS WIß
The austerity narrative captures only part of the story, however. While the development of benefits may have lagged far behind the growth of needs, the long-term care sector has steadily expanded. This holds for overall expenditures – €26 billion in 2014 compared to €17 billion in 2000 (Bundesministerium für Gesundheit, 2016a); it holds for the number of people receiving benefits – 2.6 million in 2014 compared to 1.8 billion in 2000 (Bundesministerium für Gesundheit, 2016b); and most importantly, it holds for the scope of tasks and services receiving public financing, which has been broadened and enriched
especially in recent years. For instance, this pertains to long-term care benefits for people suffering from dementia, which have become part of the benefit package only recently, or several measures aimed at improving working conditions for informal caregivers (Meißner, 2014: 62). Expansion in that sense was robust and never contested in principle, and it took place especially in the years since the economic crisis. Although the German economy recovered from the crisis surprisingly well, consolidation of public finances has been a major issue in public policymaking, particularly when it comes to the large expensive spending programs of the German welfare state, and yet, the financial crisis did not have major effects on long-term care in Germany. In this the country’s experience diverges from that of other European countries such as Spain, Great Britain, or Finland, where long-term care benefits have been cut explicitly in the wake of the crisis (Waldhausen, 2014: 11). Measures of the 2014-2015 long-term care reform established regular reviews of benefit amounts relative to the cost of care services (Hagen and Rothgang, 2014: 9), and this monitoring system is in the process of evolving into a regular and obligatory indexing scheme (Paquet and Jacobs, 2015: 4). The most recent reform of long-term care policy, which will take effect in 2017, increases benefits in both home care and residential care (Rothgang, 2015: 806). Lawmakers deliberately made sure that existing beneficiaries all experience rising benefits (Rothgang and Kalwitzki, 2015: 47), and the latest reform will result in drastic growth of costs that are most likely not covered by the contribution rate increases already enacted (Walendzik et al., 2015: 21).