Reforming Home Care Provision in Germany - Evidence from a Social Experiment

Abstract

In a long-run social experiment, personal budgets have been tested as an alternative to the home care programs of the German long-term care insurance (LTCI). Due to extending the coverage beyond LTCI approved services and agencies, personal budgets may improve care outcomes compared to the provision of in-kind services at a constant benefit level. This is a highly desirable result in light of the ongoing demographic challenge. However, personal budgets also compete with the less generous cash option of the LTCI. Any transition from cash recipients to personal budgets increases LTCI spending, while care outcomes may remain unchanged if informal caregivers are crowded out by formal care. This paper compares care outcomes of the different home care programs and provides a rough cost analysis from the perspective of the LTCI. While personal budgets improve care outcomes compared to in-kind services, the nationwide introduction of personal budgets increases LTCI spending for former cash recipients without any traceable effect on care outcomes.Keywords: consumer directed long-term care; long-term care insurance; crowding out; formal and informal care JEL Classification: I38, I12, C93 * Financial support from the project "Evaluating the use of direct payments in the long term care of the elderly. A social experiment in the context of advancing the compulsory long term care insurance according to §8 III SGB XI" is gratefully acknowledged. The usual disclaimer applies. Non-technical SummaryRising numbers of frail elderly and simultaneously shrinking numbers of informal carers pose a challenge to future viability of the mandatory and non-means-tested long-term care insurance in Germany (LTCI). In particular, the retreat of informal care and teh corresponding rising demand for formal home care (i.e. agency care) or nursing home care increases LTCI spending.With the aim of reforming professional home care to better address care needs, the German legislator therefore passed an amendment to test personal budgets (Pflegebudget) as an alternative to agency care. A personal budgets is a professionally assisted consumer-directed home care program that grants the monetary value of agency services in cash for the purchase of any care-related services, thus expanding the restricted catalogue of services and providers in case of agency care. If personal budgets supplemented existing LTCI home care programs, personal budgets would, however, also compete with the cash option of the LTCI, a consumer-directed home care program that is less generous but somewhat less restrictive than personal budgets.Based on a long-run social experiment, we therefore estimate the heterogenous effect of personal budgets on total care hours as a proxy of the attained care level, and the contribution of formal and informal carers. While we may expect personal budgets to increase formal care and the attained care level among agency care recipients, the corresponding effects for former cash recipients are ambiguous due to a potential substitution of ...

Evde Bakım Hizmetlerinin Almanya ve Türkiye Örneğinde Karşılaştırılması: Nitel Bir Araştırma

“…Aile içinde yaşanabilecek olumsuzlukların bireylere olan etkisi edebiyatta da yer almış ve Fransız yazar Marcel Proust'un "Sainte-Beuve'e Karşı" adlı eserinde söz konusu etki ve yaşlı ile yaşamanın güçlüğü Victor Hugo'nun "Yaşlılık gözlerde başlar bana kalırsa/ Daha çabuk yaşlanır insan hep yaşlılara bakarsa" dizeleriyle belirtilmiştir (Proust, 2006: 82). Ancak hizmet verenlerin sağlık riskleri olmasına rağmen sigorta kuruluşları ve hükümetler maliyetleri azalttığı gerekçesi ile evde informal bakımı özendirmekte ve devlet politikası haline getirmektedirler (Arntz ve Thomsen, 2011;Costa-Font ve Patxot, 2004;Golberstein vd., 2009;Meng, 2013;Simonazzi, 2009;Yong ve Saito, 2012, Resmî Gazete [RG], 1963. Kişilerin istemlerinin de informal bakım yönelimli olması devletlerin informal bakımı maliyet düşürücü araç olarak görme politikasıyla örtüşerek güçlendirmektedir.…”