Privatization of the risk of care: A mistake with warning

In its “10-point plan,” the Association of Private Health Insurers (PKV) has identified key points for care reform – such as better orchestration of care counseling and strengthening prevention.

The introduction of mandatory private long-term care insurance with the Pflege+ model is also on the association's wish list. Disguised as a rescue plan for long-term care, this clearly represents market-based self-interest.

As a reminder, the "Pflege-Bahr" (care allowance) was once supposed to bring about a breakthrough for private long-term care provision—subsidized by the state at five euros per month. The results are sobering.

By the end of 2022, just 900,000 such contracts had been concluded. Only around 1.1 percent of all insured persons in Germany have such policies. And many of the contracts are dormant.

Care+ Model: Expensive symbolic politics

What's striking about all private long-term care insurance plans is that premiums are increasing significantly over time. According to consumer advice centers, increases of 35 percent were observed between 2019 and 2023 alone. The Pflege+ model could face the same fate.

Furthermore, the question arises: If the insured are required to pay additionally for supplementary policies, subject to a social clause and requiring companies to contract, what is the added value compared to an (additional) payment into the social long-term care insurance scheme?

However, the model leaves other issues open: Currently, supplemental insurance only covers co-payments for nursing homes. This would significantly increase the incentive to enter a nursing home, and consequently, premiums would rise exorbitantly.

It's also unclear how to deal with alternative living arrangements that can no longer be clearly assigned to a nursing home. After all, the Care+ model focuses exclusively on inpatient care. Does this create a legal entitlement to a nursing home place – based on insurance?

Another major risk of Pflege+ is that baby boomers who retire in the coming years will only have to pay a reduced insurance premium. However, they pose the real challenge for long-term care insurance.

A particularly disadvantageous aspect of the Pflege+ insurance is that those who are cared for at home—currently 86 percent of all people in need of care in this country—are left out of the benefits. They pay into the supplementary insurance for a long time but don't benefit from it.

However, the costs of home care are also rising due to the high wages paid to caregivers . However, this fact isn't reflected in the rising number of people receiving care assistance. Many people would rather forgo benefits than apply for assistance from the social welfare office.

The Pflege+ model is therefore not the philosopher's stone. The focus should therefore be on the substantive reform of social long-term care insurance . There are plenty of opportunities there to ease the burden on those insured.