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Alexander Spermann, ZEW European Conference on Long-term Care 21 October 2005

Discussion of Roland Eisen‘s 10 Years Long-Term Care Social Insurance in Germany: What Economists expected, what happened and what we learned for the future design. Alexander Spermann, ZEW European Conference on Long-term Care 21 October 2005. AOK. Disincentive I. Heterogeneous LTC insurers

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Alexander Spermann, ZEW European Conference on Long-term Care 21 October 2005

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  1. Discussion of Roland Eisen‘s10 Years Long-Term Care Social Insurance in Germany: What Economists expected, what happened and what we learned for the future design Alexander Spermann, ZEW European Conference on Long-term Care 21 October 2005

  2. AOK Disincentive I Heterogeneous LTC insurers but unitary contribution rate 1.7% • no competition between public insurers • no incentives for public insurers to produce LTC efficiently

  3. Disincentive II Dual system LTC-SI for employees with gross income below Y* higher risk contribution rate1.7 % of Yg Private LTC for self-employed, public officers, and high income earners above Y* low risk individual premium ≤ 1.7 % of Yg

  4. Disincentive III home care Level I Level II Level III nursing home care • Disincentive to switch to nursing home, especially for level I and II • But preference of frail elderly to stay at home

  5. III I II Disincentive IV No incentive for nursing home owners to help frail elderly to reach lower care levels

  6. Alternatives (German discussion) 1. Abolition of private LTC • Proposal of incumbent and future health minister, Ulla Schmidt (SPD) • intensely discussed: use 14 billion € savings of the private LTC insurance companies to finance the public insurance deficit

  7. 2. Slow transition from public LTC to private LTC • Proposal of majority of health economists in Germany • Insurance obligation for everyone • Risk premium according to age and sex like status quo in private LTC insurance • But insurers have to accept frail elderly • Supplementary tax financed transfers for low-income earners

  8. 3. Moderate reform within LTC-SI • Proposal of some German economists • Abolition of care level I or convergence of payments between home care and nursing home care • More competition between public insurers

  9. 4. Integration of LTC and health insurance • Proposal of some economists 5. Abolition of LTC, back to 1993 • No proponents

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