CDU Economic Council promotes deregulation in care

Berlin. The Economic Council, an influential CDU front organization with 12,000 members, is proposing far-reaching changes to social long-term care insurance. Flexibility, deregulation, and self-provision are key elements. According to its own description, the association "advocates for a strong, internationally competitive business location in Germany vis-à-vis politicians, administrators, and the public."

Care should be "efficiently aligned with real needs and redesigned across sectors," states a paper by the Federal Nursing Working Group of the Economic Council, which is described as "a comprehensive reform plan" for care. The "pillarization of the reimbursement system" in care should be replaced with an "integrative financing concept."

The CDU-affiliated organization declares a nursing care insurance model "based on the hourly principle" as a "possible solution": "Instead of a fixed budget for nursing care services, specialist service hours per day should be determined based on individual care needs," the proposal reads. The prices per specialist service hour should be renegotiated annually between service providers and nursing care funds.

Hourly quota per day, which varies according to the level of care

The idea is that the hourly budget could be used flexibly, either hourly or in 10-minute units. For inpatient care, the Economic Council envisions a daily hourly quota that varies depending on the level of care and would replace the current daily rate. In shared living or group care settings, pooling of specialist service hours should be possible. The costs for these specialist service hours would be covered by long-term care insurance, while additional services would have to be booked privately under the "additional" model.

The Economic Council considers the requirement of higher staffing ratios with the aim of relieving the burden on nursing staff to be the "wrong approach" – it would "merely result in rising costs without any additional benefits." According to the authors, savings potential lies in reducing the "excessive regulation" in the regulatory laws of the federal states. What is needed is "significant deregulation and trust in the competence of nursing staff to generate more flexibility and avoid gaps in care."

The focus of the audits on the quality of documentation should be reduced to a “compact, partly digital and efficient audit of the quality of results and (...) structural quality”.

Self-provision and subsidiarity

The paper upholds the principle of subsidiarity: Individuals' own provision must "include adequate provision for the event of needing long-term care," it states. Taking out supplemental long-term care insurance or company-sponsored long-term care insurance could be effective instruments for this. Mandatory private provision is not mentioned in the paper. Permanent tax subsidies for long-term care insurance or ever-increasing expenditures for long-term care assistance are "not feasible," according to the association, which calls itself "The Voice of the Social Market Economy."

The Economic Council considers the care supplements introduced for nursing home residents in 2022, which are intended to reduce co-payments, to be incompatible with subsidiarity. "Social compensation for co-payments can only be achieved through long-term care assistance in cases of financial need. Anything beyond that is asset protection at the expense of the general public," is their position.

With regard to outpatient care, the authors are critical of the fact that in recent years, the prices for outpatient care services have risen more sharply than the benefits provided by long-term care insurance. As a result, members of lower and middle income groups, in particular, have decided to leave the workforce. They are taking on the responsibility for care and support themselves and otherwise relying on social transfers. This, combined with declining tax and social security revenues and a shortage of skilled workers, is "threatening Germany as a business location."

New service combinations in outpatient care

Proposals for redesigning outpatient care:

Relief benefits for care level 1: These 131 euros per month, according to the authors, are "regularly used for cleaning services." These funds should instead be used for preventative services to delay the increase in the need for care. In this way, 1.2 billion euros could be "reallocated" annually.

Liquidity bottlenecks in nursing services: A "reliable and timely remuneration structure" is required: "The rule must be that plausible information from nursing facilities is accepted without additional evidence."

New service combinations: The authors recommend introducing "combinable time budget solutions" – this could make "more services possible without increasing long-term care insurance costs": "The approach could be to grant people in need of care a time budget instead of a cash budget," for example, for care level 4, X hours per day. This time could then be used on a one-to-one basis or pooled with that of other people in need of care. (fst)