Fiscal and Social Policy: Financing Long-Term Care in Germany

R. Götze, H. Rothgang
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引用次数: 14

Abstract

This paper deals with the coverage of long-term care (LTC) in Germany since the post-war period. Until the 1990s, long-term care was mainly a task of the family with means-tested, tax-financed care assistance as a last resort. In 1994, after two decades of political debate, the German parliament approved the LTC Insurance Act. This path-breaking reform act introduced a two-tiered, mandatory long-term care insurance (LTCI) for virtually the entire German population. We will capture the genesis of the so-called fifth pillar of the social security system from the initial stage of problem recognition to the agenda-setting period and the decisive implementation phase. We also shed light on recent reforms of the original LTCI Act. We argue that the introduction of the LTCI can be explained as an interplay between fiscal and social policy. In order to mask their financial interests, municipalities and charities acted as advocates for the elderly in need of LTC and their families. Summarizing the effects of the LTCI and comparing them with the initial estimations and targets, we identify unresolved issues and further need for reform. Even today’s reform debates, however, can be understood as deriving from the tension between fiscal and social policy, but overshadowed by a revival of ideological debates over private vs. public provision.
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财政和社会政策:资助德国的长期护理
本文研究了战后德国长期护理的覆盖情况。直到20世纪90年代,长期护理主要是家庭的任务,通过经济状况调查和税收资助的护理援助是最后的手段。1994年,经过20年的政治辩论,德国议会批准了LTC保险法。这项开创性的改革法案为几乎所有德国人引入了两层强制性长期护理保险(LTCI)。我们将捕捉所谓社会保障制度第五支柱的起源,从认识问题的初始阶段到确定议程的阶段和决定性的执行阶段。我们还阐明了最近对原始LTCI法案的改革。我们认为LTCI的引入可以解释为财政政策和社会政策之间的相互作用。为了掩饰他们的经济利益,市政当局和慈善机构充当了需要LTC的老年人及其家人的倡导者。我们总结了长期投资基金的效果,并将其与最初的估计和目标进行了比较,发现了尚未解决的问题和进一步改革的必要性。然而,即使是今天的改革辩论,也可以被理解为源于财政政策和社会政策之间的紧张关系,但却被关于私人与公共供应的意识形态辩论的复兴所掩盖。
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