We can save money and maintain the standard of care at the same time. But only if we think in completely new ways, writes the Federal Minister of Health in his guest article for WELT AM SONNTAG.
Every person wants good care for their relatives, as well as for themselves. The need for care is an emotional challenge for survivors and their families, as it often involves changes in daily routines and restrictions on independence. Because care is not only care and attention, but also personal dependence. This makes the support we want to provide in the future through health care reform even more important.
Since the introduction of social insurance in 1995, a comprehensive care system has emerged that organizes care in everyday life and provides individual support. A strong foundation of our welfare state, long-term care insurance has been a success for over 30 years. But it has been in serious trouble for several years, and now it faces its biggest challenge since its inception. If we are to continue to deliver on our promises, comprehensive reform cannot be delayed. The principle remains that people can get help if they need it because of their care needs.
Necessary reforms begin with an honest inventory and specific statements of goals. Unfortunately, this assessment is very sobering for the financial situation of Social Securityโs long-term care insurance: for several years, their insolvency has been prevented only by loans from the federal government. This is not sustainable and will not slow the unbridled spending dynamics that are leading to multi-billion dollar deficits. Next year a financial deficit of more than 7.5 billion euros is already expected, which will double in another year. Letโs remember: about 70 billion euros are spent annually on social insurance promises. The objective conclusion is that long-term care insurance is a case of restructuring with announcement.
The fact that this is the case is also due to decisions made in the past: when the new concept of care needs was introduced in 2017, scientific advice was freely rejected in defining the criteria that lead to assignment to one of the five levels of care, even though they were created specifically for this purpose. This has made access to long-term care insurance much easier. However, the decision has left Germany at the top of international comparisons for the number of people needing care. Since the changes were introduced, the number of people requiring care has increased by more than 300,000 on average each year.
The number of victims exceeded six million people, and their number has almost doubled in a decade, far exceeding all forecasts. However, this sudden development can only be partially explained by the aging of society, as demographic changes will only lead to an increase of approximately 50,000 to 100,000 more people per year in need of care. This development has been known for several years. However, political action took too long and the situation continued to deteriorate. Therefore, returning to scientific recommendations for classifying five levels of care is unlikely to be controversial, even among experts.
The description of the goals of the necessary reform essentially follows two guiding principles: first, only sustainable financial stability can ensure good patient care. The main requirement for this is a balance between income and expenses. This has been ignored for too long, resulting in premiums increasing year after year. Stable social contributions are not an end in themselves; they provide private purchasing power and the economic competitiveness of our country.
Second, structures must provide reliable, high-quality nursing care. The reasons for the need for care should be addressed early rather than continuing to treat specific symptoms. To achieve this goal, services must be designed more precisely. Following these guidelines, I have submitted a proposal for reform. Letโs be clear: this is not the reform the Health Secretary would like to see, because some aspects of it involve inherent difficulties. But this reform is absolutely necessary in order to adapt another pillar of our social system to the conditions of our time.
A financial deficit of this magnitude cannot be closed simply by increasing revenue. With our proposals we have already reached the absolute limit of pain. Conversely, this means: it is necessary to slow down the development of costs, which will subsequently affect the benefits provided by long-term care insurance. Particular attention needs to be paid to areas where costs have risen sharply in recent years.
Reducing pension contributions for caring relatives is not easy for anyone, even if the individual consequences in euro amounts may seem relatively small to some people. The same applies to the later provision of higher subsidies to reduce out-of-pocket premiums in nursing homes. In both cases, the developments of recent years, unfortunately, leave no room for maneuver: in 2016, pension insurance contributions were paid for approximately 400 thousand caring relatives, and in 2024 โ for 1.6 million people. Over the same period, spending rose from less than one billion euros to around five billion euros. Regarding subsidies for nursing home residents, spending doubled between 2022 and 2025 to more than seven billion euros.
A clear discussion of the necessary financial reform measures has so far pushed into the background numerous structural adjustments to the project. However, the proposal is clearly not pure austerity legislation; it aims to change the paradigm of care: we must move away from focusing on providing care to those who need care, and towards avoiding it more. When social insurance for long-term care was introduced, the law stated that โassistance shall be aimed at restoring or maintaining the physical, mental and spiritual strength of those in need of care.โ In my opinion, this good and correct approach has been neglected in recent years. We are now bringing it back to life by laying the groundwork to avoid the need for care as much as possible, or at least delay it as long as possible, through the right to early professional care.
The comprehensive package of reform measures also strengthens prevention and rehabilitation to avoid the need for care, delay its onset or prevent its worsening. Healthier years of life mean a better quality of life, which primarily benefits those affected.
The discussion has so far not paid attention to the fact that with the bill we are strengthening home care and easing the burden on those in need of care and their relatives. On the one hand, we combine a range of services that are sometimes very differentiated and therefore often difficult to access, and simplify them. For many of those affected, this comes with a noticeable increase in benefits. And we are reorganizing acute crisis care: the aim is to provide better support through professional care in acute situations, for example when relatives are unable to work. There is widespread agreement about these important further changes to long-term care insurance. While they have been completely overshadowed by the discussion about the necessary restructuring of finances, this also needs to change.