The joint working group of federal and state governments tasked with reforming Germany’s care system has presented proposals aimed at ensuring adequate care provision and exploring financing options for the care insurance system. The recommendations, released Thursday, reveal a cautious and politically fraught approach to addressing a deepening crisis in elderly care.
A key element of the proposals involves adjusting the criteria for determining care needs. The aim is to “sharpen the focus” of available benefits, ostensibly directing resources towards those with the most pressing requirements. However, critics question whether this re-evaluation will truly improve care or simply restrict access for many in need. Two potential financing models are currently under consideration: a system of regular adjustments to co-payments (termed “Dynamisierung”) and a “Sockel-Spitze-Tausch” – a mechanism where individuals with the greatest need would pay a fixed baseline fee while insurance coverage would only extend to the remainder of their costs. The latter model has raised concerns about potentially creating a two-tiered system, disproportionately burdening those with the highest needs.
Efforts to strengthen preventative care and reduce bureaucratic burdens are also included. Proposals range from voluntary health check-ups for the elderly, designed for early detection of risk factors to streamlining processes by consolidating outpatient services and eliminating redundancies between federal and state regulations. While welcomed, these measures are viewed by some as insufficient to tackle the fundamental issues of staffing shortages and inadequate pay for care workers.
Federal Health Minister Nina Warken (CDU) acknowledged the core challenge remains securing the long-term financial sustainability of the care insurance system. She emphasized the government’s commitment to maintaining a system primarily funded through partial benefits, while advocating for a more targeted allocation of financial resources towards demonstrably effective services. However, the proposals have already met with significant dissent among Germany’s states.
Brandenburg’s government has explicitly rejected the working group’s paper, signaling a potential impasse in the reform process. Similarly, Schleswig-Holstein’s leadership criticized the recommendations as a deferral of essential decisions, demanding “concrete guidelines” for upcoming political discussions. This lack of consensus highlights the delicate political balancing act required to implement meaningful change and raises concerns that the urgently needed reforms may be further delayed amid jurisdictional disputes and competing priorities within the German federal system. The absence of a unified approach risks perpetuating the current shortcomings of the care system, leaving vulnerable populations at risk.