Is German Long-Term Care Insurance a Model for the United States?

2001 ◽  
Vol 31 (3) ◽  
pp. 617-634 ◽  
Author(s):  
Michaela V. Schunk ◽  
Carroll L. Estes
Keyword(s):  
United States ◽  
Consumer Choice ◽  
Social Insurance ◽  
Social Protection ◽  
Long Term Care ◽  
The United States ◽  
Term Care ◽  
Long Term Care Insurance ◽  
High Degree

German long-term care insurance, implemented in 1995, significantly extends the coverage of care-related risks. Given the similarities of German and U.S. institutional features, the German social insurance approach has been put forward as a possible model for long-term care in the United States. Using a political economy framework, the authors conducted a policy analysis that compares the main shortfalls of long-term care (LTC) provision in the United States and Germany, examines the responses provided by LTC insurance in Germany, and relates them to broader trends and proposals for change in welfare policy in both countries. German LTC insurance includes a high degree of consumer direction and compensation and protection for informal caregivers; it supports the extension of community-based services. Its shortfalls include the continued split between health and LTC insurance. In both countries, decentralization and institutional and financial fragmentation are some of the characteristics responsible for the failure to promote egalitarian social policy and substantially expand social protection to family- and care-related risks. The German LTC program is a good model for the United States. With a social insurance approach to LTC, costs are spread across the largest possible risk pool. Major goals that can be reached with such a program include establishment of universal entitlements to LTC benefits, consumer choice, and equitability and uniformity.

Does Home Equity Affect Decisions on Long-Term Care Insurance Purchases? Evidence From the United States

2019 ◽  
Vol 41 (6) ◽  
pp. 602-628
Author(s):  
Richard A. Hirth ◽  
Yubraj Acharya ◽  
Helen G. Levy ◽  
Kenneth M. Langa
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Home Equity ◽  
Term Care ◽  
Long Term Care Insurance

Federalism and the Politics of Old-Age Care in Germany and the United States

2005 ◽  
Vol 38 (8) ◽  
pp. 887-914 ◽  
Author(s):  
Andrea Louise Campbell ◽  
Kimberly J. Morgan
Keyword(s):  
United States ◽  
Social Insurance ◽  
Long Term Care ◽  
The United States ◽  
Party Politics ◽  
Term Care ◽  
Policy Makers ◽  
Group Mobilization ◽  
The Welfare State

Until the early 1990s, Germany and the United States had similar systems of long-term care. At that time, Germany created a new social insurance program, whereas American reform efforts stalled. As conventional explanations of social policies—rooted in objective conditions, policy legacies, interest group mobilization, and party politics—fail to explain the diverging trajectories, the authors show how differing federal structures shaped reform efforts. German federalism gives states a strong voice and encourages collective responses to fiscal problems, enabling comprehensive restructuring of long-term care financing. In the United States, states lack a political mechanism to compel federal policy makers to tackle this subject. This analysis suggests reform of social welfare issues with weakly mobilized publics is unlikely without proxy actors that have institutional or political means to forcibly gain the attention of policy makers. In addition, scholars should pay more attention to “varieties of federalism” in analyses of the welfare state.

Germany's Long Term Care Insurance Model: Lessons for the United States

2002 ◽  
Vol 23 (1) ◽  
pp. 44 ◽  
Author(s):  
Charlene A. Harrington ◽  
Max Geraedts ◽  
Geoffrey V. Heller
Keyword(s):  
United States ◽  
Long Term Care ◽  
The United States ◽  
Term Care ◽  
Long Term Care Insurance ◽  
Insurance Model

scholarly journals Insuring Long-Term Care in the United States

2011 ◽  
Vol 25 (4) ◽  
pp. 119-142 ◽  
Author(s):  
Jeffrey R Brown ◽  
Amy Finkelstein
Keyword(s):  
United States ◽  
Long Term Care ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The Elderly ◽  
The United States ◽  
Term Care ◽  
Variable Nature ◽  
Long Term Care Insurance

Long-term care expenditures constitute one of the largest uninsured financial risks facing the elderly in the United States and thus play a central role in determining the retirement security of elderly Americans. In this essay, we begin by providing some background on the nature and extent of long-term care expenditures and insurance against those expenditures, emphasizing in particular the large and variable nature of the expenditures and the extreme paucity of private insurance coverage. We then provide some detail on the nature of the private long-term care insurance market and the available evidence on the reasons for its small size, including private market imperfections and factors that limit the demand for such insurance. We highlight how the availability of public long-term care insurance through Medicaid is an important factor suppressing the market for private long-term care insurance. In the final section, we describe and discuss recent long-term care insurance public policy initiatives at both the state and federal level.

scholarly journals The Effectiveness of Contact Precautions on Methicillin-Resistant Staphylococcus aureus in Long-term Care Across the United States

2019 ◽  
Vol 71 (7) ◽  
pp. 1676-1683 ◽  
Author(s):  
Daniel J Morgan ◽  
Min Zhan ◽  
Michihiko Goto ◽  
Carrie Franciscus ◽  
Bruce Alexander ◽  
...  
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Long Term Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
The United States ◽  
Standard Precautions ◽  
Term Care ◽  
Contact Precautions ◽  
Care Facilities

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of health care–associated infections in long-term care facilities (LTCFs). The Centers for Disease Control and Prevention recommends contact precautions for the prevention of MRSA within acute care facilities, which are being used within the United States Department of Veterans Affairs (VA) for LTCFs in a modified fashion. The impact of contact precautions in long-term care is unknown. Methods To evaluate whether contact precautions decreased MRSA acquisition in LTCFs, compared to standard precautions, we performed a retrospective effectiveness study (pre-post, with concurrent controls) using data from the VA health-care system from 1 January 2011 until 31 December 2015, 2 years before and after a 2013 policy recommending a more aggressive form of contact precautions. Results Across 75 414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using standard precautions versus contact precautions in a multivariable, discrete time survival analysis, controlling for patient demographics, risk factors, and year of admission (odds ratio, 0.97; 95% confidence interval, .85–1.12; P = .71). Conclusions MRSA acquisition and infections were not impacted by the use of active surveillance and contact precautions in LTCFs in the VA.

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