Care economy
Nursing economics is an interdisciplinary science that deals with the production, distribution and consumption of scarce care goods in care provision and thus combines elements of nursing science as well as economics and business administration . The task of care economics is to analyze the design, supply and demand of care services.
Importance and Development
Nursing economics is a very young branch of science. Only since the year 2000 has the discussion started in Germany about whether this is an independent branch of research at all or rather a subspecies of health economics . However, long-term care can be clearly separated from medical and rehabilitation services. The need for care can be defined as limited independence and everyday skills. In Germany, the term is defined in Section 14 of SGB X. The economic importance of the area can be seen among other things. a. in the expenditure of long-term care insurance , the expenditure for long-term care overall and also the number of employees in this area.
Tasks of the care economy
In the context of the financing of long-term care, it is discussed how and to what extent the financing of care should be ensured. In Germany, the decision was made in favor of social insurance , which, unlike health insurance, only pays limited costs, the so-called partially comprehensive solution. This means that at the latest with the commissioning of professional care, you have to bear part of the costs yourself. These are the investment costs (which are funded in some federal states), in the day - care and inpatient area also the costs for accommodation and meals, but also the costs for care-related expenses if the costs exceed the benefits of the long-term care insurance. This is regularly the case in inpatient care.
The expenditure and contribution rate projection is particularly important in the area of policy advice . Since in Germany the insurance is linked to the labor costs, the question arises again and again how the tension between task fulfillment on the one hand and affordability on the other hand can be solved. Particularly in view of the demographic changes and the associated rising costs, either the contributions will increase, the benefits of the long-term care insurance will decrease or the costs will be offset by general salary increases (and thus increased income of the long-term care insurance). A combination of several or all aspects is conceivable and probable.
Another point is the organization of the offers. This includes the questions of who the providers of the services are, whether and how a requirement planning is carried out and how the pricing is carried out. In Germany, a competitive system has been chosen. Accordingly, private companies, non-profit organizations or municipal offers are represented on the market as providers . While the municipal offers, especially in the area of outpatient care, have played a subordinate role since the introduction of long-term care insurance, in recent years there has been increasing growth in private at the expense of non-profit providers. This is increasingly leading to the discussion of whether this area should not be completely transferred to state responsibility or whether profits should at least be limited
SGB XI does not provide for any real needs planning, but the federal states are responsible for an adequate care infrastructure (Section 9 SGB XI). In particular, you can intervene in the market by promoting investment costs. The federal states have made reluctant use of this option. The example of North Rhine-Westphalia , a federal state that receives a lot of funding, shows that funding can also have undesirable side effects. There is a risk that the infrastructure could be jeopardized by incorrect funding standards or that the market could slowly move out of funding
The pricing takes place at different levels. A large part of the prices is negotiated with the long-term care insurance funds , including in the inpatient area for services that the long-term care insurance fund is not responsible for financing, such as accommodation and meals. On the other hand, if no funding has been given, the investment costs can be freely calculated in accordance with Section 82 (4) SGB XI and agreed with the customer after notification to the competent authority. A very intensely discussed topic is the question of what importance the proof of real costs of the past should have for the remuneration to be agreed in the future. This topic is closely related to the question of a nationwide uniform collective agreement for nursing staff , since a significant part of the costs of a nursing facility are the personnel costs of the nursing area. If these are stipulated by a collective agreement, the system moves significantly in the direction of a cost reimbursement system with the risk of development standstill. The idea of competition originally emphasized by the legislature would then be largely overridden at an important point.
Education
In the meantime, the care economy is also anchored at several German universities, B. in Bremen in the university or in Düsseldorf in the technical college area.
Individual evidence
- ↑ Rothgang, Heinz; Sünderkamm, Susanne; Weiß, Christian: The role of private providers in long-term care in Germany. (PDF) bpa, 2015, accessed on April 19, 2020 .
- ↑ SPD parliamentary group: Shaping care in solidarity. (PDF) September 6, 2019, accessed April 19, 2020 .
- ^ Ziesche, Frank: Nursing Policy in NRW 2010-2017 . 2017, p. 6th ff . ( Unternehmensberatung-pflege.de [PDF; accessed on April 19, 2020]).
- ↑ Rothgang, H; Larisch, P .: Nursing Economics - A New Subdiscipline in Health Economics? In: Matusiewicz, David; Wasem, Jürgen (ed.): Health economics. Inventory and development prospects . Duncker and Humblot, Berlin 2014, p. 211–240, here p. 228 .
- ↑ University of Bremen: care economics and politics. Retrieved April 19, 2020 .
- ↑ Fliedner University of Applied Sciences: Nursing Management and Organizational Knowledge, BA Accessed on April 19, 2020 .