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Outpatient Care Receives Higher Benefits without Better Quality

New housing and care types form the core of the Care Report for 2019. The report is published yearly by a team of authors from the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen. The contracting party is BARMER.

The Bremen authors, the health economists Professor Heinz Rothgang and Dr. Rolf Müller, scientifically analyzed the data from the nursing care statistics for 2017 and routine data from BARMER. “The theoretical, maximum care-based benefits that are reimbursed by nursing insurance and health insurance within a certain care scale are around twice as high for outpatient care in comparison to stationary care,” explains Professor Rothgang.

Additional Benefits for Outpatient Care

This is apparently due to the circumstance that in the case of stationary care, only benefits for full inpatient nursing and supervision can be billed to the national care fund. With regards to outpatient care, day and night care, benefits for measures to improve living conditions, group living supplements, and short-term care are included alongside benefits-in-kind and supervisory benefits. Additionally, the reimbursement of home nursing is paid by the national health fund, which is generally already included in the nursing charge for full inpatient care. In outpatient care, it is billed separately. With regard to this, Rothgang talks of “stacked benefits”.

New Living and Care Forms Gaining Ground

The Bremen experts ascertain: “Based on various studies we can assume that there are up to 8,000 assisted living facilities with around 150,000 people in need of care and around 4,000 group living arrangements with around 31,000 people in need of care. According to the projections based on BARMER data, 20,400 of the stated 31,000 persons make use of the group living supplement from the nursing insurance. This resulted in the additional cost of 215 million euros for assisted living facilities in comparison to full inpatient care in 2018. With regard to the estimated 20,400 residents in group living facilities who use the group living supplement, there were additional costs of 184 million euros in comparison to nursing in care homes in 2018.

Positive and Negative Effects

According to the authors, positive effects of assisted living or group living arrangements were reflected in the quality life of the residents. The quality of care was not, however, judged as being better. Using the BARMER data, the people in need of care in assisted living and shared living facilities were compared to those in care homes based on five indicators of quality. The contact to doctors and the prescription of antipsychotic medication was less for residents in assisted living or shared living facilities. However, more cases of decubitus were newly diagnosed in assisted living facilities. Moreover, hospital cases with discharge diagnoses that suggest that they could have been avoided in many cases if a suitable non-residential care had been carried out occur more often in comparison to stationary care. Professor Heinz Rpthgang: “The presented analyses point to the danger that the care services that lead to higher costs for the nursing and health insurances and thus put a burden on the contributors are becoming more popular, but do not show a corresponding improvement in quality.”

Further Information:

BARMER Care Report: (in German only)

Statement from Rothgang: (in German only)

Presentation by Rothgang: (in German only)


Prof. Dr. Heinz Rothgang
SOCIUM Research Center on Inequality and Social Policy
University of Bremen
Secretary: Vicki May
Phone: +49 421 218-58556


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