The Introduction and Reform of Long-Term Care Insurance in Germany: The Welfare State Context

In 1995/96 Germany introduced Long-term Care Insurance (LTCI) to provide universal support in a situation of care-dependency. The introduction of LTCI finalized a long-standing debate on the necessity to accept care dependency as a social risk. Furthermore, based on New Public Management approaches professional care provision was marketized. LTCI did not only change considerably the already established residual long-term care system but also depart in significant respects from the already established mode of social insurances respectively the ideas on the role of markets in welfare state arrangements in Germany. Above all since 2008 new reforms have been undertaken, which change LTCI. Both, the establishment and reforms are developed within a distinct welfare state context. In the focus of the paper is the analysis of both the establishment and reform of LTCI within the welfare state context. Conceptually, the paper draws on neo-institutionalist approaches on the roles of ideas, actors and institutional frameworks to explain the institutional changes. Empirically, it is mainly based on document analysis.