Within the context of demographic change, the efficiency of social nursing care insurance, which was introduced in 1995 as the fifth pillar of German social insurance, appears uncertain. Both the ageing of the population and changes in immigration have an influence on revenue and expenses for social nursing care and raise the question as to whether the continued exist-ence of the present contributions system is meaningful for the financial situation of social nursing care against the background of demographic change in Germany, especially with regard to the rising immigration rate. The background to these thoughts is the assumption that as the population ages, the number of people still in active employment sinks whilst demand on the service rises. Depending on the social structure of immigrants, the same effect can be magnified or lessened. This study therefore takes up the health premium conceived for statutory health insurance and examines whether a limitation of the concept of family insurance can secure the financial situation of social nursing care insurance in the long term. This would mean that co-insurance of married couples and children after the age of 20 would be rescinded and a per capita contribution regardless of income would be introduced. Once the topic area has been delimited, this study first looks at the current state of research and then directs the question of research to its partial aspects whilst keeping its focus on the concept of family insurance. The population structure and the care situation in Germany are then examined as a basis for further statements, the concept of care is discussed and the Federal Statistical Office’s 13th co-ordinated population forecast is introduced as the most important source of data. Against the background of these framework conditions, it is possible to deduce the monetary and human aims of social nursing care insurance by examining its method of functioning and its service spectrum. A comparison of income from contributions and spending on services so far rounds off this overview. The resource-requirements model is developed to show the conflict between care needs and corresponding financial resources by means of descriptive modelling, which also illustrates the legal, social and economic influences on the system. On the basis of the resulting basic understanding of the problem, three population development scenarios are then modelled based on a secondary analysis of demographic/statistical material and, supported by complex assumptions, transposed on to a cost-benefit analysis over a period of 20 years. Both the underlying cost-benefit analysis and the subsequent sensitivity analysis which tests the robustness of the results show that the proposed change in the social nursing care insurance contribution system would definitely be beneficial for its financial situation and that a reform would be economically meaningful. Since this cannot, however, be implemented on its own due to the organisational collaboration of statutory health and social nursing care insurance, the study ends with a number of research perspectives.    «

Within the context of demographic change, the efficiency of social nursing care insurance, which was introduced in 1995 as the fifth pillar of German social insurance, appears uncertain. Both the ageing of the population and changes in immigration have an influence on revenue and expenses for social nursing care and raise the question as to whether the continued exist-ence of the present contributions system is meaningful for the financial situation of social nursing care against the background...    »