Germany: social insurance with a divide between healthcare and long-term care

The chapter analyses the challenges, obstacles and solutions for better coordination of healthcare and long-term care in Germany, based on interviews with major stakeholder organizations. In Germany, healthcare and long-term care are both organized as social insurance systems and mandatory private insurance for specific population groups. Nonetheless, there is a big divide between the two systems in organizational and professional respects. Financing is strictly separated, which often results in complex procedures during care transitions between the two systems. Coordination is further complicated by the fact that long-term care is much less professionalized than healthcare. The family and the private market still play big roles in long-term care, since social insurance covers only basic needs. In the German context, therefore, institutional and financial imbalances between the two systems as well as a high share of informal and privately organized long-term care are major obstacles for better coordination.