157 -207

NTU Social Work Review

157
No. 25, June 2012, pp.157-207

*
**

**

E-mail: ming-fang.bremen@gmail.com
2011 8 8 2011 10 3

158

2008

1990

159

long term care

1940
Organization for Economic Cooperation and
Development, OECD
fragmentationresidualsim
1980 1990

sterle & Rothgang, 2010: 380

Morel, 2006: 227

160

permanent austerityPierson, 2001: 410

retrenchment

restructuring

welfare regime

Bismarckian welfare system

2
1

Armingeon & Bonoli,

2006; Esping-Andersen, 1999
Bonoli2006: 5-9

Bonoli, 2007

Palier & Martin, 2008: 2

1990
Goodman & Peng, 1996: 192
19971998
2000

Croissant,
2003, 2004a, 2004b; Holliday, 2000; Holliday & Wilding, 2003; Jones, 1990, 1993;
Ramesh, 2004; Rieger & Leibfried, 1999, 2003; Tang, 2000

Leibfried & Mau, 2008: xii

161

2000 2008
Campell & Ikegami, 2003; Campell, Ikegami, & Kwon,
2009

regulatory structure

2008

modernization

Ramesh, 2004 Goodman Peng1996: 194

Japan-focused East Asian
social welfare regimesAspalter2001

Haggard, 2005:
46-47; Haggard & Kaufman: 2008: chap. 6

162

institutional
change
3
Sozialstaat
Morel, 2007: 620-621

male-breadwinner
model

principle of subsidiarity

3
Huber Stephens2001Myles Pierson2001Pavolini Ranci
2008

163

freedom of
choice

welfare without workEsping-Andersen,

1996; Scharpf & Schmidt, 2000

care
crisis

164

5
Morel, 2007: 631-632

Teilkasko-Versicherung

supplement

Blank, 2009: 591

1990
Myles Pierson
2001 Bonoli Palier2008Husermann
2010
2011

165

late comer

regulatory
structure

welfare sectors

Pavolini & Ranci, 2008

Zuchandke, Reddemann,
Krummaker, & von der Schulenburg, 2010: 627

1990 70%

20096Geraedts & Heller, 2000: 3766
6

166

1994 5 26 Gesetz
zur sozialen Absicherung des Risikos der Pflegebedrftigkeit

soziale PflegeversicherungSozialstaat
71994
1995 1 1 3
4 1 7 1 8

2009 7,000 90%

20095-112011150-157

Hinrichs1995

Sozialversicherungsstaat

1883 1884 1889

1927
soziale Pflegeversicherung

SocialgesetzbuchSGBElftes BuchXIsoziale
Pflegepflegeversicherung http://www.sozialgesetzbuch-sgb.de/sgbxi/
1.html

2009
2011
200919-23

167

Bundesminiterium fr Gesundheit, 2011a

Pflegebedrftigkeit
Medizinischer Dienst der Krankenversicherung, MDK10
1
1

erheblich Pflege- Schwerpflegebedrftige
bedrftige
1
1
ADLs ADLs

IADLs 1
1

11.5
13

0.75 2
ADLs
ADLs

Schwerstpflegebedrftige
24
1
15
4
ADLs

15 SGB XI Stufen der Pflegebedrftigkeit1994

basic
activities of daily living, ADLsinstrumental
activity of daily living, IADL 6 1
ADLs IADLs

Campbell & Ikegami, 2003

10

Medicproof Rothgan &

Igl, 2007: 56

168

2009 82% 65
50% 80 Bundesminiterium fr Gesundheit,
2011a
Rothgang, 2010: 442
1
2008 67.3%

2009 6.3% 5
50%Bundesminiterium fr Gesundheit, 2011b
1
19962009
40% 55%
43% 33% 17% 12%

Rothgang, 2010

2husliche
Pflegeteilstatione Tages- und Nachtpflege
vollstationre Pflege11
Pflegesachleistung
Pflegeld
11

200924-332011165-174

169

100%

!
90%

80%
70%
60%
50%
40%
30%
20%
10%
0%

III
II
I

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

1 19962009
Bundesminiterium fr Gesundheit2011c

X %
100X%12

Ungerson & Yeandle,

2007

12

490
980 50% 50%420 210

170

30.06.2008

384

921

01.07.2008

420

980

01.01.2010

440

1,040

01.01.2012

450

1,100

205
215
225
235

410
420
430
440

665
675
685
700

205a
1,432
215a
1,470
225a
1,510
235a
1,550

410a
1,432
420a
1,470
430 a
1,510
440a
1,550

665a
1,432
675a
1,470
685a
1,510
700a
1,550

1,432
1,470
1,510
1,550

1,432
1,470
1,510
1,550

1,432
1,470
1,510
1,550

30.06.2008
01.07.2008
01.01.2010
01.01.2012

4
30.06.2008
01.07.2008
01.01.2010
01.01.2012

III
II

30.06.2008
01.07.2008
01.01.2010
01.01.2012

1,432
1,918
1,470
1,918
1,510
1,918
1,550
1,918

171

30.06.2008
01.07.2008
01.01.2010
01.01.2012

30.06.2008

III
II

384
420b
440b
450b

921
980b
1,040b
1,100b

1,432
1,470b
1,510b
1,550b

460

460

460

01.07.2008
c

30.06.2008

2,400c

2,400c

1,023

1,279

01.07.2008

1,023

01.01.2010

1,023

01.01.2012

1,023

2,400c

1,432
1,688
1,279
1,470
1,750
1,279
1,510
1,825
1,279
1,550
1,918
10 %
256
31

100% 10%
25
2,557

172

III

II

133.73
113.30

267.46
226.59

401.18
339.89

7.06
5.98

130.20
16.38

45a Abs. 2 Satz 1 Nr. 1 bis 9

SGB XI 1,2002,400

14 30

Bundesminiterium fr Gesundheit2011d

1,470
3

2
76.7% 2005
67.5% 2008 69%

173

3 2009

I
II
III

215
420
675

420
980
1,470
1,918

420
980
1,470

1,023
1,279
1,470
1,750

100
90
80
70
60
50
40
30
20
10
0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

2 19962009
Bundesminiterium fr Gesundheit2011b

30%
1 84%
70% 4
1
83% 2009 45.5%
15.4% 20.4%Bundesminiterium fr Gesundheit,

174

1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
2,00,000
0

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

3 19962009
Bundesminiterium fr Gesundheit2011b

2011e

Lundsgaard, 2005

Umlageverfahren

2004

13
13

400 360
18
18 23 25
56 SGB XI Beitragsfreiheit

175

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

4 19952009
Bundesminiterium fr Gesundheit2011b

Rothgang & Igl, 2007: 54

1995 1 1 1.0%
Bruttoeinkommen1996 7 1 1.7%
2001 4 3

2004 2005 1 1 23
0.25%14 2008
1.7% 1.95%
14

1940 1 1 23
23

2,000
2009

176

12

15
2011 3,712
4
4 2011

44,550
30,660

2009
2010

3,712.50
2,555.00
400.00
360
400
16.61
37.37
72.40
8.30
11.64

Bundesminiterium fr Gesundheit2011d: 14

15

Rothgang, 2010: 441

177

2008

1995
2008 5 7 1
Pflege-Weiterentwicklungsgesetz

Igl,
2008
Rothgang, 2010: 449-453

Pflegezeit

2008

15

2008

10 6
Lebenspartner

15

178

2008

6%

2008

1,536
2,072

Pflegesttzpunke
Pflegeberater

6,000 600
2010 250
2008

179

1,000 2008 2011

10
2009 7

Schiedsstelle

2008 2010 2012 1

2

Rothgang2010: 45220072012

3.2% 3.6%

2008
3 3
2014 Heinicke & Thomsen, 2010: 29

5 1995 1 1
4
2001
2002 2004
1 8 2005 1
1

180

!
6,000
5,000
4,000
3,000
2,000

1,000
0
-1,000
-2,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
3440 1180 800 130 -30 -130 -60 -380 -690 -823 -360 -450 -320 630 990
2870 4050 4860 4990 4950 4820 4760 4930 4240 3420 3050 3500 3180 3810 4800

5 19952009
Bundesminiterium fr Gesundheit2011f

2007 2005 16

19972007 1.4%
19972004 0.8%
172008 0.25%
1.95%
2.2%

16

17

2006 13
6
2005
2004 Bundesminiterium fr Gesundheit, 2011f

181

18

1995
2008 13

10

18

Rothgang2010: 446-447

182

19

mini-jobs
midi-jobs 400 800

Rothgang, 2010: 446

20
10

60%
5

12%
80%
19

20

1997 2007 1.65% Organization for Economic

Cooperation and Development [OECD], 2011
2011

40.35% 19.9%3.0%1.95% 15.5%

Bundesminiterium fr Gesundheit, 2011d: 14

183

% %

21,610
100.0
68.7

17,860
82.6
56.8

550
2.5
1.7

2,610
12.1
8.3

590
12.7
1.9

9,840
100.0
31.3

7,660
24.4

2180
6.9

31,450
100.0
Rothgang2010: 447

2008 26
2014 2008

2009 10.4 2012 22

Bundesminiterium fr Gesundheit, 2011a

2008
Heinicke & Thomsen, 2010: 27-28

1995
Pacolet, Bouten, Lanoye, &
Versieck, 2000

184

Campbell et al., 2009

gesellschaftliche
Aufgabe

Hilfe zur Pflege

20 1973 1992 335,000
675,000 Heinicke & Thomsen, 2010: 3

stigma
21 30%

800 2,000 Rothgang, 2010:

44822

21

22

Heinicke Thomsen
2010: 2-4
Rothgang Igl2007

185

16

Merkel, 2009: 208 2002

460
2008 2,000

20072008 Rothgang, 2010:

454 2011
Bundestministerium fr Gesundheit,
2011g
2006
2009 23

23

2009 1 26 Bericht des Beirats zur

berprfung des Pflegebedrftigkeitsbegriffs 5 20
5 26 Umsetzungsbericht des Beirats zur berprfung des
Pflegebedrftigkeitsbegriffs

186

2008

2003
Bundesminiterium fr Gesundheit und Soziale Sicherung
Nachhaltigkeit in der Finanzierung der
sozialen SicherungssystemeRothgang, 2010: 452

2008
Rothgang, 2010: 453

20072012
1.4%1996
2014
0.4%2008
2014 3

30 SGB XI

Rothgang & Igl, 2007

187

OECD
permanent
austerityPierson, 2001: 410

40 2050
2009 224 2020 281 2030 327
2040 372 2050 435 624

80
6080 25

110
24

60
60 0.8%6080 4.7%80 29%Bundesministerium fr
Gesundheit, 2011d: 15

188

6 19952050
Bundesminiterium fr Gesundheit2011g

2030 170 50%Merkel, 2009:

210

2008 1999
2007 25% 8,859 11,029
6.5% 10,820 11,529
Merkel, 2009: 213
2008
3

189

3,000
Geiger, 2011)
FDP Philipp Rsle 2010

2011 Rsle

2001
Riester-Rente

Bundesministerium fr Gesundheit,
2011f

golden age

190

1990

Leibfried & Obinger, 2003; Palier &

Martin, 2008

2008

Husermann, 2010

re-individualizationre-familialization

age-related risk

dependency

Esping-Andersen, 1990

Morel, 2007
1995 2008

191

1990

25

risk-pooling

Pickard et al., 2007

25

Grundgesetz fr die
Bundesrepublik Deutschland, GG
Demokratie
Republik
Sozialstaat
Bundesstaat
Rechtsstaat

welfare state
Butterwegge2001: 11-15
1880 1927

Blanke, 1999
1994
1995
Schmidt, 1998

192

Rothgang, 2010: 455

1 14
90 10.5

Timonen, 2009; Walker

& Aspalter, 2008

193

blame avoidance
26

Rothgang & Igl, 2007

centralized

servicesneeds

26

Pierson1994, 1996, 2001Weaver1986

194

Pavolini & Ranci, 2008

Sato,
200927

welfare market

Blank, 2009: 586

20

Blank, 2009:
587

2008
27

Sato2009 19992005

Lundsgaard2005

195

Berringer, 2010

accountability

Schneider & Reyes, 2007: 140

Pavolini & Ranci, 2008: 257

196

2000 Lisbon Strategy 2010

60%
Morel, 2007: 630-632

grey care market

cash-for-care benefits

Da Roit & Le Bihan,

2010: 302-303; Theobald, 2009

care infrastructure

197

Schneider & Reyes, 2007: 139

28

28

Bode, 2008: 225

198

199

2009

2009 http://www.npf.org.tw/
post/3/5368
2011
Armingeon, K., & Bonoli, G. (Eds.). (2006). The politics of post-industrial welfare
staes: Adapting post-war social policies to new social risks. London, England:
Routledge.
Aspalter, C. (2001). Sdkorea and Taiwan: Eine ra der konservativen
Sozialpolitik. In J. Jger, G. Melinz, & S. Zimmermann (Eds.), Sozialpolitik in
der Peripheri: Entwicklungsmuste und Wandel in Lateinamerika, Afrika, Asien
und Osteuropa (pp. 193-209). Frankfurt a.M., Germany: Brandes & Apsel
Verlag.
Berringer, C. (2010, September). Quality assurance for long term care insurance in
Germany. International symposium on long term care insurance, Taipei,
Taiwan.
Blank, F. (2009). When choice and choice are not the same: Institutional
frameworks of choice in the German welfare system. Social Policy &
Administration, 43(6), 585-600.
Blanke, B. (1999). Sozialstaat im Wandel: vom Sozialversicherungsstaat zum
sozialen Dienstleistungsstaat. Diskussionspapier Nr. 23, Forschungsstelle
fr Gesundheitskonomie und Gesundheitssystemforschung.
Bode, I. (2008). Aging and the welfare state in Germany. In A. Walker & C.
Aspalter (Eds.), Securing the future for old age in Europe (pp. 223-250).
Manchester, England: Casa Verde.
Bonoli, G. (2006). New social risks and the politics of post-industrial social policies.
In K. Armingeon & G. Bonoli (Eds.), The politics of post-industrial welfare
staes: Adapting post-war social policies to new social risks (pp. 3-26). London,
England: Routledge.
Bonoli, G. (2007). Time matters: Postindustrialization, new social risks, and welfare

200

state adaptation in advanced industrial democracies. Comparative political

studies, 40(5), 495-520.
Bonoli, G., & Palier, B. (2008). When past reforms open new opportunities:
Comparing od-age insurance reform in Bismarckian welfare systems. In B.
Palier & C. Martin (Eds.), Refroming Bismarckian welfare systems (pp. 21-39).
Oxford, England: Blackwell.
Bundesminiterium fr Gesundheit. (2011a). Versicherte der der sozialen Pflegeversicherung nach Altergruppen und Geschlecht. Retrieved from http://www.
bmg.bund.de/pflege/zahlen-und-fakten-zur-pflegeversicherung/zahlen-und-fak
ten-zur-pflegeversicherung.html#c1693
Bundesminiterium fr Gesundheit. (2011b). Antragsstatistik zur Feststellung der
Pflegebedrftigkeit. Retrieved from http://www.bmg.bund.de/pflege/zahlenund-fakten-zur-pflegeversicherung/zahlen-und-fakten-zur-pflegeversicherung.
html#c1693
Bundesminiterium fr Gesundheit. (2011c). Leistungsempfnger der sozialen
Pflegeversicherung am Jahresende nach Pflegestufen. Retrieved from
http://www.bmg.bund.de/pflege/zahlen-und-fakten-zur-pflegeversicherung/zahle
n-und-fakten-zur-pflegeversicherung.html#c1693
Bundesminiterium fr Gesundheit. (2011d). Zahlen und Fakten zur
Pflegeversicherung. Retrieved from http://www.bmg.bund.de/fileadmin/
dateien/Downloads/Statistiken/Pflegeversicherung/2011_03_Zahlen_und_Fak
ten_Pflegeversicherung.pdf
Bundesminiterium fr Gesundheit. (2011e). Leistungsempfnger der sozialen
Pflegeversicherung im Jahresdurch- schnitt nach Leistungsarten. Retrieved
from http://www.bmg.bund.de/fileadmin/dateien/Downloads/Statistiken/
Pflegeversicherung/110520_Leistungsempfaenger_der_sozialen_PV_nach_Le
istungsarten.pdf
Bundesminiterium fr Gesundheit. (2011f). Die Finanzentwicklung der sozialen
Pflegeversicherung. Retrieved from https://www. bundesgesundheitsministerium.
de/fileadmin/redaktion/excel_statistiken/xls-Finanzentwicklung-der-sozialen-P
flegeversicherung-Ist-Ergebnisse.xls
Bundesminiterium fr Gesundheit. (2011g). Wir brauchen grundlegende

201

Vernderungen in unserem Pflegewesen, wenn es gestrkt den

Herausforderungen entgegentreten soll, die uns in naher Zukunft erwarten.
Retrieved
from
http://www.bmg.bund.de/pflege/zahlen-und-fakten-zurpflegeversicherung/zahlen-und-fakten-zur-pflegeversicherung.html
Butterwegge, C. (2001). Wohlfahrtsstaat im Wandel: Probleme und Perspektiven
der Sozialpolitik. Opladen, Germany: Leske + Budrich.
Campbell, J. C., & Ikegami, N. (2003). Japans radical reform of long-term care.
Social Policy & Administration, 37(1), 21-34.
Campell, J. C., Ikegami, N., & Kwon, S. (2009). Policy learning and cross-national
diffusion in social long-term care insurance: Germany, Japan, and the
Republic of Korea. Policy Learning and Social Protection, 62, 63-80.
Croissant, A. (2003). Aufholende Nachzgler? Sozialpolitik in Demokratisierung in
Sdkorea, Thailand und auf den Philippinen. WeltTrends, 39, 89-110.
Croissant, A. (2004a) Changing welfare regimes in East and Southeast Asia: crisis,
change and challenge. Social Policy & Administration, 38(5), 504-524.
Croissant, A. (2004b) Wohlfahrtsstaatliche Politiken in jungen Demokratien: Ostund Sdostasien. In A. Croissant, G. Erdmann, & F. W. Rb (Eds.),
Wohlfahrtsstaatliche Politik in jungen Demokratien. Opladen, Germany:
Leske + Budrich.
Da Roit, B., & Le Bihan, B. (2010). Similar and yet so different: Cash- for- care in
aix European countries long-term care policies. The Milbank Quarterly, 88(3),
286-309.
Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Princeton, NJ:
Princeton University Press.
Esping-Andersen, G. (Ed.). (1996). Welfare states in transition: National
adaptations in global economies. London, England: Sage.
Esping-Andersen, G. (1999). Social foundations of postindustrial economies.
Oxford, England: Oxford University Press.
Geiger, K. (2011). Die Pflegeversicherung schtzt nicht vor Armut. Retrieved from
http://www.welt.de/finanzen/altersvorsorge/
article12468811/Die-Pflegeversicherung-schuetzt-nicht-vor-Armut.html
Geraedts, M., & Heller, G. V. (2000). Germanys long-term care insurance: Putting

202

a social insurance model into practice. Milbank Quarterly, 78(3), 375-401.

Goodman, R., & Peng, I. (1996). The East Asian welfare states: peripatetic learning,
adaptive change and nation-building. In G. Esping-Andersen (Ed.), Welfare
state in transition: National adaptations in global economies (pp. 192-224).
London, England: Sage.
Haggard, S. (2005). Globalization, democracy, and the evolution of social contrasts
in East Asia. Taiwan Journal of Democracy, 1(1), 21-47.
Haggard, S., & Kaufman, R. R. (2008). Development, democracy, and welfare state:
Latin America, East Asia and Eastern Europe. Princeton, NJ: Princeton
University Press.
Husermann, S. (2010). A new reform agenda: Old-age security in the
post-industrial era. In, The politics of welfare state reform in continental
Europe (pp. 33-55). Cambridge, England: Cambridge University Press.
Heinicke, K., & Thomsen, L. S. (2010, February 22). The social long-term care
insurance in Germany: Origin, situation, threats, and perspectives. Discussion
Paper, Center of Economic Research. Mannheim, Germany.
Hinrichs, K. (1995). Die Soziale Pflegeversicherung - eine institutionelle
Innovation in der deutschen Sozialpolitik. Staatswissenschaften und
Staatspraxis, 6/2, 227-259.
Holliday, I. (2000). Productivist welfare capitalism: Social policy in East Asia.
Political Studies, 48(4), 706-723.
Holliday, I., & Wilding, P. (Eds.). (2003). Welfare capitalism in East Asia: social
policy in the tiger economies. Basingstoke, New York, NY: Palgrave
Macmillan.
Huber, E., & Stephens, J. D. (2001). Development and crisis of the welfare state:
Parties and policies in global markets. Chicago, IL: University of Chicago
Press.
Igl, G. (2008). Das Gesetz zur strukturellen Weiterentwicklung der
Pflegeversicherung. Neue Juristische Wochenschrift, 31, 2214-2219.
Jones, C. (1990). Hong Kong, Singapore, South Korea and Taiwan: Oikonomic
welfare state. Government and Opposition, 25(4), 446-462.
Jones, C. (1993). The pacific challenge: Confucian welfare states. In C. Jones (Ed.),

203

New Perspectives on the Welfare State in Europe (pp. 198-217). London,

England: Routledge.
Leibfried, S., & Man, S. (2008). Welfare States. Constraction, deconstruction,
reconstruction. Cheltenhan, England: Edward Elgar.
Leibfried, S., & Obinger, H. (2003). The state of the welfare state: German social
policy between macroeconomic retrenchment and microeconomic
recalibration. West European Politics, 26(4), 199-218.
Lundsgaard, J. (2005). Consumer direction and choice in long-term care for older
persons, including payments for informal care: How can it help improve care
outcomes, employment and fiscal sustainability? OCED Health Working
Papers no. 20. Paris, France: OECD.
Merkel, G. (2009). Herausforderungen und Trends in der Pflegeversicherung. In S.
Langsdorf (Eds.), Altenpflege und Pflegeversicherung: Modelle und Beispiele
aus China, Deutschland und Japan (pp. 206-222). Shanghai, China: Shanghai
Academy of Social Sciences Press.
Morel, N. (2006). Providing coverage against new social risks in Bismarckian
welfare states: The case of long-term care. In K. Armingeon & G. Bonoli
(Eds.), The politics of post-industrial welfare staes: Adapting post-war social
policies to new social risks (pp. 227-247). London, England: Routledge.
Morel, N. (2007). From subsidiarity to free choice: Child- and elder-care policy
reforms in France, Belgium, Germany and the Netherlands. Social Policy &
Administration, 41(6), 618-637.
Myles, J., & Pierson, P. (2001). The comparative political economy of pension
reform. In P. Pierson (Ed.), The New Politics of The Welfare State (pp.
305-333). Oxford, England: Oxford University Press.
Organization for Economic Cooperation and Development. (2011). OECD
Economic Outlook, Volume 2011 Issue 1 - No. 89, Annex Table 1. Retrieved
from http://www.oecd.org/document/0,3746,en_2649_201185_46462759_1_1
_1_1,00.html
sterle, A., & Rothgang, H. (2010). Long-term care. In F. G. Castles, S. Leibfried,
J. Lewis, H. Obinger, & C. Pierson (Eds.), The Oxford handbook of the
welfare state (pp. 378-390). Oxford, England: Oxford University Press.

204

Pacolet, J., Bouten, R., Lanoye, H., & Versieck, K. (2000). Social protection for
dependency in old age: A study of the fifteen EU member states and Norway.
Aldershot, England: Ashgate.
Palier, B., & Martin, C. (Eds.). (2008). Reforming the bismarckian welfare state.
Oxford, England: Blackwell.
Pavolini, E., & Ranci, C. (2008). Restructuring the welfare state: Reforms in
long-term care in Western European countries. Journal of European Social
Policy, 18(3), 246-259.
Pickard, L., Comas-Font, J., Gori, C., Maio, D. A., Pozzi, C., Rothgang, H., &
Wittenberg, R. (2007). Modelling an entitlement to long-term care services for
older people in Europe: Projections for long-term care expenditure to 2050.
Journal of European Social Policy, 17(1), 33-48.
Pierson, P. (1994). Dismantling the welfare state? Reagan, Thatcher, and the
politics of retrenchment. Cambridge, England: Cambridge University Press.
Pierson, P. (1996). The new politics of the welfare state. World Politics, 48(2),
143-179.
Pierson, P. (Ed.). (2001). The new politics of the welfare state. Oxford, England:
Oxford University Press.
Ramesh, M. (2004). Social policy in East and Southeast Asia: Education, health,
housing, and income maintenance. London, England: Routledge.
Rieger, E., & Leibfried, S. (1999) Wohlfahrtsstaat und Sozialpolitik in Ostasien:
der Einfluss von Religion im Kulturvergleich. Soziale Welt, Sonderband, 13,
413-499. Nomos Verlag.
Rieger, E., & Leibfried, S. (2003). The welfare state and social policy in East Asia:
religion and globalization. In E. Rieger & S. Leibfried (Eds.), Limit to
globalization: Welfare state and the world economy (pp. 241-335). Cambridge,
England: Polity Press.
Rothgang, H. (2010). Social insurance for long-term care: An evaluation of German
model. Social Policy & Administration, 44(4), 436-460.
Rothgang, H., & Igl, G. (2007). Long-term care in Germany. The Japanes Journal
of Social Security Policy, 6(1), 54-84.
Sato, E. (2009). After the launch of long-term care insurance in Germany:

205

Analyzing the transition of LTCI from 1999 to 2005 by state. Journal of

Public Health, 17, 409-415.
Scharpf, F. W., & Schmidt, V. A. (2000). Welfare and work in the open economy:
Volume I. From vulnerability to competitiveness. Oxford, England: Oxford
University Press.
Schmidt, M. G. (1998). Sozialpolitik in Deutschland: Historische Entwicklung und
internationaler Vergleich. Opladen, Germany: Leske + Budrich.
Schneider, U., & Reyes, C. (2007) Mixed blessings: Long-term care benefits in
Germany. In C. Ungerson & S. Yeandle (Eds.), Cash for care in developed
welfare states (pp. 137-165). Basingstoke, England: Palgrave Macmillan.
Tang, Kwong-Leung (2000). Social welfare development in East Asia. New York,
NY: Palgrave.
Theobald, H. (2009, August). Restructuring elder care systems in Europe:
Policy-field, policy transfer and negative integration. Paper presented at the
ISA Conference, Montreal.
Timonen, V. (2009). Ageing societies: A comparative introduction. McGraw-Hill,
UK: Open University Press.
Ungerson, C., & Yeandle, S. (Eds.). (2007). Cash for care in developed welfare
states. Basingstoke, England: Palgrave Macmillan.
Walker, A., & Aspalter, C. (Eds.). (2008). Securing the future for old age in Europe.
Manchester, England: Casa Verde.
Weaver, R. K. (1986). The politics of blame avoidance. Journal of Public Policy, 6,
371-398.
Zuchandke, A., Reddemann, S., Krummaker, S., & von der Schulenburg, J. M. G.
(2010). Impact of the introduction of the social long-term care insurance in
Germany of financial security assessment in case of long-term care need.
Geneva Papers on Risk and Insurance-Issues and Practice, 35(4), 626-643.

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Welfare State Restructuring:

Construction and Reform of
Long-Term Care Insurance in
Germany and Policy Implications
for Taiwan
Ming-Fang Chen *

Abstract
It has only quite recently been recognized that long-term care
constitutes a core institution of modern welfare states. The author argues
that while most of the mature welfare democracies are faced with fiscal
restrictions, they do have adaptive ability to modernize themselves with
system restructuring that is dominantly conditioned by the welfare regimes.
This paper elaborates the construction of the long-term care insurance in
Germany a typical conservative welfare regime and its major reform in
2008 with the illustration of core institutional contents, the analysis of
achievements,

shortcomings,

and

future

challenges.

With

the

demonstration of main characteristics of Bismarckian welfare systems and

their potential crises resulting from the new social risks, this paper explores
how the Bismarckian welfare state processes the system modernization
*

Assistant Professor, Department of Social Welfare, National Chung Cheng

University.

207

with the development of mandatory social long-term care insurance when

faced with the problems characterized by the fact that the ageing
population increases the quality and quantity of care, but the
transformation of family and employment structure decreases the
possibility of informal care. Taiwan has built a newly emerging
Bismarckian welfare state through the social policy expansion since the
1990s and is facing similar problems resulting from the new social risks;
hence, lessons learnt from the development of the long-term care insurance
in Germany will be especially important to Taiwan for system design and
policy implementation.

Keywords: long-term care insurance, Bismarckian welfare system, new

social risks, welfare state restructuring, Germany

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