Co-payments in inpatient care: An analysis of regional cost differences

The aim of the study is to identify regional cost differences at county level for full-time residential care in Germany and to examine the extent to which these differences are related to regional structural characteristics.

The analysis reveals significant regional differences in the personal contribution to be borne by those in need of care which consist of the standardised personal contributions (EEE), accommodation and meal costs, and investment costs. These vary both between federal states and within federal states. Counties in Saxony-Anhalt and Lower Saxony have the lowest personal contributions, while the highest are predominantly found in North Rhine-Westphalia. There is a clear urban-rural divide. Regression results show that, in addition to differences in remuneration, the rental price in particular correlates with all cost components of full-time residential care: In regions with high housing costs, the prices for full-time residential care are consequently significantly higher. In addition, nursing homes seem to be able to exploit economies of scale. This is because the costs for full-time residential care are lower on average in larger facilities. None of these considerations consider quality characteristics in the provision of full-time residential care.

Three federal states stand out for their comparatively low costs for full-time nursing care: Saxony-Anhalt, Lower Saxony and Mecklenburg-Western Pomerania. This suggests that these states are succeeding in ensuring a more cost-effective care infrastructure, even considering demographic and labour market conditions. Taking regional conditions into account, the city states of Hamburg and Berlin also manage to offer inpatient care more cost-effectively than many larger states. Accordingly, full-time nursing care is caught between economies of scale and negative agglomeration effects.