Germany’s “demographic storm” will see nursing care costs rise to €41.6bn by 2060

BMJ 2012; 345 doi: (Published 12 December 2012) Cite this as: BMJ 2012;345:e8434
  1. Ned Stafford
  1. 1Hamburg

With one of the lowest birth rates in the world, Germany was not prepared to cope with the massive demands that its health system will face during the next 50 years from a rapidly aging population, concludes a new study.

The first wave of Germany’s baby boom generation, generally considered those born between 1955 and 1967, will reach retirement in 2020, says the study, from the Fritz Beske Institute of Health System Research in Kiel.1 From that point on, the demands on the health system will rapidly accelerate, reaching a peak in 2040. But high demands on the system will continue to at least 2060.

Germany’s birth rate of 1.39 births per woman compares with the European average of 1.56 and with 1.98 in the United Kingdom. Although Germany’s current population of 82 million is expected to fall to 65 million by 2060, the study says that demand for nursing home beds will rise from the current 845 000 to about 1.5 million in 2040, with the added beds costing €63bn (£51bn; $82bn) to build. By 2060 a total of 1.96 million beds would be needed.

Annual costs to Germany’s nursing care insurance system to pay for that care are expected to rise from the current €19.7bn a year to €41.6bn in 2060.

Fritz Beske, the institute’s director, described the coming population changes in Germany as a “demographic storm.” Social scientists have been warning of the dangers to the health system for the past 20 years, he added.

“Our public health and social sectors are not yet prepared for the storm of demographic changes, and time is now short,” Beske said. “Politicians and policy makers must tell the truth so that each person can prepare.”

The study focused on three major areas of healthcare: hospital care, outpatient care, and drugs. Specifically, it analysed 59 hospital operations and procedures, 53 outpatient services, and the 10 most prescribed drugs and the top 10 drugs in terms of annual revenue.

Currently, in Germany, one in every 35 people needs some form of nursing care, either in an institution or at home, the study says. In 2060 the proportion will rise to one in 14. The number of people needing intensive nursing care will jump from the current level of 1.08 million people (one in every 278) to 2.2 million in 2060 (one in every 111).

Fred Brix, a coauthor of the study, told the BMJ that the study does not directly suggest what steps the German government should take to prepare for the demographic changes. But he believed that sources of revenue for public health insurance needed to be expanded, so that “whoever receives benefits must also pay premiums.”

Brix also believed that the catalogue of medical services covered by insurance needed to be “analysed and prioritised” and that the nursing care system for elderly people should be developed and professionalised. “And everything needs to be done quickly, within the next 10 to 15 years,” he said.


Cite this as: BMJ 2012;345:e8434