Consequences of demographic change on rehabilitation in German Pension Insurance

Uwe Egner, Stephan Mäder, Nadine VorsatzGerman Federal Pension Insurance (Deutsche Rentenversicherung Bund)

23rd Rehabilitation International World Congress

25th of October – 27nd of October 2016, Edinburgh, Scotland

1

Agenda

1. German Federal Pension Insurance (GFPI) – the institution

2. Background1. Population development2. Routine data from GFPI

3. Study: WOMR-Management

1. Results

4. Conclusions

2

German Federal Pension Insurance - the institution

Public service provider in the field of social security

More than 18,000,000 insured people

Tasks and benefits:

• Rehabilitation (medical and vocational)• Pension payments (retirement pensions and pensions due to

reduced earning capacity)

Funded by contributions of employers and employees

Responsible for insured people all over Germany3

Key figures medical rehabilitation

Source: ISRV claims for rehabilitation Tab.: 001.1, INFOSYS § 3 RSVwV A+E

Claims and Approvals

661,376717,818 744,824 765,405 780,312 791,511 792,196 771,415 786,135 759,332

426,087 446,623 465,235 486,690 479,900 492,959 488,812 470,765 493,783 475,003

0100,000200,000300,000400,000500,000600,000700,000800,000900,000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Claims DRV Bund Approvals DRV Bund

4

Key figures expenses for rehabilitation 2015

medical rehabilitation

vocational rehabilitation

benefits paid in place of salaryand social security fees

refunds and other

Total: 2,615 million euro *

1,740 million euro

279 million euro

602 million euro

Source: AL 8000* gross without refunds and allowances | expected annual earnings 2015 (02nd of February 2016)

-6 million euro

5

Development of population 2013 - 2030

Source: Destatis Bevölkerungspyramide 13.koordinierte Bevölkerungsvorausberechnung6

Proportions of different age groups in the population (in millions)

variant 1-W1

age group

total AQ

<20 20-65 65+

2013 14.7 49.2 16.9 80.8 34.0

2030 13.8 43.6 21.8 79.2 50.0

Assumptions : birth rate approximately constant at 1.4 children per womanLife expectancy at birth in 2060:84.8 years for boys88,8 years for girlsyearly migration balance (from 2021) + 100 000 persons

Source: Destatis Bevölkerungspyramide 13.koordinierte Bevölkerungsvorausberechnung

7

38.345.6

53.8 57 58

70.1

45.650.1

63.5 61.7 59.8

73.6

0

10

20

30

40

50

60

70

80

F EU-28 D DK GB S

2008 2013

Good news:Employment rate 55 to 64 years in Germany above the average of the EU

Source: Eurostat, 2015

proportion of older employees in percent

8

Average age of retirement due to old age

60.0

61.0

62.0

63.0

64.0

65.0

66.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

men women

aver

age

age

(yea

rs)

Source: ISRV Tab.: 102.00 Z RV 9

45.0

46.0

47.0

48.0

49.0

50.0

51.0

52.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

men women

Average age of retirement due to reduced earning capacity

Source: ISRV Tab.: 102.00 Z RV

aver

age

age

(yea

rs)

10

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

men women

Retirement due to reduced earning capacity- Musculoskeletal diseases system and connective tissue

Source: Rentenversicherung in Zeitreihen Oktober 2014

numbers

11

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

men womenSource: Rentenversicherung in Zeitreihen Oktober 2014

Retirement due to reduced earning capacityMental and behavioural disorders

12

numbers

Developments in medical rehabilitation- Average age of the rehabilitees Mental and behavioural disorders

44.2 44.2 44.444.9

45.245.8

46.146.5

46.947.3

40

41

42

43

44

45

46

47

48

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Source: ISRV Tab.: 07+16.00 M RV 13

49.5 49.7 49.950.3

50.651

51.451.8

52.152.4

45

46

47

48

49

50

51

52

53

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Source: ISRV Tab.: 16.00 M RV

Developments in medical rehabilitation- Average age of the rehabilitees Orthopedics

14

Approvals

Medical rehabilitation- Approvals by age

Source: Infosys web

0

20,000

40,000

60,000

80,000

100,000

< 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 >65age (years)

2009 2015

2009: n = 486,690, 2015: n = 475,00315

Prediction of develoment of medical rehabilitationGerman Federal Pension Insurance (total)

Source: RSD, inkl. AHB, abgeschl. Reha, * hochgerechnet2014: n = 1.008.050, 2018: n = 1.055.830

Rehabilitation2007 – 2014*

Prediction2015 - 2018

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

+ 4,7%

2014* - 2018

16

Needs for orientation in medical rehabilitation

Source: Re-Analyse MBO-Studie (Streibelt 2009)

Patient survey before starting orthopedic rehabilitation:

What do you think will help you most during

rehabilitation?

17

Needs for orientation in medical rehabilitation

80%

10%

25%

23%

87%

11%

64%

41%

35%

69%

0% 20% 40% 60% 80% 100%

gymnastics / sports

worktherapy /ergotherapy

relaxation therapy

occupationalconsultation

occupationaltherapy

<=50 years n= 981

>50 years n= 630

Source: Re-Analyse MBO-Studie (Streibelt 2009) 18

Patient survey

Source: Re-Analyse MBO-Studie (Streibelt 2009)

Patient survey after finishing a somatic rehabilitation:

Did you receive consultations and help in

the rehab-center to facilitate the situation at

your workplace or to return to work?

19

Item S50

Patient survey Situation at workplace or return to work

59%

41%

69%

31%

0% 20% 40% 60% 80% 100%

no

yes

>50 years n=11.088

<=50 years n=11.797

Source: Befragungszeitraum II/2007 + I/2008 20

21

0

0,2

0,4

0,6

0,8

1

0 500 1000 1500 2000

Tage bis Rentenzugang

Kum

ulie

rtes

Über

lebe

n

T-Wert bis 40

T-Wert größer 40 bis 60

T-Wert größer 60

Risk-Index for reduced earning capacity pensions

Quelle: Bethge et al. 2011

Goal: Prediction of early retirement (ER)Principle: Scale of 0 to 100 points, consisting of contributions of the last3 years (amount and origin) and sociodemographic factors

Risk of ER: 30 times higher

Risk of ER: 6 times higher

Hit rate of ER:

74 %

Nearly 90% in ER after 5 years!

Verb

leib

im E

rwer

bsle

ben

31%

0% 0%8%

12%

0% 0%

19%13%

32%

0%5%

63%

0%

72%

0%

19%13%

75%

1%0%

12%

68%

11%

43%

0%

20%

40%

60%

80%

100%

continousContributions to

pension insurance

temporarycontributions

early retirement retirement death

<= 29 years, n=4.705 30-39 years, n=13.537 40-49 years, n=37.737 50-59 years, n=44.095> 60 years, n=7.349

Benefit of rehabilitation Payment of contributions - two years follow upRehab caused by mental and behavioural disorders

Source: RSD 2005-2012

!

Compulsorily insured persons, who finished medical rehabilitation in 2010

22

Conclusions

Ageing workforce leads to older clients in rehab-centers

Risk of reduced earning capacity must be main focus of Pension Insurance and rehab-centers

Services for older patients must be focused strictly on return to work

Workplace orientated rehabilitation as a main focus for German Pension Insurance

23

Impressum

23rd Rehabilitation International World Congress25th of October – 27nd of October 2016, Edinburgh, Scotland

Consequences of demographic change on rehabilitation in German Pension Insurance

Uwe EgnerGerman Federal Pension Insurance

24