Drivers & Barriers

Germany is one of the most rapidly ageing member states of the European Union and the accelerating trend towards population ageing has received considerable attention in national public discourses over the last years. The demographic challenge is generally perceived in terms of potential crisis in the funding of health and social programmes. There has for instance been a widely recognised public debate on whether or not Germany will have to face severe intergenerational conflicts due to increasing competition between the young and the old for scarce resources. Against this background, for some years already diverse sectoral policies have been seeking to develop effective strategies for meeting the challenges that are expected to come with ongoing demographic developments.

As mentioned earlier, considerable financial resources have for instance been spent – and are still being spent – by the national/regional governments on ICT-related research and technology development in the field of medical/social home care and independent living more generally. This has tended to act as a facilitator for building up research capacities and expertise in relation to the development of ICT based services and products relevant to older people. There are also examples where outcomes of such research have started to be successfully mainstreamed, e.g. the SOPHIA services described earlier in this section.

Unlike some other countries, however, there is so far no dedicated policy strategy directed towards facilitating wider implementation of available ICT solutions. Although reimbursement of social alarms under the statutory long-term-care insurance scheme seems to have given some stimulus towards uptake of simple push button alarms, self-payment seems to be quite common and the social alarm market has tended to remain rather price sensitive up to now. Overall, deployment levels have remained comparatively low more than 20 years after their introduction in the national market. Beyond social alarms, no systematic funding/reimbursement streams have been put in place in relation to telecare more generally. In view of lacking reimbursement under established care and welfare systems, an underdeveloped “self-payer culture” can be regarded as a barrier towards wider uptake of current and future telecare solutions.

A well developed alarm service industry, e.g. in terms of established technology supply channels, a dense network of service centres, well stabilised organisational/service models and quality standards would, on the other hand, seem to provide a fertile ground for the deployment of more advanced telecare solutions, at least in infrastructural regard. The comparatively well developed broadband infrastructure is also a potential facilitator.

In the health domain, some health insurers have very recently started to fund home telehealth solutions in relation to specific chronic diseases. Legislative changes enabling the funding of home telehealth services in the framework specific disease management programmes have acted as a facilitator for this development. There are currently about 200 health insurers in the country and it remains to be seen how many of these will follow this approach. Preliminary evaluation activities suggest that the implementation of disease management programmes in general and telehealth services in particular provide significant potentials to improve patients’ quality of life in a cost efficient manner. Outcomes suggest for instance that patients with heart insufficiency who participated in a telehealth scheme had to be less frequently treated in a stationary setting. Overall, the number of patients who were referred to a hospital has been reported to have decreased by 42%. For those who needed to be referred to a hospital a decrease of hospital days of 24% was observed. Overall, costs for hospital treatment have been reported to have decreased by 77%. Similar benefits have been reported in relation to diabetes patients that were included in a home health monitoring scheme.

The developments briefly sketched above seem to have acted as a facilitator to the current emergence of a telemonitoring service industry in Germany. Today, service providers such as SHL telemedicine and Vitaphone cooperate with funding organisations such as health insurers, and they offer their services to individual end users as well. Due to the lack of reliable market data, however, it is difficult to assess current market volumes, e.g. in terms of users served or revenues generated. More generally, it would seem that self-payments for home telehealth can be expected to play a minor role in view of an underdeveloped “self-payment culture”.

In the field of smart home technology, the German government has recently launched a dedicated programme entitled “The Intelligent Home” (Das intelligent Heim). The programme is directed towards stimulating age-friendly design of buildings, including the utilisation ICTs for purposes such as facility management, home care provision and interpersonal communication. Overall, 65 demonstration projects have been selected. A particular focus is on developing innovative housing solutions for people with dementia. Moreover, industry players seem to be increasingly aware of this topic. For example, a network has been initiated by the Bertelsmann foundation – a major private foundation aiming at identifying key societal challenges and helping address them. Beyond this, some manufacturers of prefabricated houses have started to provide basic smart home features within their premium model ranges. Bus-systems connect different smart-home components such as heating, air-conditioning, lighting, telecommunication, sanitary facilities etc. in an intelligent way. Together these developments may act as facilitators for further integration of smart home features into the mainstream building stock.

However, mainstream housing organisations that have started to implement ICT systems/devices in selected dwellings have reported that high costs still act as a major barrier for wider deployment. This relates not only to purchasing, installing and maintaining ICT systems and components, but also to customising of the installed systems according to individual needs of the tenants. Also, the redesign of existing management processes to enable management of technology-enriched housing stock has been reported to be a factor driving up costs. Theses aspects are of particular relevance for social housing organisations as, typically, their tenants live on rather low levels of income and have already been burdened with increasing energy costs over the last years.