Vicious circle of cancer first came the disease then poverty focus online

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The cancer is pushed back, but many affected people cannot breathe a sigh of relief. They get caught in a vicious circle of economic hardship and social decline, which leads to early retirement and poverty. What health insurances, employment agencies and pension insurances would have to change – because many patients, could and would still work, would be valuable specialists.

Cancer therapy has never been as successful as it is today. And even if no cure is possible, the disease can often be treated to such an extent that it is only minimally present and allows an almost normal life to be led. That's why doctors today often refer to cancer as a chronic disease. A welcome, positive development.

After the fear of not surviving the cancer comes the existential angst

"The economic situation of many patients, on the other hand, is much less positive," says Rainer Gobel, who has been active in cancer self-help for 20 years, especially for leukemias and lymphomas. He has started groups for those affected. At the time, the IT expert was himself suffering from leukemia, but he has come to grips with the disease and is now head of IT at the Joint Cancer Registry in Berlin.

As part of his voluntary activities, he is also working scientifically on the study "Cancer and Poverty" by the Institute for Applied Research Berlin, the Alice Salomon University of Applied Sciences Berlin and the Berlin School of Economics and Law.

The earlier cancer, the greater the risk of poverty

The joy that cancer has disappeared or at least shrunk to a tolerable level is overshadowed by massive economic losses, unemployment and relegation to a (usually meager) early retirement. In a nutshell, his physical existence is no longer threatened, but his economic existence is.

Two examples that Rainer Gobel knows from the groups he reports on show how quickly this can affect anyone:

1. Sabrina

The 22-year-old had already completed her education when she fell ill with a brain tumor. Today she is considered cured, but is only able to work to a limited extent due to the consequences of the cancer treatments. She studies, can't find a job, receives disability pension and some financial support from her mother, gets a mini-job in a cancer group. If, like Sabrina, you did not work properly before the illness, the reduced earning capacity pension often amounts to only a few 100 euros, so that you can expect a total of less than 1.000 euros must live.

2. Mike

The IT entrepreneur is 33 years old when he receives the diagnosis of leukemia. The therapies, some of which continue to this day, keep the blood cancer in check, so that he can return to work to a limited extent, but he has to give up his business, and his wife leaves him with the children.

He keeps his head above water with savings, which, however, are below Hartz IV level. Nevertheless, the youth welfare office insists on alimony payments. Because he could not afford them, he would have to file a lawsuit against the youth welfare office. After great efforts, he only finds a job again at the age of 46, a part-time position.

Not enough money for rent, food and medication

Sabrina and Mike represent many fates, some of which are often no longer able to pay the rent, do not have enough money for clothing and food, as well as the accompanying medications, which are not paid for by the health insurance fund. How many cancer patients are affected in this way? After all, with cancer there are 175.000 new cases per year, roughly estimated that more than two-thirds survive.

One in three cancer patients never returns to work

"After three years, one-third of cancer patients who were previously employed did not return to their jobs afterwards," Rainer Gobel states the hard facts that are part of the study's findings. More than 300 cancer patients were interviewed, and the statements were evaluated against the routine data of around 3,300 AOK-insured patients. Those affected slip into a downward spiral that leads to poverty.

How cancer patients are driven into financial ruin

The course for it puts finally our society, the main roles in this drama play

– the health insurance companies, – the employment agencies – the pension insurance companies

The individual stages or, if you want to stay with the drama, acts one to three:

1. Continued payment of wages by the employer: Those who fall ill with cancer – or with another long-term illness that limits their ability to work – first continue to receive their wages as normal for six weeks.

2. This is followed by sickness benefit amounting to 70 percent of gross salary, for 78 weeks, i.e. one and a half years, which is paid by the health insurance funds.

3. This is followed by unemployment benefit I with 60 percent of the net income for 18 months, then Hartz IV, i.e. basic security with currently 432 euros for a single adult.

Why employment agencies are overburdened

Because the employees always have temporary contracts for two years, there could be a lack of experience, which would be particularly advantageous for the placement of former cancer patients. He had during the two years, which he had contact with the Arge, three case workers.

"In addition, there is only one placement office for academics, one for the severely disabled, yet a severely disabled person can also be a highly qualified acadamist," says Rainer Gobel, citing another of the many problems.

Another is, for example, that there are no part-time training opportunities – which would be important for patients, for example, to keep up to date with the current state of their profession. But the full-time course would exceed the forces.

Retirement can be hidden in the rehab application

Many of the patients, however, do not even get in touch with the Arge, but are sent into retirement beforehand, even though they could and would still like to work. "Often, patients are signed out into reduced earning capacity pensions while they are still receiving sick pay," warns Rainer Gobel. Health insurers are increasingly trying to do that, though not all, he adds.

Thus, there would be cases in which patients are called by the health insurance company while they are still undergoing chemo and are asked to submit a rehab application. You agree and, of course, the prognosis cannot be very positive at such an early stage of the therapy, which automatically initiates the pension procedure.

The patient's costs are shifted from the health insurance fund to the pension fund

In certain cases, the application for rehabilitation benefits then counts as a pension application (§ 116 SGB VI) "I don't want to say that this law is completely wrong, it's just that it's sometimes applied a bit too early," the cancer specialist puts it cautiously. The cost factor patient is shifted, so to speak, from one service provider to another, from the health insurance fund to the pension fund.

In this way, the patient is taxed out into the full reduction in earning capacity pension, which is usually low, in the case of most of those affected far below 1.000 euros, for example, in the case of basic benefits. Only a few succeed later, when they feel better again and can work again, at least partially, to get out of it again.

The possibility of partial retirement is too little known

For them, the partial reduction in earning capacity pension would be an option, but in Germany it is taken up far too seldom, as the study also reveals. Only about 1.000 patients were partial disability pensioners, more than 22.000 full disability pensioners "In my opinion, the pension insurance is not flexible enough to propagate this option," criticizes the expert.

Here an image change must take place, so that the patient has the freedom of choice to draw the partial pension and supplement it with a part-time job. At the moment, the hurdles for partial disability pensions seem to be higher than those for full disability pensions.

Cancer brings many to the brink of poverty

However, according to the study, 93 percent have less money available after the illness than before. In particular, those whose net household income before the disease was over 2,000 euros have to accept severe losses, and after cancer usually have only far less than half of that – the already mentioned approximately 1.000 euros.

Adequate job after cancer is the exception

The few who manage to work part-time or become self-employed out of necessity, however, often no longer work according to their qualifications. Not all of them return to their old jobs by a long shot. The reason, says Rainer Gobel, is that many employers are not flexible enough. Only a few bosses take on ex-colleagues again.

Only very few patients have the opportunity to reduce their working hours to 20 hours or even less, depending on the consequences of their illness. Both sides would benefit – the company through the knowledge, experience and commitment of the patient, who in turn has not only financial benefits, but also a gain for his psychological situation.

Poverty, unemployment and early retirement put a massive strain on the psyche

Not only the financial plight with little prospect of improvement threatens the existence, but also the psyche. In addition, those affected are depressed by the feeling that they are no longer needed, that they have lost their social support, and that they are excluded from working life, and thus also from success, communication and cooperation with colleagues.

The high potential of patients is not being utilized, as if there were a shortage of skilled workers

"Although many of them are well trained and have the potential to continue working, even if not under the same conditions as before – i.e. with somewhat less deadline prere, reduced number of hours," reports he. Especially in view of the constant complaints of entrepreneurs about the shortage of skilled workers, it is incomprehensible that this potential is ignored.

5 suggestions against the risk of poverty and social exclusion

Ultimately, it is not only the employers who are called upon, but also the health insurance companies, employment agencies and pension funds, to change this situation and improve it for the patients. "The biggest problem is that this system is not coordinated," says Rainer Gobel, citing the biggest point of criticism. A concerted action that puts the patient at the center would be the solution here. Based on his experience, Rainer Gobel has very concrete suggestions for improvement:

1. HospitalAlready at the beginning of cancer therapy, a social worker should accompany the patient in the clinics. Advice should not only be given on the severely handicapped certificate and rehabilitation, but also on how to stay in or get a job.

2. Health InsuranceDo not relegate patients to retirement, but pay sickness benefits for as long as the patient needs them. Under certain circumstances, this entitlement would have to be extended beyond the one and a half years. .Certain therapies, such as those for breast cancer, take longer.

3. Pension schemeThe pension for reduced earning capacity should be sufficient to cover the cost of living, without parents having to pay extra. Patients should not automatically be shunted into a full disability pension or basic income support.

4. Employment agencies: Taskforce, similar to the integration specialist services, which still exist, but in many cases have also been reduced by cost-cutting measures. On the one hand, this task force should take the patient by the hand regarding a partial reduction pension, on the other hand, they should make a joint effort to bring him back into working life. With the new law of participation also disabled people have a right to work.

5. Employers: More openness and flexibility in work hours and workload, getting patients in or out again. Qualification lies otherwise fallow. Could fill gaps in times of skills shortages.

This affects patients who were or are workers. It looks completely different for self-employed persons, for them financial and thus social risks are still substantially larger. Much are not adequately insured for emergency illness, because it is also very expensive. Politicians should therefore consider whether they should also pay into the social security system so that they receive unemployment benefits and pensions, as is the case in many other countries.

5 tips on what cancer patients can do themselves

1. Try, as far as the disease allows, not to lose sight of your profession during the therapy, talk to your employer, some are quite open-minded when it comes to resumption of activity.

2. It is important to maintain contact with the former workplace, with colleagues, emphasizes Rainer Gobel. In addition: "Look for the discussion with the personnel agency, perhaps there is also a severely handicapped representative", it leads out.

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