Transcript Autoreferat pracy doktorskiej

Long-term care financing
- the case of Poland
Dr Barbara Więckowska
Social Insurance Department
Warsaw School of Economics
Long-term care in Europe – discussing trends and relevant issues
Budapest, 22-23 February 2010
CURRENT LTC „SYSTEM”
FINANCIAL ANALYSIS
BENEFICIARIES PROJECTIONS
COST PROJECTIONS
Benefits are spread within social protection system
Cash benefits
(care supplement, care allowange)
Social insurance
Social assistance
3
Benefits in kind
(out-patient, in-patient)
Healthcare
Social assisance
Care supplement:
Social insurance
inability to work
 Inability
live
Careto
allowance:
independetly
disabled children up to the
Social insurance • Old-age and disability
orpension,
age of
16 requiring
permanent
insurance
(old-age
disability
pension, survival
annuity)
assistance
from another person,
for farmers
75+
• Old-age insurance (old-age pension)
• Disability insurance (disability pension, survival annuity)
Totalinsurance (disability pension,
• Workers compensation
survival annuity)
Social
assistance
4
children over the age of 16
with a moderate disability that
began before the age of 21,
seriously disabled persons,
without age criteria,
person who have reached the
age of 75
Care supplement
since 1.03.2003
since 1.03.2004
monthly
in zloty
in euro*
141.70
32.43
144.25
33.02
Care allowance
since 1.03.2003
since 1.03.2004
monthly
in zloty
in euro*
141.70
32.43
144.25
33.02
since 1.03.2005
144.25
33.02
since 1.03.2005
144.25
33.02
since 1.03.2006
153.19
35.06
since 1.03.2006
153.19
35.06
since 1.03.2007
153.19
35.06
since 1.03.2007
153.19
35.06
since 1.03.2008
163.15
37.34
since 1.03.2008
153.19
35.06
since 1.03.2009
173.10
39.62
since 1.03.2009
153.19
35.06
* exchange rate as of 20.05.2009 1 euro=4,369zł (www.nbp.gov.pl)
5
2005
2006
in thousands
Due to age
Due to frailty
1.649,93
1.453,52
Due to age
Due to frailty
TOTAL
TOTAL
TOTAL
Due to frality
Due to age
2007
2008
3.103,45
1.738,92
1.437,08
3.176,00
as %
1.839,64
1.442,22
1.941,84
1.435,62
53,16%
46,84%
54,75%
45,25%
56,05%
43,95%
57,49%
42,51%
100,00%
2006 2007
2.34% 3.33%
3.281,87
100,00%
100,00%
3.377,46
100,00%
2008 Total 2005-2008 Annual average
2.91%
8.83%
2.86%
-1.13% 0.36% -0.46%
-1.23%
-0.41%
5.39% 5.79% 5.56%
17.69%
5.58%
® Barbara Więckowska
6
Benefits in-kind: Healthcare system
In-patient care
•
•
•
•
 not qualified for hospitalization
Wards for chronicly ill
Nursing homes (ZOL, ZLP)
Hospices
Palliative care wards
 problems
with ALD (0-40
points in Barthel scale)
need for continuuing of treatment
 not last stage of cancer disease or
proverty or addiction
Out-patient care
• Home care
• Long-term care services for patients mechanically ventilated
• Nursing care
• Home hospices (including home hospices for children)
7
Inhabitants of social welfare homes
• Social assistance
 Problems with ADL
 No means testing
– In-patient care
• Social welfare homes for the elderly
• Social welfare homes for the chronically ill
• Social welfare homes for the chronically mentaly ill
• Social welfare homes for the adults intelectually disabled
• Social welfare homes for children and youth intelectually disabled
• Social welfare homes for physically disabled
– Out-patient care
• home based care services and specialized care services
• services in support centers
Barbara Więckowska
8
Inhabitants of social assistance institutions by age
100%
90%
80%
70%
60%
75 and over
50%
61-74
40%
41-60
30%
19-40
20%
18 and less
10%
0%
the elderly
for the
the chronically the adults
chronically ill
mentally ill
intellectually
disabled
® Barbara Więckowska
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Barbara Więckowska
10
2005
Cash benefits
In-kind benefits
TOTAL
Cash benefits
In-kind benefits
TOTAL
2006
in thousands
3,103.45
3, 176.00
139.04
141.88
3,242.49
3, 317.88
as %
95.7
95.7
4.3
4.3
100.0
100.0
® Barbara Więckowska
2007
3 ,281.87
142.63
3, 424.50
95.8
4.2
100.0
11
CURRENT LTC „SYSTEM”
FINANCIAL ANALYSIS*
BENEFICIARIES PROJECTIONS
COST PROJECTIONS
*BASED ON: J. Koettl, B. Więckowska, POLAND: Who will care for the
elderly and who will pay for it? Current and future public expenditures on
long-term care, World Bank Raport, January 2010
Barbara Więckowska
12
Expenditures on LTC cash benefits (in thousands)
2005
TOTAL
Due to age
Due to frality
2006
5,372.1
2,516.1
2,856.0
2005
TOTAL
Due to frality
Due to age
TOTAL
Due to frality
Due to age
Barbara Więckowska
7.60%
2007
5,838.4
2,641.8
3,196.6
2006
100%
46,84%
53,16%
2006
2007
2008
2008
6,033.0
2,651.3
3,381.7
2007
100%
45,25%
54,75%
Total 2005-2008
6,614.4
2,812.6
3,801.7
2008
100%
43,95%
56,05%
100%
42,52%
57,48%
Annual average
0.81% 5.22%
14.14%
4.51%
3.96% -2.09% 1.81%
3.63%
1.19%
23.40%
7.26%
10.82%
3.21% 7.89%
13
Expenditures on LTC benefits in-kind (in thousands)
Inpatient
Health sector
HIF
State budget
Local governments
Social sector
State budget
Local governments
2005
2,044
537
516
10
11
1,507
21
1,487
2006
2,242
599
578
7
13
1,643
42
1,601
2007
2,445
718
702
8
7
1,727
37
1,690
2008
3,022
988
970
9
10
2,033
46
1,988
Outpatient (social sector)
State budget
Local governments
2,520
36
2,484
2,756
41
2,715
3,117
48
3,069
3,637
57
3,580
Total public expenditure
Total HIF
Total state budget
Total local governments
4,564
516
66
3,982
4,998
578
90
4,329
5,562
702
93
4,766
6,659
970
111
5,578
Barbara Więckowska
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Expenditures on LTC benefits in-kind
Inpatient
Health system
HIF
State budget
Local governments
Social sector
State budget
Local governments
2006
8.57%
10.33%
10.92%
-31.06%
20.28%
7.94%
102.64%
6.63%
2007
6.39%
16.95%
18.53%
12.76%
-48.76%
2.55%
-14.50%
3.00%
2008 Total
Average annual
18.63%
37.03%
11.07%
32.20%
70.57%
19.48%
32.57%
74.30%
20.35%
1.97%
-20.74%
-7.45%
30.58%
-19.51%
-6.98%
13.00%
25.08%
7.74%
19.21%
106.55%
27.35%
12.86%
23.95%
7.42%
Outpatient (social sector)
State budget
Local governments
8.30%
15.17%
8.21%
10.34% 11.96%
14.25% 12.05%
10.28% 11.96%
33.80%
47.43%
33.60%
10.19%
13.81%
10.14%
Total public expenditure
Total HIF
Total state budget
Total local governments
8.42%
10.92%
35.24%
7.65%
8.57%
18.53%
0.76%
7.40%
35.25%
74.30%
55.34%
29.85%
10.59%
20.35%
15.81%
9.10%
Barbara Więckowska
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14.89%
32.57%
13.99%
12.31%
Expenditures on LTC benefits - Total
2005
2006
2007
2008
Cash benefits - total expenditure
due to frailty
due to age
5,372
2,516
2,856
5,838
2,642
3,197
6,033
2,651
3,382
6,614
2,813
3,802
In-kind benefits - total expenditure
Inpatient
Outpatient (social sector)
4,564
2,044
2,520
4,998
2,242
2,756
5,562
2,445
3,117
6,659
3,022
3,637
Total public expenditure
9 ,936
10 ,836
11 ,595
13, 273
Barbara Więckowska
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Expenditures on LTC benefits - Total
Cash benefits
due to frailty
due to age
In-kind benefits
Inpatient
Outpatient (social sector)
TOTAL
2006
7.60%
3.96%
10.82%
2007
0.81%
-2.09%
3.21%
2008 Total
Average annual
5.22%
14.14%
4.51%
1.81%
3.63%
1.19%
7.89%
23.40%
7.26%
8.42%
8.57%
8.30%
8.57%
6.39%
10.34%
14.89%
18.63%
11.96%
35.25%
37.03%
33.80%
10.59%
11.07%
10.19%
9,06%
7,00%
14,47%
33,58%
10,13%
® Barbara Więckowska
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Expenditures per beneficiary by benefit type and sector
2005
Cash benefits
Inpatient benefits
In health sector
In social sector
Cash and inpatient benefits
Outpatient benefits
n.a.
2006
2007
2008
1,867
1,963
1,915
1,958
22,482
35,607
19,872
24,244
37,792
21,443
24,647
35,340
21,895
28,791
46,002
24,361
2,499
2,635
2,609
2,767
1,567
1,731
2,214
2,377
n.a.
Total
® Barbara Więckowska
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Annual real growth rates of expenditures per beneficiary by
benefit type and sector
Average
2008 Total
annual
2.24%
4.88%
1.60%
Cash benefits
2006
5.15%
2007
-2.44%
Inpatient benefits
In health sector
In social sector
7.83%
6.14%
7.91%
1.67%
-6.49%
2.11%
16.81%
30.17%
11.26%
28.06%
29.19%
22.59%
8.59%
8.91%
7.02%
Cash and inpatient
benefits
5.46%
-0.98%
6.04%
10.73%
3.46%
10.46%
10.46%
10.46%
7.39%
7.39%
7.39%
Outpatient benefits
Total
n.a.
n.a.
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Real expenditures on LTC benefits by benefit type and sector as
share of real GDP
2005
Cash benefits
2006
2007
2008
0.54%
0.55%
0.52%
0.52%
due to frailty
0.25%
0.25%
0.23%
0.22%
due to age
0.29%
0.30%
0.29%
0.30%
In-kind benefits
0.46%
0.47%
0.48%
0.52%
0.21%
0.21%
0.21%
0.24%
Health sector
0.05%
0.06%
0.06%
0.08%
Social sector
0.15%
0.15%
0.15%
0.16%
0.25%
0.26%
0.27%
0.29%
1.00%
1.02%
1.00%
1.05%
Inpatient benefits
Outpatient benefits
Total expenditure
® Barbara Więckowska
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Annual growth in shares of real GDP spent on LTC benefits, by benefit
type and sector
Cash benefits
due to frailty
due to age
2006
1.32%
-2.11%
4.35%
2007
-5.52%
-8.24%
-3.27%
2008 Total
Annual average
0.40%
-3.89%
-1.31%
-2.85%
-12.74%
-4.44%
2.95%
3.91%
1.29%
In-kind benefits
Inpatient benefits
Health sector
Social sector
Outpatient benefits
2.09%
2.23%
3.88%
1.64%
1.98%
1.75%
-0.29%
9.61%
-3.89%
3.41%
9.63%
13.20%
26.14%
7.82%
6.83%
13.89%
15.39%
43.63%
5.32%
12.67%
4.43%
4.89%
12.83%
1.74%
4.06%
Total expenditure
1.68%
-2.16%
4.83%
4.28%
1.41%
® Barbara Więckowska
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CURRENT LTC „SYSTEM”
FINANCIAL ANALYSIS
BENEFICIARIES PROJECTIONS
COST PROJECTIONS
*BASED ON: J. Koettl, B. Więckowska, POLAND: Who will care for the
elderly and who will pay for it? Current and future public expenditures on
long-term care, World Bank Raport, January 2010
Polish society is aging rapidly, yet not at a constant rate, but in waves
Source: Eurostat
Annual population growth rate
Source: Eurostat
Dependency level by age group for Poland
Source: SILC
® Barbara Więckowska
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Projected annual population growth rates by dependency level
Source: own calculation
Projected dependency ratios
Source: own calculation
CURRENT LTC „SYSTEM”
FINANCIAL ANALYSIS
BENEFICIARIES PROJECTIONS
COST PROJECTIONS*
*BASED ON: J. Koettl, B. Więckowska, POLAND: Who will care for the
elderly and who will pay for it? Current and future public expenditures on
long-term care, World Bank Raport, January 2010
• Scenario 1 - assumes that real expenditures per beneficiary
continue to grow at the average rate over the last three years.
• Scenario 2, on the other hand, represents to opposite
extreme, assuming that real expenditures per beneficiary stay
constant at 2008 levels for in-kind benefits. For cash benefits,
Scenario 2 assumes a moderate annual increase of 20 percent
of GDP per capita growth.
• Scenario 3 therefore assumes that real expenditures per
beneficiary for the different types of benefits will grow at the
same rate as real GDP per capita
Projected public expenditures on LTC by benefit type (Scenario 1,
percent of real GDP, 2008 to 2060)
® Barbara Więckowska
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Projected annual change of public expenditures (as share of real
GDP) on LTC by benefit type (Scenario 1, percent, 2009 to 2060)
Projected public expenditures on LTC by benefit type (Scenario 2,
percent of real GDP, 2008 to 2060)
® Barbara Więckowska
33
Projected annual change of public expenditures (as share of real
GDP) on LTC by benefit type (Scenario 2, percent, 2009 to 2060)
® Barbara Więckowska
34
Projected public expenditures on LTC by benefit type (Scenario 3,
percent of real GDP, 2008 to 2060)
® Barbara Więckowska
35
Projected annual change of public expenditures (as share of real GDP) on
LTC by benefit type (Scenario 3, percent, 2009 to 2060)
® Barbara Więckowska
36
the policy responses fall into three categories:
 securing financing of future LTC expenditures,
 controlling demand for LTC services
controlling costs of publicly provided LTC services and
cash benefits.