Transcript Zofia Czepulis-Rutkowska - Long Term Care in comparative

LONG TERM CARE
IN COMPARATIVE PERSPECTIVE
IV International Conference "SOCIAL SECURITY SYSTEMS IN THE
LIGHT OF DEMOGRAPHIC, ECONOMIC AND TECHNOLOGICAL
CHALLENGES", Poznań, 24-25 September 2015.
Zofia Czepulis-Rutkowska ,IPiSS
This presentation was prepared as a part of realization of the Research
Project: ” Social Security Institutions for the Elderly in the Context of
Social Policy Models”, OPUS 5, No 2013/09/B/HS5/00039
Outline
• Long Term Care concept
• LTC importance
• Systems in the high income countries („old”EU
member states)
• Systems in the middle income countries („new”
member states)
• Conclusions
Long Term Care Concept
• Definition
• Long Term Care and other social security institutions
• Long term care earlier provided by families, charities, churches
• Since introduction of comprehensive social security systems –
disability benefits, old-age pensions, social assistance constituted
parts of long term care in this system
• Only recently (2-3 decades in the higher income countries) more
interest in the (so called) Long Term Care
LTC importance
• Population aging
• More elderly and especially the old elderly (the number of 65+ 20%
in 2030, 25% by 2050; 85+ 3% in 2030, 5,2% by 2050)
• Lower fertility rate - less younger people (carers)
• Social and economic change
• Smaller families (often childless)
• Change of families structure and functions;
• Women active at the formal labour market
• Migrations (positive or negative impact depending on a
country)
• Migrant carers
• Care drain and other social consequences of labour migrations
Systems in the High Income Countries
• Traditional social regimes division (as a starting point)
• Conservative regime (Germany)
• Nordic regime (Sweden)
• Liberal regime (England, the LTC is devolved)
• Does it still holds – yes to some extent due to
stickiness of institutions and institutional
agreement with society
Systems in the High Income Countries
• Expenditures as a percentage of GDP
• Germany: 1.4% in 2010, 3.1% by 2060
• Sweden: 3.9% in 2010, 6.4% by 2060
• UK: 2.0% in 2010; 2.7% by 2060
*GDP per capita in international dollars in 2014
Germany: 45.615.8
Sweden:
45.143.5
UK: 39.136.8
Systems in the High Income Countries
Germany
• In 1994 a new branch of social insurance
introduced – care insurance. Financed like other
social insurance branches by contributions
(1,95% of salary)
• Why social insurance at a time when this system
is already seen as inadequate due to labour
market changes
• Path dependency or only possible political
consensus?
Systems in the High Income Countries
Germany
• Many changes along the way
• Rising contributions
• Higher contribution for childless persons
• 1/3 paid out of other sources than contributions
• Tight qualifying conditions
• No benefit adjustments for a long time
• Dementia problem (many persons in need excluded)
Systems in the High Income Countries
Germany
• Strong points:
• Transparency
• Legimatization
• Problem of financing method
Systems in the High Income Countries
Sweden
• Social services and health care
• Social services administered at the level of municipalities
• Health care at the level of the countries
Systems in the High Income Countries
Sweden
• Important values
• Autonomy of local administration
• Municipalities – local policy makers
• Equity
• Individualization
• Conflict between autonomy and equity
• Policy towards centralization to avoid inequity
Systems in the High Income Countries
Sweden
• Integration between counties and administartion
responsible for social services
• A project under previous central political authority
• Long negotiations to make those administrations
work together
• One example of possible good impact – more
attention from GP’s to LTC illnesses syndroms
• Also more individualized attitude in care, more
understanding of people’s individual habits
Systems in the High Income Countries
England
• Health care and social care involved
• Long time interest in LTC – many high profile documents
starting with Royal Commission on Care, recently Act on
Health and Social Care focused on integretion
• Various solutions across local administrations
• Problem of means test - cap on life long spending
Systems in the Middle Income Countries
• LTC expenditure as a percentage of GDP
• Poland: 0.7% in 2010; 1,7% by 2060
• Czech Republic: 0.8% in 2010; 1,5% by 2060%
• Bulgaria: 0.5% in 2010; 0,8% by 2060
*GDP per capita in international dollars in 2014
Poland: 24.882.3
Czech Republic: 30.444.9
Bulgaria: 16.323.8
Systems in Middle Income Countries
Poland
• Health Care
• Residential establishements (nursing facilities)
• Home care - nurses
• Social Care
• Care homes
• Semi-residential homes
• Community services
• Debate on one comprehensive systems
• Focus on Seniors
• New departement in the Ministry of Labour and Social Policy
• New Parliamentary Commission
Systems in the Middle Income Countries
• Less financial resources
• Less developed LTC institutions
• Other social security system being reformed
(pensions, health systems)
• Care drain problem
Conclusions
• Rising demand for LTC in all EU countries
• Some issues indicated in debates in all countries:
insufficient resources, insufficient quality of services,
• Integration of health and social care one of the
central policy effort
• In middle income countries – belief that introducing
one system would solve the problem
• Care drain – problem beyond LTC for middle and low
income countries
• Main differences due to absolute and relative
resources dedicated to LTC
•