2010年-世界发展银行全球_Long-Term_Care_and_Ageing___Case_Studies_-_Bulgaria_Croatia_Latvia_and_Poland_112页_3mb

Summary of World Bank Report: Long-Term Care and Ageing (Bulgaria, Croatia, Latvia, Poland)

Core Content

This report examines the challenges and policy responses related to long-term care (LTC) in four European countries: Bulgaria, Croatia, Latvia, and Poland. It highlights the demographic shifts, economic context, current LTC systems, financing mechanisms, and future policy directions in each country. The report underscores the importance of LTC as both a health and fiscal issue, particularly in the context of aging populations and the increasing need for support services.

Main Views and Key Information

1. Bulgaria

• Demographic Background:
  Bulgaria has one of the fastest aging populations in Europe, with the proportion of people aged 65+ rising to 17.3% of the total population. The country's population is declining, and the dependency ratio is expected to increase significantly, from 4:1 in the current year to less than 2:1 by 2050.

• Macro-Economic and Fiscal Context:
  Bulgaria is an upper-middle-income country with a GDP per capita of €10,400 (in PPS), well below the EU-27 average of €25,100. Despite economic growth, 13% of the population still lives in poverty, with elderly women being three times more likely to be in poverty than elderly men.

• LTC and Social Services System:
  LTC and social services in Bulgaria are divided into two systems: social services (regulated by SAA and RISAA) and health services (regulated by the Medical Treatment Facilities Act). Social services include personal assistants, social assistants, home helpers, daycare centers, and rehabilitation centers. Health services include specialized hospitals and hospices.

• Financing of LTC Services:
  Government spending on LTC is minimal, with only 0.034% of GDP allocated to elderly care in 2006, compared to the EU average of 0.48%. Health care spending is 6.69% of GDP, but per capita expenditure is only €232. Most services are publicly funded, with some user fees.

• Future Policy Directions:
  The report emphasizes the need for a more comprehensive LTC system, improved coordination between health and social services, and increased investment in LTC. It also suggests the expansion of community and home-based services to reduce institutional reliance and improve accessibility and quality.

2. Croatia

• Demographic Trends:
  Croatia has experienced a decline in the working-age population and an increase in the elderly population. The share of people aged 65+ has grown from 17.0% in 2008 to 17.3% in 2020, with a similar trend for the 80+ age group.

• Provision, Regulation, and Financing:
  LTC services are regulated by the Social Assistance Act and the Rules for the Implementation of Social Assistance Act. There is a growing emphasis on community-based services, but institutional care still plays a significant role. The cost of LTC is a concern, and public expenditures are expected to rise with demographic changes.

• Long-Term Social and Health Care:
  Social care for the elderly and informal care are increasingly important. The report highlights the need for better integration of health and social services to ensure more efficient and effective care for the elderly.

• Cost of LTC:
  The cost of LTC is rising, and the demographic shift is putting pressure on public finances. The report notes that the cost of LTC is expected to increase significantly in the coming years.

• Demographic Change on Public Expenditures:
  The aging population is expected to increase public expenditures on LTC, particularly for health services. The report suggests that this will require more efficient use of resources and better policy planning.

• Future Policy Directions:
  The report recommends better coordination between health and social services, increased investment in LTC, and the development of more community-based services to reduce the burden on institutional care.

3. Latvia

• Aging Population and Dependency Ratio:
  Latvia has a rapidly aging population, with the proportion of people aged 65+ increasing. The dependency ratio is expected to rise, putting pressure on the social protection system.

• LTC Provision and Financing:
  LTC services are provided through a combination of social and health services. The report highlights the need for better financing mechanisms and more efficient use of resources.

• Current Public Expenditures:
  Public expenditures on LTC are relatively low, and there is a need for increased investment to meet the growing demand for services.

• Future Policy Directions:
  The report suggests the development of a more comprehensive LTC system, improved coordination between health and social services, and increased investment in LTC.

4. Poland

• Demographic Prospects:
  Poland's population is aging, with the proportion of people aged 65+ increasing. The country is expected to face significant challenges in providing LTC services to an aging population.

• LTC Provision and Financing:
  LTC services are provided through a combination of social and health services. The report highlights the need for better financing mechanisms and more efficient use of resources.

• Current Public Expenditures:
  Public expenditures on LTC are relatively low, and there is a need for increased investment to meet the growing demand for services.

• Fiscal Impact of Future LTC Spending:
  The report notes that future LTC spending will have a significant fiscal impact, particularly on public finances.

• Future Policy Directions:
  The report recommends better coordination between health and social services, increased investment in LTC, and the development of more community-based services to reduce the burden on institutional care.

Conclusion

The report highlights the importance of LTC as a critical component of social protection and health care systems in aging populations. It emphasizes the need for comprehensive LTC systems, improved coordination between health and social services, and increased investment in LTC to meet the growing demand for services. The report also notes the importance of addressing the specific needs of elderly women, who are more vulnerable to poverty and isolation.