2008年-世界发展银行全球_Economic_Implications_of_Chronic_Illness_and_Disability___In_Eastern_Europe_and_the_Former_Soviet_Union_156页_6mb

Economic Implications of Chronic Illness and Disability in Eastern Europe and the Former Soviet Union

Core Content

This report, edited by Cem Mete, explores the economic implications of chronic illness and disability in Eastern Europe and the Former Soviet Union (FSU). It includes contributions from various researchers and focuses on the relationship between disability, employment, poverty, and social protection programs in the region. The report is part of a World Bank series and covers 25 countries, including Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyz Republic, Latvia, Lithuania, Moldova, Poland, Romania, Russia, Serbia, Slovakia, Slovenia, Tajikistan, Turkey, Ukraine, Uzbekistan, and FYR Macedonia.

Main Causes of Disability

• Non-communicable diseases and injuries are the most common causes of disability in the region.
• Movement restrictions are prevalent, especially in countries with advanced fertility transitions.
• Congenital disabilities are also significant, often leading to long-term disadvantages in employment and education.

Employment and Disability

• Disabled adults are significantly less likely to be employed compared to non-disabled adults in all transition countries.
• The employment gap varies from 20 to 60 percentage points.
• Earnings of disabled individuals are lower, with a larger gap for those classified as "disabled" compared to those with chronic illnesses only.
• Employment can reduce poverty among the disabled, but this is not universally true. Romania is an exception, where being a wage employee does not eliminate the poverty disadvantage for disabled individuals.

Poverty and Disability

• Poverty and disability are strongly linked, with disabled individuals more likely to be poor.
• The disability rate increases with poverty, but the variation is not always significant across countries.
• Social protection transfers are more effective in targeting the poor in most countries, though Tajikistan and Georgia are exceptions with less targeted disability pensions.

Non-Monetary Costs

• Disabled individuals place a greater burden on family caregivers, particularly females and those without tertiary education.
• Time spent on caregiving is significantly higher in Romania (over 80 minutes per day) compared to Estonia, Hungary, and the UK (under 55 minutes per day).
• Urbanization may lead to convergence in caregiving time across countries, as urban areas show patterns closer to those in the Netherlands and the UK.

Disability and Children's Education

• Disabled children are less likely to enroll in school, highlighting the need for renewed focus on their educational outcomes.
• Children's schooling is affected by parental health shocks, with higher dropout rates observed when parents experience health deterioration.

Key Findings

• Disability prevalence is highly dependent on the definition used, with significant variations across countries.
• Employment is not always a protective factor against poverty for the disabled, especially in transition economies.
• Disability benefits are generally well-targeted to the poor, but poor transition countries have lower coverage and less effective targeting.
• Non-monetary costs of disability, such as caregiving time, are significant and vary by country and demographic group.
• Disability and employment are inversely correlated in transition economies, unlike in OECD countries, due to the large informal sector.

Future Research Directions

• Need for better data collection on disability and health status, especially in time-use and household surveys.
• Preventive interventions should be evaluated in terms of their costs and benefits, comparing them to direct and indirect costs of disability.
• Policy implications require further analysis, particularly in relation to social protection programs, training for disabled individuals, and workplace discrimination.
• Disability and education require more attention, especially in rural vs. urban areas, due to varying needs and challenges.
• Social integration and institutional care shortcomings are areas that need more detailed study to inform effective policy responses.

Conclusion

The report emphasizes that disability has profound economic implications, especially in transition economies. It calls for improved data collection, targeted social protection programs, and policies that address the specific challenges faced by disabled individuals and their families. The findings suggest that the poverty-disability relationship is particularly strong in these countries, and that addressing this relationship is essential for achieving equitable and sustainable development.