The increasing life expectancy and the alarming growth in the incidence of chronic illness make long term care services in high demand and in dire need of change and innovation. As part of the ANCIEN initiative, which aims to comprise a database of European approaches for dealing with long term care, this document creates an overview of the health systems organized in Romania which target individuals with long term care needs. The method of governance, the people’s needs and the available services are presented herein.
For the most part, the services provided in this field are covered through the efforts of the family of those in need and are therefore difficult to quantify or analyze. Public services are either insufficient (in terms of quality or accessibility) and the moral stigma associated to using them prevents families from making this choice. However, due to a high demand and a low supply of high quality LTC services, the private market of nursing homes has exploded in the last few years, funded either privately, through NGOs or external donations. The quality and number of available services has greatly improved but the accessibility is still low.
At this moment, Romania still does not have an integrated long term care system neither from the legal or the organization of services being offered. There are social and medical services that are run, provided and legislated independently. The current national strategy is to coordinate these services and to create an integrated system with multidisciplinary teams which would include different types of medical specialists and nurses but still maintain and improve the services offered formally or informally as a home based care package.
Authored by: Daniela Popa
Developing responsive to needs, efficient and sustainable long-term care systems for elderly becomes due to rising demographic pressures an urgent issue all over Europe. Czech Republic is among the countries that have redesigned long-term care system according the principles of accessibility, quality and fiscal tenacity in the past couple of years. The reform process was well rooted in the practice of local governments and social sector empowering institutions that existed before 2006, when the reform was introduced, but were insufficiently anchored in legal regulations. The newly established long term care system covers a wide spectrum of services, from cash benefits to dependent in need via different types of social services and institutional care. Still, similarly to other countries of the Central and Eastern Europe region long care is disintegrated between the social system and health care which also is responsible for some types of institutional establishments. The system is also not free from critique for the lack of formal definition of long term care, lack of integration of services, their shortage and poor quality. Thus despite state efforts, the care over elderly remains family responsibility and state support is not always sufficient.
Authored by: Agnieszka Sowa
Published in 2010
RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized
Rashtriya Swasthya Bima Yojana – Performance Trends and Policy RecommendationsCIRM
India is characterized by modest health indicators, a paucity of medical financing schemes that have reached scale, high per capita out-of-pocket health expenditure, and very low public health spending on low-income citizens. The lack of financing options especially when the population is facing a double burden of disease (frequent communicable and catastrophic lifestyle diseases) leads to poor health outcomes and to poverty traps. Hence, optimal public health financing is important for improving national health outcomes and reducing vulnerability.
Valerie Davidson, vice president of the Alaska Native Health Consortium, provides an overview of Federal Health Reform and the Indian Health Care Improvement Act and its potential impact the Native health system. The presentation was presented at the Sept. 2, 2010 Alaska Health Provider Forum.
Developing responsive to needs, efficient and sustainable long-term care systems for elderly becomes due to rising demographic pressures an urgent issue all over Europe. Czech Republic is among the countries that have redesigned long-term care system according the principles of accessibility, quality and fiscal tenacity in the past couple of years. The reform process was well rooted in the practice of local governments and social sector empowering institutions that existed before 2006, when the reform was introduced, but were insufficiently anchored in legal regulations. The newly established long term care system covers a wide spectrum of services, from cash benefits to dependent in need via different types of social services and institutional care. Still, similarly to other countries of the Central and Eastern Europe region long care is disintegrated between the social system and health care which also is responsible for some types of institutional establishments. The system is also not free from critique for the lack of formal definition of long term care, lack of integration of services, their shortage and poor quality. Thus despite state efforts, the care over elderly remains family responsibility and state support is not always sufficient.
Authored by: Agnieszka Sowa
Published in 2010
RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized
Rashtriya Swasthya Bima Yojana – Performance Trends and Policy RecommendationsCIRM
India is characterized by modest health indicators, a paucity of medical financing schemes that have reached scale, high per capita out-of-pocket health expenditure, and very low public health spending on low-income citizens. The lack of financing options especially when the population is facing a double burden of disease (frequent communicable and catastrophic lifestyle diseases) leads to poor health outcomes and to poverty traps. Hence, optimal public health financing is important for improving national health outcomes and reducing vulnerability.
Valerie Davidson, vice president of the Alaska Native Health Consortium, provides an overview of Federal Health Reform and the Indian Health Care Improvement Act and its potential impact the Native health system. The presentation was presented at the Sept. 2, 2010 Alaska Health Provider Forum.
PowerPoint Presentation giving a brief history of care and support and the context for the current changes to the social care system. Presentations was delivered by Simon Medcalf and Kevin Kitching at the 'Personalisation and the Care Act consultation events' hosted by TLAP, Department of Health, the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on Monday 21st July 2014 in London and 23 July 2014 in Manchester.
Simon Medcalf is Deputy Director of Social Care Policy and Legislation at Department of Health and Kevin Kitching is Personalisation Policy Manager Social Care, Local Government and Care Partnerships Directorate at Department of Health.
Dr azilina 1 care for ph conference 12july2011 11july 2011EyesWideOpen2008
Slide 18 shows the implementation process of 1Care. In phases 1 to 3 the name 1Care doesn't even appear but it is part of the process.
The MOH Deputy Director General, Datuk Dr Noor Hisham Abdullah has confirmed that 1Care is currently in phase 1 & 2 of implementation.
Presentation on the Informatics contribution in social care by Terry Dafter, Director of Adult Social Care Stockport at Metropolitan Borough Council and Chair of ADASS IMG. Presented at the Local-Central Discovery Day on the Impacts of the Care Act in Leeds on 29 July 2014.
In the field of social protection, Poland belongs to the EU group of countries with the familybased welfare model, what is extremely visible for the long-term care where family is the main care provider for elderly individuals with limitations in activities of daily living. At the same time the proportion of elderly in the coming decades is projected to be among the highest in the European Union, what raises questions on the design of the long-term care. For the moment the system is highly unregulated and disintegrated between social assistance and health care services. But it is the health sector that concentrates policy debate with a proposal of an introduction of nursing insurance. In the social sector, the significant changes that were favorable to LTC services development were introduced by the
law on the social assistance (2004) and family benefits (2003) widening the scope of care available at home and in adult day care centers. But still provision of services is insufficient and a market of private services, paid out-of-pocket rapidly develops. It seems that main problems of the long-term care development in the future will be raising demand against insufficient resources and diversified priorities of the health care system.
Authored by: Stanislawa Golinowska
Published in 2010
PowerPoint Presentation giving a brief history of care and support and the context for the current changes to the social care system. Presentations was delivered by Simon Medcalf and Kevin Kitching at the 'Personalisation and the Care Act consultation events' hosted by TLAP, Department of Health, the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) on Monday 21st July 2014 in London and 23 July 2014 in Manchester.
Simon Medcalf is Deputy Director of Social Care Policy and Legislation at Department of Health and Kevin Kitching is Personalisation Policy Manager Social Care, Local Government and Care Partnerships Directorate at Department of Health.
Dr azilina 1 care for ph conference 12july2011 11july 2011EyesWideOpen2008
Slide 18 shows the implementation process of 1Care. In phases 1 to 3 the name 1Care doesn't even appear but it is part of the process.
The MOH Deputy Director General, Datuk Dr Noor Hisham Abdullah has confirmed that 1Care is currently in phase 1 & 2 of implementation.
Presentation on the Informatics contribution in social care by Terry Dafter, Director of Adult Social Care Stockport at Metropolitan Borough Council and Chair of ADASS IMG. Presented at the Local-Central Discovery Day on the Impacts of the Care Act in Leeds on 29 July 2014.
In the field of social protection, Poland belongs to the EU group of countries with the familybased welfare model, what is extremely visible for the long-term care where family is the main care provider for elderly individuals with limitations in activities of daily living. At the same time the proportion of elderly in the coming decades is projected to be among the highest in the European Union, what raises questions on the design of the long-term care. For the moment the system is highly unregulated and disintegrated between social assistance and health care services. But it is the health sector that concentrates policy debate with a proposal of an introduction of nursing insurance. In the social sector, the significant changes that were favorable to LTC services development were introduced by the
law on the social assistance (2004) and family benefits (2003) widening the scope of care available at home and in adult day care centers. But still provision of services is insufficient and a market of private services, paid out-of-pocket rapidly develops. It seems that main problems of the long-term care development in the future will be raising demand against insufficient resources and diversified priorities of the health care system.
Authored by: Stanislawa Golinowska
Published in 2010
The aim of this paper is to identify patterns of utilization of formal and informal long term care (LTC) across European countries and discuss possible determinants of demand for different types of care. Specific research questions are of the volume of different types of care and conditions under which care is undertaken. The latter include demographic factors, especially ageing of the society, health status and limitations caused by poor health, family settings and social networking. The analysis indicates substantial differences in obtaining LTC across European countries depending on the tradition and social protection model that determine availability of institutional care and provision of informal care. In the Nordic-type countries with high state responsibility and high provision of institutional care, informal care is of less importance and - if received - it is mostly care provided from on irregular basis from outside the family. With growing needs for care, formal settings come in. Countries of the continental Europe are less unified with high share of people using formal settings of care, but also combining formal and informal care. In Mediterranean countries provision of informal care, including personal care, plays much greater role than formal LTC.
Authored by: Agnieszka Sowa, Izabela Styczynska
Published in 2011
Long-term care (LTC) in the new EU member states, which used to belong to the former socialist countries, is not yet a legally separated sector of social security. However, the ageing dynamics are more intensive in these states than in the old EU member states. This paper analyses the process of creating an LTC sector in the context of institutional reforms of social protection systems during the transition period. The authors explain LTC’s position straddling the health and social sectors, the underdevelopment of formal LTC, and the current policies regarding the risk of LTC dependency. The paper is based mainly on the analysis of information provided by country experts in the ANCIEN project.
Authored by: Stanislawa Golinowska and Agnieszka Sowa
Published in 2013
Roadmap to Develop and Implement the Basic Health Service Package Paid by Hea...HFG Project
The roadmap is a legal document guiding the development process of Basic Health Service Package (BHSP) paid by health insurance, identifying the involvement, coordination and cooperation mechanisms of stakeholders. The main content of the roadmap is to: Define goals, including general and specific objectives for each phase; analyze the situation and the challenges in developing the package, principles and solutions to achieve the identified goals, phases of the roadmap (timelines and objectives to be achieved), organization and roles of stakeholders.
Presentation giving an overview of the Care Bill and the upcoming consultation. Presented on 2 May 2014 by Simon Medcalf, Deputy Director Social Care Policy and Legislation at the Department of Health at the Local-Central Government Discovery Day on the Impact of the Care Bill hosted by the Department for Communities and Local Government.
Chapter 30 International Efforts, Issues, and InnovationsHyeoun-.docxchristinemaritza
Chapter 30 International Efforts, Issues, and Innovations
Hyeoun-Ae Park
To promote international development in health and nursing informatics it is necessary to provide tools for the development of national and regional ehealth initiatives and strategies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Outline key international health informatics initiatives
2.Describe key organizations leading international health informatics initiatives
3.Discuss the role of health practitioners such as nurses in international health informatics initiatives
Key Terms
Derived classifications, 482
eHealth initiatives, 474
Reference classifications, 482
Related classifications, 482
Abstract
This chapter highlights international health informatics initiatives, international organizations involved in these initiatives, and how health practitioners such as nurses are involved in the activities of these organizations. There are numerous international health informatics–related activities that have been initiated across the different regions of the world. In addition academic societies within these regions are pursuing health informatics theory and practice developments. These international health informatics initiatives, along with associated academic organizations, are introduced here with brief histories and the key activities of each region. There are also several international organizations involved in the development of health informatics, such as the World Health Organization, the International Medical Informatics Association, the International Organization for Standardization, the International Council of Nurses, the International Health Terminology Standards Development Organisation, and Health Level Seven. These organizations are introduced with a short description of health practitioners' contributions to their activities. Finally, global issues in health informatics initiatives are also described.
Introduction
In many parts of the world healthcare is one of the largest sectors of the economy. As a result, health spending plays a major role in economic policy throughout the world with growing pressure on the healthcare industry to streamline costs, gain efficiency, and become more innovative in improving and maintaining the health of the population. Today the health industry around the world is looking for better ways of providing healthcare and improved health for all. The application of health information technology (health IT), called information and communication technology or ICT in international settings, to healthcare is seen as key to realizing this aim. The World Health Organization (WHO) uses ehealth as an umbrella term to cover all aspects of the use of ICT in healthcare. While the terminology differs—from health IT to ICT to ehealth—the goal of using technology to effectively and efficiently improve the health of individuals, families, and communities remains the same. An important differenc ...
Personal Health Systems: State-of-the-ArtTotti Könnölä
This report takes stock on the wide range of initiatives in the area of PHS. We examine the PHS research, innovation and policy areas to attain deeper understanding of mismatches between the potential of, and need for, PHS, and current policy and innovation initiatives and framework conditions. As this report is to be considered a working document the findings and statements here have to be considered preliminary and subject for discussion between the European Commission, the PHS stakeholders and the PHS Foresight consortium.
Join the conversion in our website: www.phsforesight.eu and send us feedback to info(at)phsforesight.eu.
In countries of Western Balkan situation concerning social protection and development of social services is
similar. Legal framework is developed, or is developing with the intention to create environment for decentralized
provision and financing of social services, developed in line with the needs of beneficiaries. In all the countries,
there is a need for improvement of policy framework in this area, particularly in context of making social services
accessible for all vulnerable groups in need.
The report examines the social and economic drivers and impact of circular migration between Belarus and Poland, Slovakia, and the Czech Republic. The core question the authors sought to address was how managing circular migration could, in the long term, help to optimise labour resources in both the country of origin and the destination countries. In the pages that follow, the authors of the report present the current and forecasted labour market and demographic situation in their respective countries as well as the dynamics and characteristics of short-term labour migration flows between Belarus and Poland, Slovakia, and the Czech Republic, concentrating on the period since 2010. They also outline and discuss related policy responses and evaluate prospects for cooperation on circular migration.
Podręcznik został opracowany w celu przekazania trenerom i nauczycielom podstawowej wiedzy, która może być przydatna w prowadzeniu szkoleń promujących pracę rejestrowaną. Prezentuje on z jednej strony korzyści z pracy rejestrowanej, z drugiej – potencjalne koszty związane z pracą nierejestrowaną. W pierwszej kolejności informacje te przedstawiono w odniesieniu do pracowników najemnych (rozdział 2), podkreślając w sposób szczególny to, że negatywne konsekwencje pracy nierejestrowanej są ponoszone przez całe życie. Ze względu na specyficzną sytuację cudzoziemców pracujących w Polsce konsekwencje ponoszone przez tę grupę opisano oddzielnie (rozdział 3). Ponadto zaprezentowano skutki dotyczące pracodawców z szarej strefy z wyodrębnieniem tych, którzy zatrudniają cudzoziemców (rozdział 4). Uzupełnieniem przedstawionych informacji jest opis działań podejmowanych przez państwo w celu ograniczenia zjawiska pracy nierejestrowanej w Polsce (rozdział 5) oraz prowadzonych w Wielkiej Brytanii, czyli w kraju będącym liderem w walce z szarą strefą (rozdział 6).
European countries face a challenge related to the economic and social consequences of their societies’ aging. Specifically, pension systems must adjust to the coming changes, maintaining both financial stability, connected with equalizing inflows from premiums and spending on pensions, and simultaneously the sufficiency of benefits, protecting retirees against poverty and smoothing consumption over their lives, i.e. ensuring the ability to pay for consumption needs at each stage of life, regardless of income from labor.
One of the key instruments applied toward these goals is the retirement age. Formally it is a legally established boundary: once people have crossed it – on average – they significantly lose their ability to perform work (the so-called old-age risk). But since the 1970s, in many developed countries the retirement age has become an instrument of social and labor-market policy. Specifically, in the 1970s and ‘80s, an early retirement age was perceived as a solution allowing a reduction in the supply of labor, particularly among people with relatively low competencies who were approaching retirement age, which is called the lump of labor fallacy. It was often believed that people taking early retirement freed up jobs for the young. But a range of economic evidence shows that the number of jobs is not fixed, and those who retire don’t in fact free up jobs. On the contrary, because of higher spending by pension systems, labor costs rise, which limits the supply of jobs. In general, a good situation on the labor market supports employment of both the youngest and the oldest labor force participants. Additionally, a lower retirement age for women was maintained, which resulted to a high degree from cultural conditions and norms that are typical for traditional societies.
Until now, the banking sector has been one of the strong points of Poland’s economy. In contrast to banks in the U.S. and leading Western European economies, lenders in Poland came through the 2008 global financial crisis without a scratch, without needing state financial support. But in recent years the industry’s problems have been growing, creating a threat to economic growth and gains in living standards.
For an economy’s productivity to increase, funds can’t go to all companies evenly, and definitely shouldn’t go to those that are most lacking in funds, but to those that will use them most efficiently. This is true of total external financing, and thus funding both from the banking sector and from parabanks, the capital market and funds from public institutions. In Poland, in light of the relatively modest scale of the capital market, banks play a clearly dominant role in external financing of companies. This is why the author of this text focuses on the bank credit allocation efficiency.
The author points out that in the very near future, conditions will emerge in Poland which – as the experience of other countries shows – create a risk of reduced efficiency of credit allocation to business. Additionally, in Poland today, bank lending to companies is to a high degree being replaced by funds from state aid, which reduces the efficiency of allocation of external funds to companies (both loans and subsidies), as allocation of government subsidies is not usually based on efficiency. This decline in external financing allocation efficiency may slow, halt or even reverse the process, that has been uninterrupted for 28 years, of Poland’s convergence, i.e. the narrowing of the gap in living standards between Poland and the West.
The economic characteristics of the COVID-19 crisis differ from those of previous crises. It is a combination of demand- and supply-side constraints which led to the formation of a monetary overhang that will be unfrozen once the pandemic ends. Monetary policy must take this effect into consideration, along with other pro-inflationary factors, in the post-pandemic era. It must also think in advance about how to avoid a policy trap coming from fiscal dominance.
This paper is organized as follows: Chapter 2 deals with the economic characteristics of the COVID-19 pandemic and its impact on the effectiveness of the monetary policy response measures undertaken. In Chapter 3, we analyse the monetary policy decisions of the ECB (and other major CBs for comparison) and their effectiveness in achieving the declared policy goals in the short term. Chapter 4 is devoted to an analysis of the policy challenges which may be faced by the ECB and other major CBs once the pandemic emergency comes to its end. Chapter 5 contains a summary and the conclusions of our analysis.
Purpose: This paper tries to identify the wage gap between informal and formal workers and tests for the two-tier structure of the informal labour market in Poland.
Design/methodology/approach: I employ the propensity score matching (PSM) technique and use data from the Polish Labour Force Survey (LFS) for the period 2009–2017 to estimate the wage gap between informal and formal workers, both at the means and along the wage distribution. I use two definitions of informal employment: a) employment without a written agreement and b) employment while officially registered as unemployed at a labour office. In order to reduce the bias resulting from the non-random selection of
individuals into informal employment, I use a rich set of control variables representing several individual characteristics.
Findings: After controlling for observed heterogeneity, I find that on average informal workers earn less than formal workers, both in terms of monthly earnings and hourly wage. This result is not sensitive to the definition of informal employment used and is
stable over the analysed time period (2009–2017). However, the wage penalty to informal employment is substantially higher for individuals at the bottom of the wage distribution, which supports the hypothesis of the two-tier structure of the informal labour market in Poland.
Originality/value: The main contribution of this study is that it identifies the two-tier structure of the informal labour market in Poland: informal workers in the first quartile of the wage distribution and those above the first quartile appear to be in two partially different segments of the labour market.
The rule of law, by securing civil and economic rights, directly contributes to social prosperity and is one of our societies’ greatest achievements. In the European Union (EU), the rule of law is enshrined in the Treaties of its founding and is recognised not just as a necessary condition of a liberal democratic society, but also as an important requirement for a stable, effective, and sustainable market economy. In fact, it was the stability and equality of opportunity provided by the rule of law that enabled the post-war Wirtschaftswunder in Germany and the post-Communist resuscitation of the economy in Poland.
But the rule of law is a living concept that is constantly evolving – both in its formal, de jure dimension, embodied in legislation, and its de facto dimension, or its reception by society. In Poland, in particular, according to the EU, the rule of law has been heavily challenged by government since 2015 and has evolved amid continued pressure exerted on the institutions which execute laws. More recently, the outbreak of the COVID-19 pandemic transformed the perception of the rule of law and its boundaries throughout the EU and beyond (Marzocchi, 2020).
This Study contains Value Added Tax (VAT) Gap estimates for 2018, fast estimates using a simplified methodology for 2019, the year immediately preceding the analysis, and includes revised estimates for 2014-2017. It also includes the updated and extended results of the econometric analysis of VAT Gap determinants initiated and initially reported in the 2018 Report (Poniatowski et al., 2018). As a novelty, the econometric analysis to forecast potential impacts of the coronavirus crisis and resulting recession on the evolution of the VAT Gap in 2020 is reported.
In 2018, most European Union (EU) Member States (MS) saw a slight decrease in the pace of gross domestic product (GDP) growth, but the economic conditions for increasing tax compliance remained favourable. We estimate that the VAT total tax liability (VTTL) in 2018 increased by 3.6 percent whereas VAT revenue increased by 4.2 percent, leading to a decline in the VAT Gap in both relative and nominal terms. In relative terms, the EU-wide Gap dropped to 11 percent and EUR 140 billion. Fast estimates show that the VAT Gap will likely continue to decline in 2019.
Of the EU-28, the smallest Gaps were observed in Sweden (0.7 percent), Croatia (3.5 percent), and Finland (3.6 percent), the largest – in Romania (33.8 percent), Greece (30.1 percent), and Lithuania (25.9 percent). Overall, half of the EU-28 MS recorded a Gap above 9.2 percent. In nominal terms, the largest Gaps were recorded in Italy (EUR 35.4 billion), the United Kingdom (EUR 23.5 billion), and Germany (EUR 22 billion).
The euro is the second most important global currency after the US dollar. However, its international role has not increased since its inception in 1999. The private sector prefers using the US dollar rather than the euro because the financial market for US dollar-denominated assets is larger and deeper; network externalities and inertia also play a role. Increasing the attractiveness of the euro outside the euro area requires, among others, a proactive role for the European Central Bank and completing the Banking Union and Capital Market Union.
Forecasting during a strong shock is burdened with exceptionally high uncertainty. This gives rise to the temptation to formulate alarmist forecasts. Experiences from earlier pandemics, particularly those from the 20th century, for which we have the most data, don’t provide a basis for this. The mildest of them weakened growth by less than 1 percentage point, and the worst, the Spanish Flu, by 6 percentage points. Still, even the Spanish Flu never caused losses on the order of 20% of GDP – not even where it turned out to be a humanitarian disaster, costing the lives of 3-5% of the population. History suggests that if pandemics lead to such deep losses at all, it’s only in particular quarters and not over a whole year, as economic activity rebounds. The strength of that rebound is largely determined by economic policy. The purpose of this work is to describe possible scenarios for a rebound in Polish economic growth after the epidemic.
A separate issue, no less important, is what world will emerge from the current crisis. In the face of the 2008 financial crisis, White House Chief of Staff Rahm Emanuel said: “You never want a serious crisis to go to waste. And what I mean by that is an opportunity to do things that you think you could not do before.” Such changes can make the economy and society function better than before the crisis. Unfortunately, the opportunities created by the global financial crisis were squandered. Today’s task is more difficult; the scale of various problems has expanded even more. Without deep structural and institutional changes, the world will be facing enduring social and economic problems, accompanied by long-term stagnation.
"Many brilliant prophecies have appeared for the future of the EU and our entire planet. I believe that Europe, in its own style, will draw pragmatic conclusions from the crisis, not revolutionary ones; conclusions that will allow us to continue enjoying a Europe without borders. Brussels will demonstrate its usefulness; it will react ably and flexibly. First of all, contrary to the deceitful statements of members of the Polish government, the EU warned of the threats already in 2021. Secondly, already in mid-March EU assistance programs were ready, i.e. earlier than the PiS government’s “shield” program. The conclusion from the crisis will be a strengthening of all the preventive mechanisms that allow us to recognize threats and react in time of need. Research programs will be more strongly directed toward diagnosing and treating infectious diseases. Europe will gain greater self-sufficiency in the area of medical equipment and drugs, and the EU – greater competencies in the area of the health service, thus far entrusted to the member states. The 2021-27 budget must be reconstructed, to supplement the priority of the Green Deal with economic stimulus programs. In this way structural funds, which have the greatest multiplier effect for investment and the labor market, may return to favor. So once again: an addition, as a conclusion from the crisis, and not a reinvention of the EU," writes Dr. Janusz Lewandowski the author of the 162nd mBank-CASE seminar Proceeding.
Dla wielu rodaków europejskość Polski jest oczywista, trudno jest im nawet wyobrazić sobie, jak kształtowałyby się losy naszego kraju bez uczestnictwa w integracji europejskiej. Szczególnie młode pokolenie traktuje osiągnięty przez nas dzięki uczestnictwie w Unii ogromny postęp cywilizacyjny jako coś danego i naturalnego. Jednak świadomość tego, jaki był nasz punkt wyjścia, jaką przeszliśmy drogę i jak przyczyniły się do tego unijne działania oraz jakie wynikały z tego korzyści powinna nam stale towarzyszyć. Bez tej świadomości, starannego weryfikowania faktów i docenienia naszych osiągnięć grozi nam uleganie niesprawdzonym argumentom przeciwników integracji europejskiej i popełnienie nieodwracalnych błędów. Dla tych, którzy chcą poznać te fakty, przygotowany został raport "Nasza Europa. 15 lat Polski w Unii Europejskiej". Podjęto w nim ocenę 15 lat członkostwa Polski z perspektywy doświadczeń procesu integracji, z jego barierami i sukcesami, a także wyzwaniami przyszłości.
Raport jest wynikiem pracy zbiorowej licznych ekspertów z różnych dziedzin, od wielu lat analizujących wielowymiarowe efekty działania instytucji UE oraz współpracy z krajami członkowskimi na podstawie europejskich wartości i mechanizmów. Autorzy podsumowują korzyści członkostwa Polski w Unii Europejskiej na podstawie faktów, nie stroniąc jednakże od własnych ocen i refleksji.
This report is the result of the joint work of a number of experts from various fields who have been - for many years – analysing the multidimensional effects of EU institutions and cooperation with Member States pursuant to European values and mechanisms. The authors summarise the benefits of Poland’s membership in the EU based on facts; however, they do not hide their own views and reflections. They also demonstrate the barriers and challenges to further European integration.
This report was prepared by CASE, one of the oldest independent think tanks in Central and Eastern Europe, utilising its nearly 30 years of experience in providing objective analyses and recommendations with respect to socioeconomic topics. It is both an expression of concern about Poland’s future in the EU, as well as the authors’ contribution to the debate on further European integration.
Poland’s new Employee Capital Plans (PPK) scheme, which is mandatory for employers, started to be implemented in July 2019. The article looks at the systemic solutions applied in the programme from the perspective of the concept of the simultaneous reconstruction of the retirement pension system. The aim is to present arguments for and against the project from the point of view of various actors, and to assess the chances of success for the new system. The article offers a detailed study of legal solutions, an analysis of the literature on the subject, and reports of institutions that supervise pension funds. The results of this analysis point to the lack of cohesion between certain solutions of the 1999 pension reform and expose a lack of consistency in how the reform was carried out, which led to the eventual removal of the capital part of the pension system. The study shows that additional saving for old age is advisable in the country’s current demographic situation and necessary for both economic and social reasons. However, the systemic solutions offered by the government appear to be chiefly designated to serve short-term state interests and do not create sufficient incentives for pension plan participants to join the programme.
Belarus was among the few post-communist countries to resign from comprehensive market reforms and attempt to improve the efficiency of the economy through administrative means, leaving market mechanisms only an auxiliary role. Since its inception, the ‘Belarusian economic model’ has undergone several revisions of a de-statisation and de-regulation kind, but still the Belarusian economy remains dominated by the state. This paper analyses the characteristic features of the Belarusian economic system – especially those related to the public sector – as well as its evolution over time during the period following its independence. The paper concludes that during the post-Soviet period, the Belarusian economy evolved from a quasi-Soviet system based on state property, state planning, support to inefficient enterprises and the massive redistribution of funds to a more flexible hybrid model where the public sector still remains the core of the economy. The case of Belarus shows that presently there is no appropriate theoretical perspective which, in an unmodified form, could be applied to study this type of economic system. Therefore, a new perspective based on an already existing but updated approach or a multidisciplinary approach that incorporates the duality of the Belarusian economy is required.
Belarusian economy has been stagnating in 2011-2015 after 15 years of a high annual average growth rate. In 2015, after four years of stagnation, the Belarusian economy slid into a recession, its first since 1996, and experienced both cyclical and structural recessions. Since 2015, the Belarusian government and the National Bank of Belarus have been giving economic reforms a good chance thanks to gradual but consistent actions aimed at maintaining macroeconomic stability and economic liberalization. It seems that the economic authorities have sustained more transformation efforts during 2015-2018 than in the previous 24 years since 1991.
As the relative welfare level in Belarus is currently 64% compared to the Central and Eastern Europe (CEE) countries average, Belarus needs to build stronger fundaments of sustainable growth by continuing and accelerating the implementation of institutional transformation, primarily by fostering elimination of existing administrative mechanisms of inefficient resource allocation. Based on the experience of the CEE countries’ economic transformation, we highlight five lessons for the purpose of the economic reforms that Belarus still faces today: keeping macroeconomic stability, restructuring and improving the governance of state-owned enterprises, developing the financial market, increasing taxation efficiency, and deepening fiscal decentralization.
Inflation in advanced economies is low by historical standards but there is no threat of deflation. Slower economic growth is caused by supply-side constraints rather than low inflation. Below-the-target inflation does not damage the reputation of central banks. Thus, central banks should not try to bring inflation back to the targeted level of 2%. Rather, they should revise the inflation target downwards and publicly explain the rationale for such a move. Risks to the independence of central banks come from their additional mandates (beyond price stability) and populist politics.
Estonia has Europe’s most transparent tax system (while Poland is second-to-last, in 35th place), and is also known for its pioneering approach to taxation of legal persons’ income. Since 2000, payers of Estonian corporate tax don’t pay tax on their profits as long as they don’t realize them. In principle, this approach should make access to capital easier, spark investment by companies and contribute to faster economic growth. Are these and other positive effects really noticeable in Estonia? Have other countries followed in this country’s footsteps? Would deferment of income tax be possible and beneficial for Poland? How would this affect revenue from tax on corporate profits? Would investors come to see Poland as a tax haven? Does the Estonian system limit tax avoidance and evasion, or actually the opposite? Is such a system fair? Are intermediate solutions possible, which would combine the strengths or limit the weaknesses of the classical and Estonian models of profit tax? These questions are discussed in the mBank-CASE seminar Proceeding no. 163, written by Dmitri Jegorov, deputy general secretary of the Estonian Finance Ministry, who directs the country’s tax and customs policy, Dr. Anna Leszczyłowska of the Poznań University of Economics and Business and Aleksander Łożykowski of the Warsaw School of Economics.
The trade war between the U.S. and China began in March 2018. The American side raised import duties on aluminum and steel from China, which were later extended to other countries, including Canada, Mexico and the EU member states. This drew a negative reaction from those countries and bilateral negotiations with the U.S. In June 2018 America, referring to Section 301 of its 1974 Trade Act, raised tariffs to 25% on 818 groups of products imported from China, arguing that the tariff increase was a response to years of theft of American intellectual property and dishonest trade practices, which has caused the U.S. trade deficit.
Will this trade war mean the collapse of the multilateral trading system and a transition to bilateral relationships? What are the possibilities for increasing tariffs in light of World Trade Organization rules? Can the conflict be resolved using the WTO dispute-resolution mechanism? What are the consequences of the trade war for American consumers and producers, and for suppliers from other countries? How high will tariffs climb as a result of a global trade war? How far can trade volumes and GDP fall if the worst-case scenario comes to pass? Professor Jan J. Michałek and Dr. Przemysław Woźniak give answers to these questions in the mBank-CASE Seminar Proceeding No. 161.
This Report has been prepared for the European Commission, DG TAXUD under contract TAXUD/2017/DE/329, “Study and Reports on the VAT Gap in the EU-28 Member States” and serves as a follow-up to the six reports published between 2013 and 2018.
This Study contains new estimates of the Value Added Tax (VAT) Gap for 2017, as well as updated estimates for 2013-2016. As a novelty in this series of reports, so called “fast VAT Gap estimates” are also presented the year immediately preceding the analysis, namely for 2018. In addition, the study reports the results of the econometric analysis of VAT Gap determinants initiated and initially reported in the 2018 Report (Poniatowski et al., 2018). It also scrutinises the Policy Gap in 2017 as well as the contribution that reduced rates and exemptions made to the theoretical VAT revenue losses.
More from CASE Center for Social and Economic Research (20)
Even tho Pi network is not listed on any exchange yet.
Buying/Selling or investing in pi network coins is highly possible through the help of vendors. You can buy from vendors[ buy directly from the pi network miners and resell it]. I will leave the telegram contact of my personal vendor.
@Pi_vendor_247
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
Lecture slide titled Fraud Risk Mitigation, Webinar Lecture Delivered at the Society for West African Internal Audit Practitioners (SWAIAP) on Wednesday, November 8, 2023.
Seminar: Gender Board Diversity through Ownership NetworksGRAPE
Seminar on gender diversity spillovers through ownership networks at FAME|GRAPE. Presenting novel research. Studies in economics and management using econometrics methods.
how to sell pi coins in all Africa Countries.DOT TECH
Yes. You can sell your pi network for other cryptocurrencies like Bitcoin, usdt , Ethereum and other currencies And this is done easily with the help from a pi merchant.
What is a pi merchant ?
Since pi is not launched yet in any exchange. The only way you can sell right now is through merchants.
A verified Pi merchant is someone who buys pi network coins from miners and resell them to investors looking forward to hold massive quantities of pi coins before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
Currently pi network is not tradable on binance or any other exchange because we are still in the enclosed mainnet.
Right now the only way to sell pi coins is by trading with a verified merchant.
What is a pi merchant?
A pi merchant is someone verified by pi network team and allowed to barter pi coins for goods and services.
Since pi network is not doing any pre-sale The only way exchanges like binance/huobi or crypto whales can get pi is by buying from miners. And a merchant stands in between the exchanges and the miners.
I will leave the telegram contact of my personal pi merchant. I and my friends has traded more than 6000pi coins successfully
Tele-gram
@Pi_vendor_247
USDA Loans in California: A Comprehensive Overview.pptxmarketing367770
USDA Loans in California: A Comprehensive Overview
If you're dreaming of owning a home in California's rural or suburban areas, a USDA loan might be the perfect solution. The U.S. Department of Agriculture (USDA) offers these loans to help low-to-moderate-income individuals and families achieve homeownership.
Key Features of USDA Loans:
Zero Down Payment: USDA loans require no down payment, making homeownership more accessible.
Competitive Interest Rates: These loans often come with lower interest rates compared to conventional loans.
Flexible Credit Requirements: USDA loans have more lenient credit score requirements, helping those with less-than-perfect credit.
Guaranteed Loan Program: The USDA guarantees a portion of the loan, reducing risk for lenders and expanding borrowing options.
Eligibility Criteria:
Location: The property must be located in a USDA-designated rural or suburban area. Many areas in California qualify.
Income Limits: Applicants must meet income guidelines, which vary by region and household size.
Primary Residence: The home must be used as the borrower's primary residence.
Application Process:
Find a USDA-Approved Lender: Not all lenders offer USDA loans, so it's essential to choose one approved by the USDA.
Pre-Qualification: Determine your eligibility and the amount you can borrow.
Property Search: Look for properties in eligible rural or suburban areas.
Loan Application: Submit your application, including financial and personal information.
Processing and Approval: The lender and USDA will review your application. If approved, you can proceed to closing.
USDA loans are an excellent option for those looking to buy a home in California's rural and suburban areas. With no down payment and flexible requirements, these loans make homeownership more attainable for many families. Explore your eligibility today and take the first step toward owning your dream home.
The secret way to sell pi coins effortlessly.DOT TECH
Well as we all know pi isn't launched yet. But you can still sell your pi coins effortlessly because some whales in China are interested in holding massive pi coins. And they are willing to pay good money for it. If you are interested in selling I will leave a contact for you. Just telegram this number below. I sold about 3000 pi coins to him and he paid me immediately.
Telegram: @Pi_vendor_247
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
Abhay Bhutada Leads Poonawalla Fincorp To Record Low NPA And Unprecedented Gr...Vighnesh Shashtri
Under the leadership of Abhay Bhutada, Poonawalla Fincorp has achieved record-low Non-Performing Assets (NPA) and witnessed unprecedented growth. Bhutada's strategic vision and effective management have significantly enhanced the company's financial health, showcasing a robust performance in the financial sector. This achievement underscores the company's resilience and ability to thrive in a competitive market, setting a new benchmark for operational excellence in the industry.
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
how can i use my minded pi coins I need some funds.DOT TECH
If you are interested in selling your pi coins, i have a verified pi merchant, who buys pi coins and resell them to exchanges looking forward to hold till mainnet launch.
Because the core team has announced that pi network will not be doing any pre-sale. The only way exchanges like huobi, bitmart and hotbit can get pi is by buying from miners.
Now a merchant stands in between these exchanges and the miners. As a link to make transactions smooth. Because right now in the enclosed mainnet you can't sell pi coins your self. You need the help of a merchant,
i will leave the telegram contact of my personal pi merchant below. 👇 I and my friends has traded more than 3000pi coins with him successfully.
@Pi_vendor_247
3. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
2
Contents
Abstract ...........................................................................................................................................4
1. The long term care system in Romania.................................................................................5
1.1. Overview of the system....................................................................................................5
1.2. Assessment of needs.......................................................................................................6
1.3. Available LTC services.....................................................................................................7
1.4. Management and organisation..........................................................................................8
1.5. Integration of LTC.............................................................................................................9
2. Funding .....................................................................................................................................10
3. Demand and supply of ltc .....................................................................................................13
3.1. The need for LTC...............................................................................................................13
3.2. The role of informal and formal care in the LTC system (including the role of cash
benefits).....................................................................................................................................15
3.3. Demand and supply of informal care ...........................................................................15
3.4. Demand and supply of formal care...............................................................................16
4. Ltc policy...................................................................................................................................18
4.1. Policy goals .......................................................................................................................18
4.2. Integration policy ..............................................................................................................19
4.3. Recent reforms and current policy debate ....................................................................19
4.4. Critical appraisal of the LTC system ..............................................................................19
References ....................................................................................................................................21
4. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
Daniela Popa has completed her formal education in general medicine in Romania at the Victor
Babes University of Medicine and Pharmacy Timisoara, from which she holds a medical doctor
degree. She started her residency in family medicine in Romania, which was interrupted in 2008
when she moved to the Netherlands and changed her focus to public health issues. There she
completed a master of science in public health, specialized in health services innovations at
Maastricht University. In 2009 she collaborated with CASE on the ANCIEN project for which she
performed an elaborate overview of long term care services offered in Romania. Since 2010 she
has taken on the position of lecturer and placement coordinator for the European Public Health
bachelor and master program at Maastricht University. She is passionate about improving health
systems, creating awareness of one's inner ability to heal and empowering individuals to take
responsibility for their own mental and physical health.
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5. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
4
Abstract
The increasing life expectancy and the alarming growth in the incidence of chronic illness make
long term care services in high demand and in dire need of change and innovation. As part of
the ANCIEN initiative, which aims to comprise a database of European approaches for dealing
with long term care, this document creates an overview of the health systems organized in
Romania which target individuals with long term care needs. The method of governance, the
people’s needs and the available services are presented herein.
For the most part, the services provided in this field are covered through the efforts of the family
of those in need and are therefore difficult to quantify or analyze. Public services are either
insufficient (in terms of quality or accessibility) and the moral stigma associated to using them
prevents families from making this choice. However, due to a high demand and a low supply of
high quality LTC services, the private market of nursing homes has exploded in the last few
years, funded either privately, through NGOs or external donations. The quality and number of
available services has greatly improved but the accessibility is still low.
At this moment, Romania still does not have an integrated long term care system neither from
the legal or the organization of services being offered. There are social and medical services
that are run, provided and legislated independently. The current national strategy is to
coordinate these services and to create an integrated system with multidisciplinary teams which
would include different types of medical specialists and nurses but still maintain and improve the
services offered formally or informally as a home based care package.
6. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
1. The long term care system in Romania
1.1. Overview of the system
The long term care (LTC) system in Romania includes all medical and social services delivered
over a long period of time to those in need such as the chronically ill, terminally ill, the disabled
and the dependent elderly who need help with activities of daily living or instrumental activities of
daily living. The term ‘elderly’ is defined by the Law 17/2000 as referring to all persons at or
above the Romanian official age of retirement.
Concerning the non-disabled elderly, who are the focus of this report, there are 6 acts of
legislation, which regulate entitlements and organisation of services:
1. Law 17/2000 on the Social Assistance for the Elderly (Legea privind asistenta sociala a
persoanelor varstnice) with the additional modifications (Law 281/2006, Law 270/2008 and GO
118/2008) and
2. Law 47/2006 establishing the National System of Social Assistance (Sistemul National de
Asistenta Sociala).
The medical services for all categories of people, including the disabled and the non-disabled
elderly, are supported by the social medical insurance and are regulated by:
3. Law 95/2006 on Health Reform (Legea priving reforma in domeniul sanatatii) which set the
grounds for national reform in the health care system and established the national social health
insurance system.
The regulation of quality assurance is stated by the following decrees:
4. Decree (Ordin) 318/2003 refers to the norms regarding the organization and functioning of
home care services as well the authorization of people who provide these services
5. Decree (Ordin) 246/2006 which established the minimum specific quality standards for home
care services and residential centres for the elderly in terms of organization and administration,
human resources, access to services, service provision, rights and ethics.
The decentralization of the administrative bodies is legislated by:
6. Law 435-XVI/2006 (Legea privind descentralizarea administrativă nr. 435-XVI/2006).
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7. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
1.2. Assessment of needs
The individual assessment of needs is conducted according to the Socio-Medical Evaluation
Sheet for the elderly. This Evaluation Sheet is binding and is used throughout the nation. This
Evaluation Sheet contains criteria for assessing a person’s social and economic status, his/her
medical status and the degree of dependency. It establishes the types of social or socio-medical
services that are needed to fulfil the person’s needs according to the level of dependency, the
wishes of the person or of his/her informal caretakers and the available local services that meet
the requirements (GO, Ordonanta de Guvern, 886/2000).
The social evaluation refers to the type of living conditions, family network, and the person’s
network of friends and neighbours. The economic evaluation reviews the person’s steady
monthly income, other sources of income and material assets. The evaluation of the person’s
medical status refers to the established medical conditions the person suffers from and his or
her current medical status.
The National Grid for Evaluating the Needs of the Elderly / National Grid for Dependent Elderly
Assessment (Grila Nationala de Evaluare a Nevoilor Persoanelor Varstnice) (GO, Ordonanta de
Guvern, 886/2000, Annex 1) evaluates the person’s degree of dependency and it is based on
his or her functional status (for basic activities of daily living and instrumental activities of daily
living) and his or her sensorial and psycho-affective status. Based on this evaluation, there are
three levels of dependency, each of which is further divided into three classes, A, B, C, with the
first degree being the most severe:
I. A - the person has lost autonomy and needs continuous care; B - the person cannot perform
daily activities and needs help and medical care for most activities throughout the day and night;
C - the person needs permanent surveillance and help due to behavioural disorders and regular
care for activities related to bodily hygiene.
II. A - the person has perfect mental abilities but partial motor functions and needs daily care for
the basic activities of daily life; B - the person needs help to stand up and partial help with daily
activities; C - the person has no motor problems, but needs help with daily activities related to
bodily hygiene.
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8. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
III. A - the person needs regular help with daily life activities, but when placed in an elderly
institution can be considered independent; B - the person has complete autonomy and can
perform daily activities without help.
The assessment is carried out by a team of two social workers from the Local Council and the
General Directorate of Social Assistance and Child Protection from the County Council, together
with the medical specialist who has supervised the medical progress of the individual. This team
may be completed by a representative of the Pensioners Organization or other Non
Governmental Organizations (NGOs) which provide social assistance to the elderly. (Law
17/2000, Art. 28)
1.3. Available LTC services
Types of services
The available settings for LTC are institutional and home-based, the latter being either formal or
informal. The types of services for the elderly include:
a) home care - temporary or permanent services
b) nursing home care (old-age home) - temporary or permanent services
c) institutional care (residential care) in day care centres, clubs for the elderly, temporary care
homes, assisted living arrangements, social apartments and dwellings, as well as other similar
settings (Law 17/2000).
At this time, Romania has a major deficit of institutionalized services. Home care is the most
commonly used care option for dependant elderly because of the comfort the family provides
and the reduced costs as compared to institutionalized care. This, however, raises many
problems. Most family caretakers are women, the wives or daughters of the dependent. Many
caretakers are elderly persons themselves and may also become dependant. Family care is
most common in the rural areas, where the traditions and moral values are maintained to a
greater extent (Strategic National Report Regarding Social Protection and Social Inclusion 2008-
2010 - Romania).
Community services provided for the elderly include:
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9. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
• social services, particularly for the prevention of social marginalization and supporting social
reintegration, legal and administrative counseling, payment of some services and current
obligations, home and household attendance, help for the household, and food making;
• medical-social services, especially help with personal hygiene, adaptation of the home to the
elderly person’s needs, encouraging economic, social and cultural activities plus temporary
attendance in day care centers, night shelters or other specialized centers;
• medical services, such as medical consultations provided in public health institutions or in the
home by the General Practitioner, dentistry consultations, medicine administration, supporting
sanitary materials and medical devices.
Eligibility
The right to social assistance is guaranteed to all Romanian citizens and to all foreign and
stateless persons who have residence in Romania and are elderly people (defined as persons
who have reached the standard retirement age). They must be without family or legal guardians,
without a home or the possibility to ensure one with their own resources. They must not be
earning income or have insufficient income to cover the appropriate care, and must be unable to
ensure (i) ADL or need specialized care or cannot meet their socio-medical needs because of
illness, physical or psychological status (Law 17/2000, art. 3 and Law 47/2006, art. 7).
1.4. Management and organisation
The local actors involved in the management of elderly care are the county and the municipal
authorities, who follow the guidelines and legislation set by the government. The country is
divided into 41 counties or districts plus Bucharest.
The central bodies involved in LTC regulation are part of the Parliament and the Government.
The Romanian Parliament has two chambers: the Senate and the Deputies Chamber. The
bodies within the Senate involved in social assistance to the elderly are the Commission for
Public Health and the Commission for Labour, Family and Social Protection. The bodies within
the Deputies Chamber are the Commission for Health and Family, which deals with medical
assistance, social problems of the elderly and the disabled, and the Commission for Labour and
Social Protection, which deals with pensions, indemnities and social assistance as cash
benefits.
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10. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
The government ensures the provision of LTC in Romania through the Ministry of Labour, Family
and Social Solidarity, namely the Department of Social Assistance and Familial Policies, in
cooperation with the Ministry of Public Health, which are represented at the county (provincial)
and the municipal levels by the County Council and the Local Council respectively. The legal
authorization to provide or obtain social services is given by the Ministry of Labour, Social
Solidarity and Family, represented in each county by the General Directorate of Social
Assistance and Child Protection, which is subordinate to the County Council. The responsibilities
of the General Directorate include applying policies, creating strategies (which must be approved
by the County Council), collaborating with other public institutions and undertaking certain
measures of social assistance regarding the protection of children, family, single persons, the
elderly, the disabled or any person in need (GD 1434/2004 r1, Hotarare de Guvern privind
organizarea si functionarea Directiei generale de asistenta sociala si protectia copilului).
The General Directorate of Social Assistance and Child Protection has the responsibility of
monitoring the national quality standards set by the Ministry of Labour, Family and Social
Solidarity and by the Ministry of Public Health through Decrees 318/2003 and 246/2006. Each
County Council has the ability to create its own strategies and goals in line with national goals,
organize and supervise the relevant institutions and raise additional funding. The capacity
planning differs throughout the country because each County Council can organize LTC
services according to the evaluated or perceived need and the funding is distributed according
to financial availability and the need for care.
1.5. Integration of LTC
The Romanian LTC system is organized to provide care services in a coordinated fashion
through two key ministries operating at the county level. Currently, LTC services include both
medical and social services, each of which is regulated by different bodies with separate
legislation. The medical services are regulated by the Health Reform Law 95/2006 through the
Ministry of Health. Social services are regulated by laws 17/2000 and 47/2006 through the
Ministry of Labour, Social Solidarity and Family. However, the legislation for each type is also
targeted at other categories of people, such as children or victims of abuse, in which case
medical services include rehabilitation and treatment. There is no clear distinction for regulations
of the LTC system which makes it difficult to integrate the medical and social services for this
type of care.
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11. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
This creates a great variety among counties, as they have the freedom to administer funds and
coordinate services in the way they see fit. Therefore the current national strategy is aimed at
linking these two types of services within a common, unified system of LTC (Strategic National
Report Regarding Social Protection and Social Inclusion 2008-2010 - Romania).
The integrated system would make provision for a multidisciplinary team which would be
comprised of geriatric specialists, ergotherapists, kinetotherapists, and dentists. This is currently
not the case because in most cases the evaluations, decisions and implementation of care are
carried out in a disjointed way and without proper communication among specialists. In addition,
in both public and private institutionalized homes, the personnel structure is incomplete and
specialists that should be included in care delivery are lacking (geriatric specialists,
ergotherapists, kinetotherapists, dentists) (National Council of the Elderly).
10
2. Funding
LTC for the elderly is funded through both public and private means. The largest share of
responsibility lies with the central public administration, which fund all types of care through the
consolidated state budget and the local public administration, which draws from the local budget.
Private funds come mainly from Non-Governmental Organizations (NGOs).
Both tax and insurance based financing are included in all forms of institutional care. For all
types of care, expenses for the medical personnel and the medical equipment are covered
solely from the consolidated state budget, which is comprised of the national social insurance
budget and the national medical insurance budget and other taxes. For institutional types of
care, administrative costs like water, heating, electricity, repairing, food, and furniture are
covered solely by the local budgets which are comprised mainly of local taxes and earnings.
Table 1 gives an overview of the public and private expenditures for services provided to the
non-disabled elderly in 2008.
12. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
Table 1. LTC expenditure in 2008 in Romania
TYPES OF CARE COSTS COVERED BY (in Euro)
Local Budgets NGOs Other sources
INSTITUTIONAL CARE
Elderly homes 23.546.401 4.980.109 2.241.324
Day care centers 2.396.033 788.322 78.744
Assisted living arrangements 952.834 256.193 114.395
HOME CARE 6.104.350 2.701.522
Source: Statistical data regarding activities for social inclusion in 2008. Ministry of Labor, Family and Social Protection
(Date statistice privind activitatea de incluziune socială in anul 2008, MMFPS)
Institutionalized care for the elderly is for the most part funded from the local budgets through
the County Council. In case the local budgets become insufficient, then the state budget will
complete the extra-budgetary sources of income for retirement homes to ensure their proper
functioning (Law 17/2000, art. 21). According to the law, funding for medical services, materials,
medical devices and medication is covered by the system of social health insurance. Expenses
that are not covered by the health insurance system must be covered by the retirement home
where care is provided through the person’s own income, external credits, external grants,
donations and sponsorships according to article 23 of Law 17/2000.
The financial responsibility of the beneficiaries of care who live in retirement homes is set every
year by the County Council. The average monthly maintenance cost per person, set by the
government for public services covered by the County Council, is 69.37 euro (290 RON). Based
on this, the contribution of each elderly person living in an institutional home is calculated
(Decree 687/2005). Every person that receives care in an elderly home must contribute a
monthly amount of up to 60% of their monthly income, without exceeding the monthly
maintenance costs set for every nursing home. If there is a gap between the amount requested
and the amount paid by the beneficiary, that difference must be covered by the family or the
legal guardian of the family if their monthly income is above 150 euros/month/family member
(600 RON). This amount changes every year according to the inflation rate (GO 118/2008, art.
IV). These payments are considered extra-budgetary sources of income for the nursing home.
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13. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
The elderly without income, family, or legal guardians are exempt from making financial
contributions. The amount is covered by the local budget to a certain extent.
Formal home care for the dependent elderly is organized by the Local Council which can
employ personnel who are paid hourly on a part time or full time basis, depending on the needs
and the time frame of care. The beneficiary does not pay an individual contribution for these
services. Informal home care can be provided by the spouse or the relatives of dependent
elderly who can opt for a part time working schedule, the other part being financially supported
by the local budget at a value calculated according to the monthly gross salary of a junior social
worker with a high school education (Law 17/2000, art. 13).
There are no cash benefits legalized in Romania for elderly care at this time. Legalized cash
benefits and greater in-kind benefits are available for persons who were officially recognized as
having a disability. Many elderly who are chronically or terminally ill or have multiple
comorbidities are granted a degree of disability and the number of these cases has risen
consistently in recent years. Therefore there is a legal delimitation between care for the elderly
(Law 17/2000) and care for the disabled (Law 448/2006), but in reality many services and
classifications overlap and the beneficiary could combine other benefits (old age, invalidity or
survivor) with disability benefits. This report however focuses solely on LTC for the elderly who
are not included in any disability category.
Other benefits in kind for all elderly include: a discount of 50% for a maximum of 6 train tickets
per year, a 50% discount for one medication prescription per month valued to a maximum of 72
euros (300 RON) and the possibility to go to a resort for rest and treatment for 18 days per year
with a maximum cost of 50% of the monthly income, a limited number of tickets approved by the
National Pension House for every county.
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3. Demand and supply of ltc
3.1. The need for LTC
Due to population aging and the increase in overall life expectancy, there is a greater need for
all types of LTC for the elderly. In 2008, when the total number of inhabitants in Romania was
21,528,627, 14.9% of the population was older than 65 years of age with 28% more women than
men (8.8% females and 6.1% males). 18.7% of the elderly population was made up of
individuals over 80 years of age. The age dependency ratio in Romania was estimated to be
23.6% and it is predicted to grow substantially over the next couple of decades (Eurostat 2008).
This alone shows the acute need for these types of services.
The percentage of the population aged 65 and above has increased by 43% over the last 15
years, from 10.4% to 14.9%, while the percentage of people aged 80 and above has increased
by 55%, from 1.8% to 2.8% (Table 2).
Table 2. Structure of the population by age and life expectancy at birth
Items 1990 1995 2000 2002 2003 2004 2005 2006 2007 2008
Share of 65+ 10.4 12.0 13.3 14.1 14.3 14.5 14.7 14.8 14.9 14.9
Share of 80+ 1.8 2.1 1.8 2.0 2.2 2.3 2.5 2.6 2.7 2.8
Life Expectancy at birth
Male 66.6 65.3 67.7 67.4 67.7 68.3 68.7 68.7 69.2 69.5
Female 73.1 73.1 74.8 74.8 75.1 75.5 75.7 75.8 76.1 76.7
Source: EUROSTAT 2009
It is predicted that these percentages will rise over the next 25 years by 54% for people 65 and
above and by an astounding 114% for those aged 80 and above (Table 3).
Table 3. Projections
Items 2009 2010 2015 2020 2025 2030 2035
Share of 65+ 14.9 14.9 15.6 17.4 19.4 20.3 22.9
Share of 80+ 2.9 3.0 3.6 4.2 4.3 4.9 6.2
Source: EUROSTAT 2009
15. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
Due to limited accessibility and financial resources, there are inequalities in geographical
distribution and in the number of services. The need for care services throughout the country in
2008 was evidenced by the large number of people waiting to access elderly homes (Table 4).
Table 4. Areas and counties with elderly homes funded by Local Councils and NGOs,
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2008
County Number of
elderly homes
Monthly
average number
of beneficiaries
Capacity:
Number of
Places
Number of
people on
waitlist
North-East
Bacău 2 253 269 71
Iaşi 4 443 445 751
Neamţ 1 59 73 3
Suceava 4 121 130 29
Vaslui 1 19 50 0
Botoşani 0 0 0 0
South-East
Brăila 5 483 472 38
Buzău 7 276 284 99
Constanţa 3 287 298 450
Galaţi 7 407 464 27
Tulcea 2 64 114 2
Vrancea 1 31 40 4
South (Muntenia)
Arges 3 146 155 16
Calarasi 1 4 30 8
Dambovita 5 120 150 32
Giurgiu 1 61 90 0
Ialomita 2 63 100 5
Teleorman 1 29 35 6
Prahova 0 0 0 0
South- West (Oltenia)
Dolj 2 375 376 10
Gorj 1 32 30 17
Mehedinti 2 42 59 0
Olt 4 167 222 20
Valcea 0 0 0 0
West
Arad 3 180 190 5
Caras severin 2 244 260 44
Hunedoara 2 45 46 37
Timis 6 375 389 247
North-West
Bihor 6 204 189 85
Bistrita-nasaud 1 29 47 1
Cluj 5 257 260 338
Maramures 1 62 62 5
Satu mare 1 29 30 16
salaj 4 149 182 30
Center
Alba 4 158 220 18
Brasov 6 240 283 19
16. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
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County Number of
elderly homes
Monthly
average number
of beneficiaries
Capacity:
Number of
Places
Number of
people on
waitlist
Covasna 3 134 140 38
Harghita 3 206 230 39
Mures 3 169 238 32
Sibiu 6 309 326 181
Bucuresti-Ilfov
Ilfov 1 40 40 30
Bucuresti 6 462 597 162
Total 122 6774 7615 2915
Source: Statistical data regarding activities for social inclusion in 2008. Ministry of Labor, Family and Social Protection
(Date statistice privind activitatea de incluziune socială in anul 2008, MMFPS)
The national distribution of providers is unequal. There is a greater shortage in the rural areas,
where most activities are performed by NGOs and public services of home care are scarce (The
National Council of the Elderly).
3.2. The role of informal and formal care in the LTC system (including
the role of cash benefits)
Most of the dependant elderly benefit from the care services provided inside the family.
However, family care is ensured mainly in rural areas, where the traditions and moral values are
maintained to a higher extent. This reality raises numerous problems that need to be solved.
The urban population has a greater need for services for the elderly. Most family caretakers are
women, wives or daughters. Many caretakers are elderly persons and may also become
dependant (Strategic National Report Regarding Social Protection and Social Inclusion 2008-
2010 - Romania).
3.3. Demand and supply of informal care
There is very little statistical data available about the extent of informal care among the
population. The importance of informal care is widely recognized throughout the country but no
official estimates have been made so far.
17. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
3.4. Demand and supply of formal care
The demand for all types of social services for the elderly has continuously grown over the past
years following trends in population aging and increased life expectancy. The supply has so far
been insufficient. In recent years, however, there has been an explosion in the number and
diversity of both public and private institutions as well as individuals that offer formal LTC
services (Table 5). However it is not sufficient to meet the demand for all those in need (Table
4). In addition, NGOs have become very involved in recent years and now represent the second
greatest source of services for the elderly, following the public services:
Table 5. Supply of elderly homes through 2005-2008
Elderly homes
Local budgets NGO budgets
16
No. of
units
No. of
Beneficiaries
Capacity:
No. of
places
No. of
units
No. of
beneficiaries
Capacity:
No. Of
places
2005 19 1891 2011 NA NA NA
2006 54 4441 4827 32 1147 1267
2007 68 4711 5588 38 1301 1429
2008 81 5337 6076 42 1437 1538
Source: Strategic National Report Regarding Social Protection and Social Inclusion 2008-2010 – Romania; Statistical
data regarding activities for social inclusion in 2008. Ministry of Labor, Family and Social Protection (Date statistice
privind activitatea de incluziune socială in anul 2008, MMFPS)
The table below offers an overview of the provision of formal care in 2008, both in institutional
and home settings. The institutions that cover most needs and were evaluated in this report are
the elderly homes, day care centers and assisted living arrangements. The home care services
shown here cover both social and medical assistance.
Table 6. Statistics on formal care for services funded by the Local Councils, NGOs and
other sources. Romania 2008
Types of services No. of
units
Monthly
average no.
of
beneficiaries
Capacity:
No. of
places
Number of
people on
waitlist
Elderly homes funded from the
Local Budget* 81 5.337 6.076 1.310
Elderly homes funded by NGOs* 42 1.437 1.538 1.605
Elderly homes funded through
other means 27 1.606 1.684 895
Day Centers funded from the
Local Budget ** 73 11.259 4.232
Day Centers funded by NGOs** 31 1.655 1.885
Day Centers funded through 9 1.620 810
18. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
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Types of services No. of
units
Monthly
average no.
of
beneficiaries
Capacity:
No. of
places
Number of
people on
waitlist
other means ***
Assisted living arrangements
funded from Local Budget **** 14 253 268
Assisted living arrangements
funded by NGOs 8 141 137
Assisted living arrangements
funded through other means**** 3 46 52
Home care services funded from
Local Budget 7.318
Home care services funded by
NGOs 10.192
Approximate Total 288 40864 16682 3810
*One elderly home is financed both by the local budget and an NGO
**Four centers have mixed financing
***Five centers have mixed financing
****One center is also financed by the General Directorate of Social Assistance and Child Protection
“Other sources” represents finances coming from donations or other private involvements. The
exact number of people receiving formal care, the number of people on waitlists, the number of
providers and their capacities could not be established because some institutions were listed
twice since they receive funding both from the Local Councils and NGOs. However, in most
cases where there is mixed funding, the largest share is covered by the local budgets. There are
no waitlists for people receiving formal home care, but there are long waitlists for those trying to
access elderly homes.
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4. Ltc policy
4.1. Policy goals
Home care is the most efficient strategy for dependant elderly care, not only because this
method is less costly than institutionalised care, but also because it is preferred by the persons
themselves, representing an essential attribute for ensuring an increase in quality of life.
In order to provide home care services in Romania, priority is being placed on developing a
social infrastructure in order to support a network of services that could be coordinated among
the medical and social fields. This implies sufficient financial means, granted according to a well
structured model defined at the national level, specialised personnel, the number of which
should be proportionate to the social problem, the involvement of civil society, the development
of voluntary services and support granted to families and caretakers (Strategic National Report
Regarding Social Protection and Social Inclusion 2008-2010 - Romania).
The current institutions do not sufficiently address the subject of palliative care. There are
several problems such as the price of prescription drugs (especially opioids), training for
palliative care, and the absence of guidelines and protocols. The present provision of palliative
care is done mainly through public non-for-profit organizations and covers no more than 5% of
the country’s palliative care needs. Developing a national plan for palliative care is one
component of the National Cancer Plan currently under development (Vladescu 2008).
Preparing the elderly for retirement is not an easy task, but one that Romania is undertaking
right now. The government is discussing ways for elderly people to maintain active lives and
remain socially involved. From this perspective, home care could take on new dimensions,
including programs for social reintegration along with medical and socio-medical care.
The National Council of the Elderly have advocated for the further development and
improvement of activities related to home care which are currently insufficient and only cover
iADL, rather than nursing or other types of care like occupational therapy or kinetotherapy.
(National Council of the Elderly)
For the past 3 years there have been many discussions about introducing a ‘dependency
allowance’ for retired people whose monthly income is below the average national pension.
20. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
According to the dependency level, the allowance is considered between 50 and 100 euros
(roughly 200 to 400 RON), from the third dependency level to the first. So far, no action has
been taken in this area.
4.2. Integration policy
The following strategies aim to integrate social and medical services to provide better care and
better social integration for the elderly and the disabled:
1. National Strategy regarding the integrated system of social services 2008-2011, Ministry of
Social Protection, Family and Child (Strategia Nationala cu privire la sistemul integrat de servicii
sociale 2008-2011, Ministerul Protectiei Sociale, Familiei si Copilului)
2. National strategy on the social protection, integration and inclusion of the disabled persons for
2006 – 2013, also called “Equal opportunities for disabled persons – towards a society without
discrimination”. (Strategiei nationale pentru protectia, integrarea si incluziunea sociala a
persoanelor cu handicap in perioada 2006-2013)
4.3. Recent reforms and current policy debate
Recent reforms have concentrated on the social protection system of the elderly, especially for
those with no income, no family or support or insufficient means of living. They are covered in
the National Strategy for the Development of the Social Assistance System for the Elderly (2005
-2008) and the National Strategy for Social Protection 2003-2007. These strategies were
implemented differently by each County Council responsible.
4.4. Critical appraisal of the LTC system
The current tendency in Romania is to shift elderly care away from institutional care to home
care or assisted living (Strategic National Report Regarding Social Protection and Social
Inclusion 2008-2010 - Romania). The assumption is that home care is the preferred method of
care by the elderly because it allows them to maintain their independence and social network
and also decreases governmental expenditure on LTC. However, this assumption may not be
correct since home care implies a greater involvement on the part of the person’s family or legal
guardian, who in turn may be giving up part of his/her job in order to provide the needed care.
The financial opportunity cost of people who devote their time and attention to their dependents
was not properly evaluated in Europe or in Romania.
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21. CASE Network Studies & Analyses No.419 – Long Term Care in Romania Country report
In conclusion, Romania is following the trend towards increased home care, although the
perceived reduced costs of home care services may turn out to be unrealistic in the long run
(Berg, 2004).
Note:
The values in euro were calculated using the exchange rate set by the Romanian National Bank
on May 27, 2009 at: 1 euro= 4.18 RON
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References
Berg, B. v. d., Brouwer, W. B., & Koopmanschap, M. A. (2004). Economic valuation of informal
care. An overview of methods and applications. European journal of health economics, 5(1), 36-
45.
Cronica Romana, June 2007, Two years waiting time for a place in elderly homes
http://www.9am.ro/stiri-revista-presei/2007-06-04/doi-ani-de-asteptare-pentru-un-loc-la-caminele-
de-batrani.html
Department of Social Assistance and Familial Policies, Ministry of Labour, Family and Social
Solidarity, http://sas.mmssf.ro
Eurostat European Database 2008,
http://epp.eurostat.ec.europa.eu/portal/page/portal/population/data/database
Quality in and equality of access to health care services, Country Report Romania 2007, Mioara
Predescu
Online database on Romanian legislation, Resursa ta de drept, www.dreptonline.ro
Ministry of Labour, Social Solidarity and Family, www.mmssf.ro
Strategic National Report Regarding Social Protection and Social Inclusion 2008-2010. Romania
The National Council of the Elderly, www.cnpv.ro
Vladescu C, Scintee G, Olsavszky V. (2008) Health systems in transition. Romania, Health
System Review. European Observatory on Health Systems and Policies. Vol. 10 No. 3 2008