This presentation was made by Eva Zver, Slovenia, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
Long-term care: Integrating health and social care -- Eva Zver, SloveniaOECD Governance
The document discusses key budgetary challenges for long-term care (LTC) in Slovenia. The current LTC system is fragmented across different social programs and lacks a uniform system. Expenditure on LTC is lower than OECD averages and private LTC spending is growing rapidly. A major reform is planned to create an integrated LTC system with standardized assessment, unified governance, expanded community-based services, and sustainable integrated financing including both public and private sources. The reform aims to shift spending from institutions to home and community-based care. Pilot programs will test solutions before full implementation of the new LTC system.
Ageing: Fiscal implications and policy responses -- Christian Lorenz, GermanyOECD Governance
The document discusses Germany's long-term care (LTC) system and a newly created LTC precaution fund. Key points:
- Germany has a separate social LTC insurance pillar funded by contributions that is managed similarly to but independently from its health care system.
- LTC expenditures are expected to double or triple as a percentage of GDP by 2060 due to demographic aging, making reforms necessary.
- The new LTC precaution fund will stabilize LTC premiums starting in 2035 by collecting contributions now and investing them to be drawn upon when more funding is needed to cope with the aging population.
The document discusses Ghana's pension reform act of 2008 which introduced a three-tier contributory pension system. The first tier is a mandatory basic social security scheme managed by SSNIT. The second and third tiers are privately managed and optional. The reform aims to improve retirement benefits and income security. Trade unions can influence how workers' pension funds are invested through advocacy and shareholder activism.
The document discusses Finland's earnings-related pension system. It notes that:
- Earnings-related pensions make up about half of pensions in Finland and are the most important type. They are managed by pension funds and insurance companies.
- The Finnish Centre for Pensions is a statutory body that produces common services to support the administration of earnings-related pensions, which cover virtually all employed people in Finland.
- In 2012, earnings-related pensions accounted for 19.49 billion euros in social insurance expenditures, making it the largest single program. Most pensioners receive an earnings-related pension, with the average monthly payment being 1,415 euros.
PRESENTATION ON PENSIONS CONFERENCE HELD IN ACCRA GHANAPrince Owusu
This document summarizes Ghana's national pension reform and benefits. It outlines the establishment of a presidential commission to examine the country's pension arrangements and make recommendations. The commission's main recommendation was to create a new contributory three-tier pension system comprising a mandatory basic social security scheme, a mandatory privately-managed occupational pension, and voluntary personal pension schemes. The reform aims to provide universal pension coverage and higher benefits than the previous system. Challenges include ensuring adequate investment returns for the privately-managed defined contribution schemes.
The document discusses Turkey's private pension system and recent regulations that affect savings. It provides an overview of Turkey's private pension system established in 2001, including key statistics as of 2013. It then compares Turkey's system to those of peer countries like Czech Republic, Chile, and Poland. The document concludes by projecting growth of Turkey's private pension assets over the next 10 years, anticipating the system could reach $90-100 billion in assets by 2020 with 5.5-6 million participants, though more needs to be done to increase financial literacy and support for lower income groups.
This document summarizes pension reforms in Italy, Latvia, Poland, and Sweden that introduced notional defined contribution (NDC) pension systems. It outlines key features of the NDC designs such as individual accounts, contribution rates, retirement ages. It also discusses challenges faced by NDC systems including maintaining accurate individual account records, ensuring adequate replacement rates for low earners, and balancing pension costs with demographic changes. Overall the reforms aim to improve financial sustainability, fairness between generations, and transparency of pension benefits.
Long-term care: Integrating health and social care -- Eva Zver, SloveniaOECD Governance
The document discusses key budgetary challenges for long-term care (LTC) in Slovenia. The current LTC system is fragmented across different social programs and lacks a uniform system. Expenditure on LTC is lower than OECD averages and private LTC spending is growing rapidly. A major reform is planned to create an integrated LTC system with standardized assessment, unified governance, expanded community-based services, and sustainable integrated financing including both public and private sources. The reform aims to shift spending from institutions to home and community-based care. Pilot programs will test solutions before full implementation of the new LTC system.
Ageing: Fiscal implications and policy responses -- Christian Lorenz, GermanyOECD Governance
The document discusses Germany's long-term care (LTC) system and a newly created LTC precaution fund. Key points:
- Germany has a separate social LTC insurance pillar funded by contributions that is managed similarly to but independently from its health care system.
- LTC expenditures are expected to double or triple as a percentage of GDP by 2060 due to demographic aging, making reforms necessary.
- The new LTC precaution fund will stabilize LTC premiums starting in 2035 by collecting contributions now and investing them to be drawn upon when more funding is needed to cope with the aging population.
The document discusses Ghana's pension reform act of 2008 which introduced a three-tier contributory pension system. The first tier is a mandatory basic social security scheme managed by SSNIT. The second and third tiers are privately managed and optional. The reform aims to improve retirement benefits and income security. Trade unions can influence how workers' pension funds are invested through advocacy and shareholder activism.
The document discusses Finland's earnings-related pension system. It notes that:
- Earnings-related pensions make up about half of pensions in Finland and are the most important type. They are managed by pension funds and insurance companies.
- The Finnish Centre for Pensions is a statutory body that produces common services to support the administration of earnings-related pensions, which cover virtually all employed people in Finland.
- In 2012, earnings-related pensions accounted for 19.49 billion euros in social insurance expenditures, making it the largest single program. Most pensioners receive an earnings-related pension, with the average monthly payment being 1,415 euros.
PRESENTATION ON PENSIONS CONFERENCE HELD IN ACCRA GHANAPrince Owusu
This document summarizes Ghana's national pension reform and benefits. It outlines the establishment of a presidential commission to examine the country's pension arrangements and make recommendations. The commission's main recommendation was to create a new contributory three-tier pension system comprising a mandatory basic social security scheme, a mandatory privately-managed occupational pension, and voluntary personal pension schemes. The reform aims to provide universal pension coverage and higher benefits than the previous system. Challenges include ensuring adequate investment returns for the privately-managed defined contribution schemes.
The document discusses Turkey's private pension system and recent regulations that affect savings. It provides an overview of Turkey's private pension system established in 2001, including key statistics as of 2013. It then compares Turkey's system to those of peer countries like Czech Republic, Chile, and Poland. The document concludes by projecting growth of Turkey's private pension assets over the next 10 years, anticipating the system could reach $90-100 billion in assets by 2020 with 5.5-6 million participants, though more needs to be done to increase financial literacy and support for lower income groups.
This document summarizes pension reforms in Italy, Latvia, Poland, and Sweden that introduced notional defined contribution (NDC) pension systems. It outlines key features of the NDC designs such as individual accounts, contribution rates, retirement ages. It also discusses challenges faced by NDC systems including maintaining accurate individual account records, ensuring adequate replacement rates for low earners, and balancing pension costs with demographic changes. Overall the reforms aim to improve financial sustainability, fairness between generations, and transparency of pension benefits.
The document summarizes major UK welfare reforms being implemented between 2011-2017, including:
1) Migration to Employment and Support Allowance (ESA) and Work Programme, with less referrals to the latter than expected.
2) Introduction of flat-rate state pension and increase in pension age.
3) Tax credit changes reducing amounts and tightening eligibility.
4) Measures in the Welfare Reform Act 2012 replacing benefits and increasing conditionality, such as the household benefit cap.
The document discusses upcoming reforms to state pensions and long-term care in England. For state pensions, a New State Pension will replace current plans starting in 2016, aiming to provide an income just above the minimum guaranteed by Pension Credit. Long-term care reforms introducing a lifetime cap on individual care costs have been postponed until 2020. Hypothetical scenarios are used to illustrate how different individuals may be impacted by the interactions between pension and care reforms. Key findings are that home-owners and higher earners generally benefit from both sets of reforms, while low-income renters may lose means-tested benefits that offset pension gains. The combined reforms' long-term costs and impacts depend on future policy decisions.
Aviva Mind The Gap survey regional uk pensions gapcoussey
The document summarizes a report by Aviva that quantifies Europe's "pensions gap", which is the difference between the pension provision people need for an adequate standard of living in retirement and the pension amount they can currently expect to receive.
The key findings are:
1) Across the EU, the annual pensions gap is €1.9 trillion, or 19% of 2010 GDP. No single policy change can close the gap entirely on its own.
2) At an individual level, some people will need to increase savings by an average of €12,000 per year to fully close their personal pensions gap.
3) Non-pension assets, such as property, are only expected to
The federal budget deficit grew during the 2008-2009 recession and remained larger in 2013 than in 2008, amounting to $680 billion or 4.1% of GDP. Federal spending was 20.8% of GDP in 2013, slightly above the 40-year average, while revenues were 16.7% of GDP. Large budget deficits in recent years substantially increased federal debt held by the public to 72% of GDP in 2013, the highest level in over 60 years, which could negatively impact long-term economic growth.
The Congressional Budget Office presentation analyzed the growth in costs of the Federal Pell Grant Program between 2006-2007 and 2011-2012. It found the increase was due to a rise in both the number of recipients and average grant amount. The number of recipients grew as undergraduate enrollment and the percentage of students receiving grants increased. The average grant amount rose as the maximum amount was raised and eligibility expanded. The presentation outlined options to reduce costs such as decreasing grants amounts or tightening eligibility, or increase costs such as raising grant amounts or simplifying the application process.
The document discusses how the postponement of reforms to long-term care financing in England from 2016 to 2020 will financially impact various hypothetical individuals. It finds that individuals with median or high earnings who own homes will receive substantially less from the state to contribute to their care costs due to the delay. This is because the lifetime cap on care costs, which was to be implemented in 2016, will now begin in 2020. As a result, these individuals' care costs will not exceed the cap before they pass away. In contrast, individuals with low earnings are unaffected by the postponement as the state was already funding most of their care costs.
The Congressional Budget Office (CBO) estimates the budgetary impacts of prevention policies by:
1) Establishing baselines for health risks, spending, and outcomes and projecting them over time.
2) Estimating behavioral responses to policies and how these affect health.
3) Calculating how changes in health, spending, and the economy feedback into federal spending and revenues over decades.
The CBO uses this framework to analyze policies like cigarette taxes, estimating long-term effects on outcomes like longevity, spending, the deficit, and challenges in the evidence.
FSC Future Leaders Award - Stephen FleggSteve Flegg
This document discusses policy changes that could help insulate Australia from the future economic impacts of an aging population. It identifies three key issues with the current system: 1) inadequate retirement savings among many Australians, 2) a lack of regulation around how superannuation funds are used post-retirement, and 3) inadequacies in the age pension that discourage employment and burden individuals with longevity risk. Reforming contribution caps, increasing financial assistance, regulating post-retirement spending, and restructuring the age pension are some policy solutions proposed to address these issues and better prepare Australia for its aging population.
Health care in Turkey consists of a mix of public and private health services. Turkey has universal health care under its Universal Health Insurance (Genel Sağlık Sigortası) system. Under this system, all residents registered with the Social Security Institution (SGK) can receive medical treatment free of charge in hospitals contracted to the SGK
Presentation at the Fifth Biennial Conference of the American Society of Health Economists, by Allison Percy, Health, Retirement, and Long-Term Analysis Division
This document from the Congressional Budget Office provides additional information on CBO's 2013 long-term projections for Social Security. It finds that:
- Social Security outlays exceeded tax revenues for the first time in 2010 and CBO projects the gap will average 12% of tax revenues over the next decade as more baby boomers retire.
- The Disability Insurance trust fund is projected to be exhausted in 2017 and the Old-Age and Survivors Insurance trust fund in 2033, though combining the two the funds would be exhausted in 2031.
- The amount of taxes paid and benefits received through Social Security varies between groups based on earnings, with higher earners paying more in taxes but receiving proportionately lower replacement rates
The social security system in Turkey draws on both the Bismarck and Mediterranean models. It is predominantly similar to the Bismarck model where premiums paid on wages are collected in a joint pool to provide benefits based on paid premiums for retirement, accidents, and sickness. However, it also shares elements with the Mediterranean model such as a large informal economy and families providing support. Recent reforms have aimed to unify standards and ensure sustainability while maintaining these influences. The system includes both compulsory and voluntary social insurance programs managed through the Social Security Institution and various insurance companies.
This document summarizes a presentation by the Congressional Budget Office (CBO) director on federal health care spending growth and potential policy options. The CBO provides nonpartisan analysis to Congress. Federal health spending is growing faster than other spending and the economy due to population aging, expanded insurance subsidies, and rising per person costs. The Affordable Care Act will significantly reduce the uninsured but have little effect on most with coverage. Improving health, reducing subsidies, changing payments, and restructuring programs could help budgets but have various effects on different groups.
The document summarizes Germany's social insurance system, including its history and present situation. It discusses the five main parts of social insurance - health, nursing care, unemployment, pension, and accident insurance. It provides details on contribution rates, benefits provided, and how the system is financed. The document also briefly compares social insurance systems in other countries and considers future prospects for Germany's system.
- Mental health in Ireland is under strain due to the economic crisis, with rising unemployment, income inequality, suicide and self-harm rates.
- The document calls on the government to continue investing in community-based mental health services, as promised in the Programme for Government, and to ensure no further cuts to mental health funding.
- Key recommendations include continuing to invest €35 million annually in community mental health services, investing in governance structures to support the mental health reform plan, and ensuring social welfare rates and supports for those with mental health issues are maintained.
1) The effective retirement age in Finland has been rising, with the expected effective retirement age for a 25-year-old reaching 61.2 years and for a 50-year-old reaching 62.8 years in 2014.
2) The number of new retirees on earnings-related pensions decreased by 3,000 compared to 2013, with declines in those retiring on old-age and disability pensions.
3) Employment rates of older age groups have been increasing, with the rate for 55-59-year-olds reaching a record high of 74.1% in 2014, though Finland still lags behind other Nordic countries in employment of older groups.
Despite recent efforts to equalize the treatment of men and women in the pension system design in many countries, the gender gap in pensions persists. This gap contributes to old-age income inequality in Europe and beyond. The interplay of pension and family policies has a major impact on mitigating the gender gap in pensions.
Long-term care: integrating health and social care -- Zva Zver, SloveniaOECD Governance
This presentation was made by Eva Zver, Slovenia, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
Yuki Murakami (OESO) - De meerwaarde van ouderenzorg in België: een profielsc...Ria Binst
This document summarizes a presentation by Yuki Murakami from the OECD on long-term care for older people. It notes that the population over 80 years old will double in Belgium by 2050 due to demographic aging. This will increase demand for formal long-term care and pressure on the long-term care workforce and financing. It also discusses different long-term care models across OECD countries and options to improve the efficiency and value of long-term care systems.
Long-term care: Integrating health and social care - Albert Veraart, NetherlandsOECD Governance
This presentation was made by Albert Veraart, Netherlands, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Budget execution - Eva Zver, Josar Dusan, SloveniaOECD Governance
This presentation was made by Eva Zver and Josar Dusan, Slovenia, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
The document summarizes major UK welfare reforms being implemented between 2011-2017, including:
1) Migration to Employment and Support Allowance (ESA) and Work Programme, with less referrals to the latter than expected.
2) Introduction of flat-rate state pension and increase in pension age.
3) Tax credit changes reducing amounts and tightening eligibility.
4) Measures in the Welfare Reform Act 2012 replacing benefits and increasing conditionality, such as the household benefit cap.
The document discusses upcoming reforms to state pensions and long-term care in England. For state pensions, a New State Pension will replace current plans starting in 2016, aiming to provide an income just above the minimum guaranteed by Pension Credit. Long-term care reforms introducing a lifetime cap on individual care costs have been postponed until 2020. Hypothetical scenarios are used to illustrate how different individuals may be impacted by the interactions between pension and care reforms. Key findings are that home-owners and higher earners generally benefit from both sets of reforms, while low-income renters may lose means-tested benefits that offset pension gains. The combined reforms' long-term costs and impacts depend on future policy decisions.
Aviva Mind The Gap survey regional uk pensions gapcoussey
The document summarizes a report by Aviva that quantifies Europe's "pensions gap", which is the difference between the pension provision people need for an adequate standard of living in retirement and the pension amount they can currently expect to receive.
The key findings are:
1) Across the EU, the annual pensions gap is €1.9 trillion, or 19% of 2010 GDP. No single policy change can close the gap entirely on its own.
2) At an individual level, some people will need to increase savings by an average of €12,000 per year to fully close their personal pensions gap.
3) Non-pension assets, such as property, are only expected to
The federal budget deficit grew during the 2008-2009 recession and remained larger in 2013 than in 2008, amounting to $680 billion or 4.1% of GDP. Federal spending was 20.8% of GDP in 2013, slightly above the 40-year average, while revenues were 16.7% of GDP. Large budget deficits in recent years substantially increased federal debt held by the public to 72% of GDP in 2013, the highest level in over 60 years, which could negatively impact long-term economic growth.
The Congressional Budget Office presentation analyzed the growth in costs of the Federal Pell Grant Program between 2006-2007 and 2011-2012. It found the increase was due to a rise in both the number of recipients and average grant amount. The number of recipients grew as undergraduate enrollment and the percentage of students receiving grants increased. The average grant amount rose as the maximum amount was raised and eligibility expanded. The presentation outlined options to reduce costs such as decreasing grants amounts or tightening eligibility, or increase costs such as raising grant amounts or simplifying the application process.
The document discusses how the postponement of reforms to long-term care financing in England from 2016 to 2020 will financially impact various hypothetical individuals. It finds that individuals with median or high earnings who own homes will receive substantially less from the state to contribute to their care costs due to the delay. This is because the lifetime cap on care costs, which was to be implemented in 2016, will now begin in 2020. As a result, these individuals' care costs will not exceed the cap before they pass away. In contrast, individuals with low earnings are unaffected by the postponement as the state was already funding most of their care costs.
The Congressional Budget Office (CBO) estimates the budgetary impacts of prevention policies by:
1) Establishing baselines for health risks, spending, and outcomes and projecting them over time.
2) Estimating behavioral responses to policies and how these affect health.
3) Calculating how changes in health, spending, and the economy feedback into federal spending and revenues over decades.
The CBO uses this framework to analyze policies like cigarette taxes, estimating long-term effects on outcomes like longevity, spending, the deficit, and challenges in the evidence.
FSC Future Leaders Award - Stephen FleggSteve Flegg
This document discusses policy changes that could help insulate Australia from the future economic impacts of an aging population. It identifies three key issues with the current system: 1) inadequate retirement savings among many Australians, 2) a lack of regulation around how superannuation funds are used post-retirement, and 3) inadequacies in the age pension that discourage employment and burden individuals with longevity risk. Reforming contribution caps, increasing financial assistance, regulating post-retirement spending, and restructuring the age pension are some policy solutions proposed to address these issues and better prepare Australia for its aging population.
Health care in Turkey consists of a mix of public and private health services. Turkey has universal health care under its Universal Health Insurance (Genel Sağlık Sigortası) system. Under this system, all residents registered with the Social Security Institution (SGK) can receive medical treatment free of charge in hospitals contracted to the SGK
Presentation at the Fifth Biennial Conference of the American Society of Health Economists, by Allison Percy, Health, Retirement, and Long-Term Analysis Division
This document from the Congressional Budget Office provides additional information on CBO's 2013 long-term projections for Social Security. It finds that:
- Social Security outlays exceeded tax revenues for the first time in 2010 and CBO projects the gap will average 12% of tax revenues over the next decade as more baby boomers retire.
- The Disability Insurance trust fund is projected to be exhausted in 2017 and the Old-Age and Survivors Insurance trust fund in 2033, though combining the two the funds would be exhausted in 2031.
- The amount of taxes paid and benefits received through Social Security varies between groups based on earnings, with higher earners paying more in taxes but receiving proportionately lower replacement rates
The social security system in Turkey draws on both the Bismarck and Mediterranean models. It is predominantly similar to the Bismarck model where premiums paid on wages are collected in a joint pool to provide benefits based on paid premiums for retirement, accidents, and sickness. However, it also shares elements with the Mediterranean model such as a large informal economy and families providing support. Recent reforms have aimed to unify standards and ensure sustainability while maintaining these influences. The system includes both compulsory and voluntary social insurance programs managed through the Social Security Institution and various insurance companies.
This document summarizes a presentation by the Congressional Budget Office (CBO) director on federal health care spending growth and potential policy options. The CBO provides nonpartisan analysis to Congress. Federal health spending is growing faster than other spending and the economy due to population aging, expanded insurance subsidies, and rising per person costs. The Affordable Care Act will significantly reduce the uninsured but have little effect on most with coverage. Improving health, reducing subsidies, changing payments, and restructuring programs could help budgets but have various effects on different groups.
The document summarizes Germany's social insurance system, including its history and present situation. It discusses the five main parts of social insurance - health, nursing care, unemployment, pension, and accident insurance. It provides details on contribution rates, benefits provided, and how the system is financed. The document also briefly compares social insurance systems in other countries and considers future prospects for Germany's system.
- Mental health in Ireland is under strain due to the economic crisis, with rising unemployment, income inequality, suicide and self-harm rates.
- The document calls on the government to continue investing in community-based mental health services, as promised in the Programme for Government, and to ensure no further cuts to mental health funding.
- Key recommendations include continuing to invest €35 million annually in community mental health services, investing in governance structures to support the mental health reform plan, and ensuring social welfare rates and supports for those with mental health issues are maintained.
1) The effective retirement age in Finland has been rising, with the expected effective retirement age for a 25-year-old reaching 61.2 years and for a 50-year-old reaching 62.8 years in 2014.
2) The number of new retirees on earnings-related pensions decreased by 3,000 compared to 2013, with declines in those retiring on old-age and disability pensions.
3) Employment rates of older age groups have been increasing, with the rate for 55-59-year-olds reaching a record high of 74.1% in 2014, though Finland still lags behind other Nordic countries in employment of older groups.
Despite recent efforts to equalize the treatment of men and women in the pension system design in many countries, the gender gap in pensions persists. This gap contributes to old-age income inequality in Europe and beyond. The interplay of pension and family policies has a major impact on mitigating the gender gap in pensions.
Long-term care: integrating health and social care -- Zva Zver, SloveniaOECD Governance
This presentation was made by Eva Zver, Slovenia, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
Yuki Murakami (OESO) - De meerwaarde van ouderenzorg in België: een profielsc...Ria Binst
This document summarizes a presentation by Yuki Murakami from the OECD on long-term care for older people. It notes that the population over 80 years old will double in Belgium by 2050 due to demographic aging. This will increase demand for formal long-term care and pressure on the long-term care workforce and financing. It also discusses different long-term care models across OECD countries and options to improve the efficiency and value of long-term care systems.
Long-term care: Integrating health and social care - Albert Veraart, NetherlandsOECD Governance
This presentation was made by Albert Veraart, Netherlands, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Budget execution - Eva Zver, Josar Dusan, SloveniaOECD Governance
This presentation was made by Eva Zver and Josar Dusan, Slovenia, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
HLEG thematic workshop on measuring economic, social and environmental resili...StatsCommunications
HLEG thematic workshop on Measuring economic, social and environmental resilience, 25-26 November 2015, Rome, Italy, More information at: http://oe.cd/StrategicForum2015
2014.03.18 - NAEC Seminar_Assessing the vulnerabilities of social institution...OECD_NAEC
This document summarizes a presentation on the social impacts of the economic crisis and policy responses. It discusses how the crisis widened income gaps and increased poverty and financial hardship. While governments initially increased social spending, fiscal pressures later led many to implement spending cuts. This compromised the effectiveness of social policies at a time when more support was needed. The presentation argues for policies that cushion income losses, support self-sufficiency, and prioritize social investments to avoid high future costs. Social policies need to adapt to economic cycles to maintain their effectiveness during times of both growth and crisis.
1) The document analyzes how health care financing systems, payment methods, and public/private roles impact health care expenditures (HCE) across countries.
2) It finds that tax-based systems have lower HCE than social security/insurance systems, and global budgeting and capitation payments are linked to lower costs than fee-for-service.
3) Over time, the effect of increased public financing on HCE has declined, though remains significant, while factors like urbanization and technology growth contribute to rising HCE.
2014.03.18 - NAEC Seminar_Assessing the vulnerabilities of social institution...OECD_NAEC
This document discusses the vulnerabilities of social institutions like pension systems, health care systems, and unemployment insurance to various risks and shocks. It outlines trends that affect social spending like population aging. Charts show how aging will decrease support ratios and increase pension and health spending. Macroeconomic shocks can also impact unemployment insurance spending. The document recommends policy options to make systems more sustainable and resilient to risks, like increasing retirement ages, cost sharing in health care, and active labor market policies for unemployment insurance.
The document discusses social and economic reforms implemented in Slovakia in the lead up to its accession to the European Union in 2004. Key reforms included fiscal reforms to increase budget transparency, banking system reforms, tax reforms to simplify the system and lower rates, decentralization of public administration, pension system reforms, and social system reforms to increase work incentives. These reforms helped modernize Slovakia's economy and public institutions to meet EU standards. However, regional disparities remain a challenge.
Determinants of public health care expenditure & fiscal sustainability - Thom...OECD Governance
This presentation was made by Thomas Brändle and Carsten Colombier, Switzerland, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
This presentation was made by Vlasta KOVACIC MEZEK, Slovenia, at the 5th Meeting of the joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems held on 4-5 February 2016 at the OECD Conference Centre in Paris.
Keynote speech from Andrew Dilnot, Chair of the Commission on Funding of Care and Support - 'Searching for Social Care Solutions'
Find out more at http://www.ageuk.org.uk/conferences
Large Scale roll-out of telehealth/Telecare : approach and examples – Scotla...flanderscare
Wat is de toekomst van zorg op afstand in Vlaanderen? Dat was de centrale vraag van het event van 17 juni. 100 deelnemers dachten hier samen over na. Studiebezoeken aan andere Europese regio's toonden dat daar reeds op grote schaal met telecare en telehealth gewerkt en geëxperimenteerd wordt.
Ageing: fiscal implications and policy responses -- Christian Lorenz, GermanyOECD Governance
This presentation was made by Christian Lorenz, Germany, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
This paper examines social transfers in kind (STiK) in Finland and the UK using microdata. It finds that STiK represent 31.3% and 23.6% of disposable income in Finland and the UK respectively based on national accounts, but microdata only captures 51.5% and 70% of STiK. The paper also finds that including STiK significantly reduces income inequality and poverty rates in both countries. However, the results for Finland may be impacted by underreporting of STiK in the microdata. Key issues discussed include whether to value health STiK based on actual consumption or an insurance approach.
This document discusses the design and policy issues surrounding Taiwan's proposed universal long-term care insurance (LTCI) scheme. It outlines Taiwan's aging population trends, the projected increase in those needing long-term care, and reviews international LTC systems. The proposed LTCI scheme would provide universal coverage through a single-payer system administered by Taiwan's National Health Insurance Administration. It would offer both home and institutional long-term care benefits determined through a needs assessment process. Major policy issues include ensuring adequate long-term care services and workforce, financial sustainability, and gaining public and employer support for the program.
Ageing: fiscal implications and policy responses -- Chris James, OECDOECD Governance
This presentation was made by Chris James, OECD, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
Ageing: Fiscal implications and policy responses -- Chris James, OECDOECD Governance
This presentation was made by Chris James, OECD Secretariat, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Similar to Long-term care reform in Slovenia: financing perspective - Eva Zver, Slovenia (20)
The document discusses transparency and oversight of political party financing. It finds that financial contributions to political parties are not fully transparent and are still vulnerable to political and foreign influence. Additionally, financial reports from political parties are not always publicly available or submitted on time according to regulations.
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...OECD Governance
Presented at the OECD expert meeting "Construction Risk Management in Infrastructure Procurement: The Loss of Appetite for Fixed-Price Contracts", held on 17 May 2023 at the OECD, Paris and online.
Using AI led assurance to deliver projects on time and on budget - D. Amratia...OECD Governance
Presented at the OECD expert meeting "Construction Risk Management in Infrastructure Procurement: The Loss of Appetite for Fixed-Price Contracts", held on 17 May 2023 at the OECD, Paris and online.
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)OECD Governance
This document discusses different construction project delivery and payment models. It begins by outlining common delivery models like design-bid-build and design-build. It then explains different payment methods that can be used like fixed price, unit prices, and cost-reimbursable. The document also discusses pricing strategies and how they relate to risk transfer between parties. It provides details on collaborative models like early contractor involvement and discusses selecting the optimal contract based on a client's project risks, desired influence, and market conditions.
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...OECD Governance
Presented at the OECD expert meeting "Construction Risk Management in Infrastructure Procurement: The Loss of Appetite for Fixed-Price Contracts", held on 17 May 2023 at the OECD, Paris and online.
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...OECD Governance
Presented at the OECD expert meeting "Construction Risk Management in Infrastructure Procurement: The Loss of Appetite for Fixed-Price Contracts", held on 17 May 2023 at the OECD, Paris and online.
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...OECD Governance
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Long-term care reform in Slovenia: financing perspective - Eva Zver, Slovenia
1. LONG-TERM CARE REFORM IN SLOVENIA
– FINANCING PERSPECTIVE
EVA ZVER, INSTITUTE OF MACROECONOMIC ANALYSIS AND
DEVELOPMENT
DAVOR DOMINKUŠ , MINISTRY OF LABOUR, FAMILY, SOCIAL AFFAIRS
AND EQUAL OPPORTUNITIES
O E C D , 4 T H M E E T I N G O F T H E J O I N T N E T W O R K O N F I S C A L S U S T A I N A B I L I T Y O F
H E A L T H S Y S T E M S
2. Slovenia – in general
Capital: Ljubljana (350.000)
Geographical size: 20 273 km2
Population: 2,06 mio (2014)
Currency: Euro
forecast
2012 2013 2014
GDP (in mio EUR) 36006 36144 36931
GDP per capita (in EUR) 17,506 17550 17899
GDP real growth rates -2,6 -1,0 2,0
Inflation (year average) 2,6 1,8 0,3
Employment (growth rate) -0,8 -1,5 0,6
Unemployment (rate by ILO) 8,9 10,1 10,0
Average wage
General government deficit
(in % of GDP) -3,1 -4,3
General government debt (in
% GDP) 53,4 70,4
IMAD, Autumn forecast of economic trends 2014
3. Overview of presentation
1. LTC reform in Slovenia – reasons behind the need for a reform
2. Current state of health and LTC financing
3. Information on the envisaged LTC reform
4. Information on the proposed changes of HC and LTC financing
The focus of presentation is on two questions:
- Why do we have to link LTC and health care funding reform?
- What could be a solution to the problem of additional public (tax)
resources needed to finance LTC in Slovenia?
4. LTC reform – reasons behind the need for a reform
• Demographic reasons
• Fiscal sustainability reasons
• Social reasons (poverty and social exclusion among the elderly)
• Health reasons (Healthy life years are low; impact on savings in
health expenditure)
• Reasons deriving from the existing system, its imbalances and
fragmentation
5. LTC reform – reasons behind the need for a reform:
demografic reasons
Source: Eurostat – EUROPOP 2013
0
10
20
30
40
50
60
2013 20202030204020502060
Old-age dependency ratio, in
%
4.5
12.3
0
10
20
30
40
50
60
70
80
2013 2020 2030 2040 2050 2060
Demografic projections
Population aged 0-14 (%)
Population aged 15-64 (%)
Population aged 65 or more (%)
Population aged 80 or more (%)
80+ : 2050: 11 %; OECD: 10 %
6. LTC reform – reasons behind the need for a reform:
People under the poverty threshold %
Source: SORS, 2013
0
5
10
15
20
25
2009 2010 2011 2012 2013
The share of population under the poverty threshold, in
%
ALL age groups ALL 65+
7. LTC reform – reasons behind the need for a reform:
fiscal sustainability
Projection of age-related public expenditure for Slovenia, 2010-2060
(AWG reference scenario)
11.2 11.8 12.2 13.3
15.8
17.9 18.3
6.1 6.3 6.4
6.8
7.0
7.2 7.2
1.4 1.6 1.7
1.9
2.4
2.8 3.0
4.7
4.7 4.9
4.8
4.6
5.0 5.2
0
5
10
15
20
25
30
35
2010 2015 2020 2030 2040 2050 2060
ShareinGDP,in%
unemployment
education
long-term care
health
pension
Source: The 2012 Ageing Report, European Commission, 2012
8. LTC reform – reasons behind the need for a reform:
health
50.0
52.0
54.0
56.0
58.0
60.0
62.0
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
86.0
88.0
90.0
50
52
54
56
58
60
62
64
66
68
70
72
74
SlovakRep.
Slovenia
Estonia
Finland
Latvia
Germany
Romania
Lithuania
Portugal
Hungary
Denmark
Poland
Netherlands
Austria
Italy
EU-28
CzechRep.
Croatia
France
Cyprus
Bulgaria
United…
Greece
Belgium
Spain
Luxembourg
Ireland
Switzerland
Iceland
Sweden
Norway
Malta
Share,in%
numberofyears
HLY - women HLY - men Ratio HLY/Life expectancy
Source: Eurostat Database; calculations by IMAD
Healthy life years at birth and ratio of HLY to life expectancy
9. C U R R E N T LY N O U N I F O R M S Y S T E M O F LT C :
• LT C b e n e f i t s i n k i n d a n d c a s h - b e n e f i t s a r e p r o vi d e d a n d
f i n a n c e d w i t h i n :
- health care system,
- social and parental protection systems,
- pension and disability system
• B e n e f i t s i n k i n d :
• Institutional care is prevailing
• Lack of community based services
• Underdeveloped home based services and integrated health/social care
• B e n e f i t s i n c a s h :
- not related to comparable needs
- different levels of benefits related to specific legislation
- not means tested
N o u n i f i e d e n t r y p o i n t a n d n o u n i f i e d n e e d s a s s e s s m e n t
LTC reform – reasons behind the need for a reform:
Imbalances and fragmentation of current LTC provision
10. Current state of health financing:
Bismarck (insurance based) system of health
founding
The structure of total health expenditure in Slovenia, 2012
Source : SORS, http://www.stat.si/novica_prikazi.aspx?id=6382
5
2
65
14
12
3 Central government
Local government
Social security funds
Private health insurance
Households
Corporations (excluding
health insurance)
NPISG
- Public: 71 %; Private: 29 %,
- very low share of government expenditure
- Low share of OOP expenditure (OECD:19 %; EU: 21 %)
11. 7.8
13.9
35.1
15.8
26.4
Central government (Ministry of Labor and Social
Affaires)
Local governments
Health Insurance Institute of Slovenia
Pension Insurance Fund
Out of pocket
Current state of LTC financing:
high share of funding from compulsory health
insurance
73
27
Public Private
Structure of total LTC expenditure by source of funding, 2012
Source : SORS, calculations by IMAD
12. Current state of LTC financing:
very fast growth of private LTC expenditure
132
123
163
95
105
115
125
135
145
155
165
175
2005 2006 2007 2008 2009 2010 2011 2012
Realgrowthindex,2005=100
Total
Public
Private
Real growth of expenditure for long-term care, 2005-2012
Source : SORS, calculations by IMAD
13. The structure of current health expenditure
by functions, 2003 and 2012
8 10
0%
20%
40%
60%
80%
100%
2003 2012
Governance and health administration (HC.7)
Preventive care (HC.6)
Medicines and therapeutic appliances (HC.5)
Anciliary services (HC.4)
Long-term care - health (HC.3)
Rehabilitative care (HC.2)
Curative care (HC.1)
2.3
5.7
0
1
2
3
4
5
6
Health
expenditure*
LTC
expenditure**
In%
Average annual real growth rate,
2003-2012
Current state of LTC :
LTC expenditure grow even faster then health expenditure
Source : SORS, calculations by IMAD
14. Current state of LTC financing:
high share of LTC health component
68
32
LTC (health) LTC (social)
Total LTC expenditure
89.0
11.0
Public LTC expenditure
LTC expenditure by purpose - health and social care, 2012
15. Current situation – conclution
Key challenges for LTC reform in Slovenia:
- Demographic aging is faster than the average of EU and OECD
countries
- Fiscal sustainability problem is serious
- High share of disabled/dependent – low indicator of Healthy Life Years
- High growth of private LTC expenditure
- Underdeveloped home care and integrated care
- Underdeveloped ICT, preventive and rehabilitative services (important
to lower the costs of health LTC services)
16. Information on the envisaged LTC reform
Preparation of the LTC reform started 10 years ago!
Since than several drafts of legislative act were prepared
Since 2013 recommendations from EC and OECD
In 2014: developed official statistics on LTC with detailed information
on LTC expenditure and recipients
Since 2014 better collaboration of the Ministry of Health with the
Ministry of Labor, Familiy, Social Affaires and Equal Opportunities
17. Information on the envisaged LTC reform:
planned future financing of LTC services and rights
The starting point of reform: a need for LTC as a (new) social risk
Ensuring a sustainable financing system that needs to be adaptable
and predictable in times
To keep three pilars of funding:
A compulsory public LTC insurance, based on the merged parts of
the existing health and disability/pension insurance currently
intended for LTC
Tax based financing (including the introduction of new special public
source (tax/levy) for LTC provision)
Out of pocket co-payments (and optional voluntary private
insurance)
18. Major issue still remains…
Where to find additional public resources to finance LTC under new
legislation ! (approx. 0,2 % of GDP)
- After the long period of crisis Slovenia is still facing a problem of
fiscal consolidation! It is not possible to get additional resources for
LTC reform from central or local budgets.
- Contribution rates to social security funds are already very high
- Dedicated tax/levy – the idea comes from the envisaged
health financing reform (proposed in the coalition agreement
of current government)
Information on the envisaged LTC reform
19. Source: SORS, Health expenditure and financing ( http://www.stat.si/novica_prikazi.aspx?id=6382)
5 2
65
14
12
3
Central
government
Local
government
Social
security
funds
Private health
insurance
Households
(OOP)
Other private
(corporations
and
nonprofit)
5
2
65
14
12
3
Central
government
Local
government
Social
security
funds
New public
source
(dedicated
tax?)
Households
(OOP)
A replacement of complementary private health insurance with
new public source of funding (dedicated tax/levy ?)
20. - Very high user-charges even for some health-critical
services
- Currently it is urgent to buy private health insurance
because the risk for not having it is too high (95 % of
population with compulsory health insurance also have
private complementary health insurance)
- High operating administration costs of private health
insurance companies
- Flat rate premiums – no income solidarity
Key reasons for the proposed abolishment of the current
system of complementary private health insurance:
21. - It has to replace total amount of resources which are
currently collected by complementary private health
insurance premiums
- It should not burden the labour costs (the proposal is to set
up a tax on net personal income?)
- it should not burden only active population - has to be
obligatory also for pensioners (Important for sustainability
in a long-term)
- Income solidarity
Key features that are important for new public source of
health funding:
22. What would be the effect for public-private mix in
health financing?
The share of public health expenditure in Slovenia before and after the
proposed replacement of current complementary private health
insurance with public source of funding – international comparison, 2012
Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Health Expenditure Database;
own calculation for Slovenia; Note: * Slovenia after the replacement of complementary health insurance with new
public source
86
86
85
85
85
84
84
83
81
80
79
77
77
77
76
75
75
73
73
72
71
71
70
69
68
67
67
65
63
58
55
43
0
10
20
30
40
50
60
70
80
90
100
Netherland
Danmark
SLOVENIA*
Norvey
Croatia
Czech
UnitedKingdom
Luxemburg
Sweden
Romunia
Estonia
France
Italy
Germany
Austria
Belgium
Finland
EU
Spain
OECD
SLOVENIA
Lithuania
Slovakia
Poland
Ireland
Malta
Greece
Portugal
Hungary
Latvia
Bulgaria
Ciprus
Shareintotalhealthexpenditure,in
%
23. The share of public health expenditure in Slovenia before and after the
proposed abolishment of complementary private health insurance and
replacement with public source of funding – international comparison, 2012
Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Health Expenditure Database.
What would be the effect for the share of public
health expenditure in GDP?10.1
9.4
9.0
8.6
8.4
7.8
7.6
7.1
7.1
6.8
6.7
6.7
6.6
6.3
6.3
6.2
6.0
6.0
5.9
5.7
5.6
5.0
4.7
4.7
4.7
4.6
4.0
3.6
3.2
0
2
4
6
8
10
12
The share of public health expenditure in GDP, %
24. In the case of a replacement of current system of complementary health insurance
with a new public source of funding there would be some room to increase private
funding (at least for 0,2-0,5 % of GDP)
Possible options are:
To set up new (reasonable) user-charges
To set up co-payments (at least small co-payments on medicines and technical
appliances and for the first visit at the doctor)
Changing the scope of rights stemming from compulsory health insurance
Other options: (to set up the system of franchises)
Important:
- Taking into account the criteria of accessibility, efficiency and cost effectiveness
- Protection of certain groups of population
- Introducing the method of health technology assessment (HTA) to prevent
investments in inefficient procedures/treatments
There would be some room to increase private
health expenditure…
25. What would be the effect for the share of out-of-
pocket expenditure in THE?
The share of OOP expenditure in THE would increase.
Source: OECD Health Statistics 2014; Eurostat Statistics Database; WHO Global Health Expenditure Database;
own calculation for Slovenia;
6
7
9
11
12
12
13
15
15
15
17
17
17
18
19
19
19
20
20
21
21
22
23
27
27
28
28
32
36
43
49
0
10
20
30
40
50
60
Netherland
France
UnitedKingdom
Luxemburg
SLOVENIA
Danmark
Germany
Norvey
Czech
Croatia
Sweden
Austria
Ireland
Estonia
Finland
Italy
OECD
Romania
Belgium
Spain
EU
Slovakia
Poland
Lithuania
Portugal
Hungary
Greece
Malta
Latvia
Bulgaria
Ciprus
Shareintotalhealthexpenditure,in%
26. New public source of funding HC could be partly dedicated
for LTC!
Public expenditure for LTC as % of GDP, 2012
3.7 3.6
2.4 2.4
2.1 2.0
1.8 1.7
1.5 1.4 1.4 1.3 1.2 1.2 1.2
1.0 1.0 1.0
0.7 0.7 0.6 0.6 0.4
0.3 0.3 0.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Netherland
Sweden
Norvey
Danmark
Finland
Belgium
France
Island
Switherland
OECD(24)
NewZeland
Canada
Austria
SLOVENIJA*
Luxemburg
Lithuania
Germany
Slovenia
Spain
Romunia
USA
Hungary
Poland
Czech
Estonia
Portugal
Source: OECD Health Statistics 2014; IMAD calculation for Slovenia; Note: * Slovenia with additional public
resources for LTC
27. Conclutions
High share of LTC health component in total LTC expenditure
Reform of LTC financing has to be linked to health financing reform (important
is flexibility to move funding between health and LTC system)
Ensuring a sustainable financing system that needs to be adaptable and
predictable in times
In the case of a replacement of complementary private health insurance with
new public source of funding it would be necessary to create new user-
charges and/or copayments for certain services and drugs
New public tax/levy could be partly dedicated to an increase in aggregate
expenditure on health and partly to finance long-term care – to reasses
boundaries between public and private funding at the same time for HC and
LTC