Abstract

Background: Social policies and health care systems in countries from Central and Eastern Europe (CEE) are often considered to be very similar. However, a closer look reveals some marked differences and, among other things, the issue of a long-term care (LTC) represents one of the newest examples of divergence in the region. In the Czech Republic the comprehensive reform of social services took place in 2007. It has introduced the new scheme, namely the universal care allowance for people who are dependent on the help of others. In contrast, in Poland the meanstested system of social services still prevails and generates strong pressure on the dependant people and their caregivers. Moreover, even though the growing number of dependent elderly people represents a challenge to the health care systems in both countries, only limited efforts have been made to improve the coordination of health and social services.

Objective: The objective of this presentation is to empirically evaluate and compare policy developments in Poland and the Czech Republic as well as to examine the LTC reform options. Given the predominance of informal care in both countries, the macro-micro analytical perspective is adopted. Consequently, the following questions will be posed: 1. How have the changes on the macro policy level affected households’ strategies concerning the LTC in Poland and the Czech Republic? 2. What are the constraints and determinants of the LTC reforms associated with households’ structures, their needs and opportunities?

Data and methods: The systematic and comparative analysis is based on the data compiled from many sources: national databases (i.e. Czech and Polish), national reports, relevant legislation and blueprints (proposal for change) prepared by different political actors. In addition, data from the SHARE database. Since data for the Czech Republic and Poland were collected in two points in time (2006 and 2012), it will be possible to test whether or to what extent the reform of the LTC policy in the Czech Republic changed the situation of the private households.

Results: The reform in 2007 brought the Czech Republic to the forefront of the LTC policies in the CEE region. However, some pre-reform predictions concerning the usage of formal home care have not been fulfilled because most of the dependent people opt for informal care instead of services offered by the registered providers. It is evident that – so far, at least – Poland has employed remarkably different policies: the incremental changes, such as tightening the eligibility criteria, are directed towards increasing the involvement of private resources in the LTC systems.

Policy implications: Implementation of policies concerning the LTC should take into account specific determinants of informal care in the CEE countries, such as high rate of coresidence of elderly parents and their adult children. The importance of this aspect is crucial with regard to policies aiming at increasing the supply of the home-based formal LTC i.e. by raising the number of providers operating on the quasi-markets.

Slides