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LONG - TERM CARE INSURANCE THE CASE OF SLOVENIA

Explore the case of long-term care insurance in Slovenia in November 2012, focusing on the challenges of an aging population, increased chronic diseases, and the existing system. Learn about the mix of public and private funding, financing models in EU countries like Germany and Luxembourg, and the proposed reforms to enhance accessibility and quality of long-term care services.

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LONG - TERM CARE INSURANCE THE CASE OF SLOVENIA

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  1. LONG - TERM CARE INSURANCE THE CASE OF SLOVENIA November 2012

  2. LTC NEW SOCIAL RISK POPULATION AGING INCREASED SHARE OF OLD AND VERY OLD PEOPLE INCREASE OF DEGENRATIVE AND CHRONIC DISEASES

  3. Recipients of formal LTC by age groups - Slovenia (2009) and the OECD (2008) Source: OECD Health Data 2012 (publication OECD Help Wanted, 2011); For Slovenia: data collected under AWG 2012 (Questionaty of the European commission), calculations by UMAR.

  4. Financing of LTC in EU MIX OF PUBLIC AND PRIVATE FOUNDING Dedicated social insurance (DE, LU); Taxsation (Nordic countries); Mixed financing system (BE, FR, SI)

  5. LTC financing in Germany 1. Universal, statutory LTC insurance 2. LTC provided to everybody who is insured in the statutory health insurance scheme. 3. Contributions to the LTC budget (pay-as-you-go insurance system ) are paid by: - employees (0.975) and the employers (0.975): 1,95% of the income, (childless individuals pay an additional contribution of 0.25%) - pensioners: 1,95 % of the pension, - unemployed (contribution for LTC is covered by unemployment ins.) 4. LTC budget covers costs (cca 50 % of total LTC costs) of: - institutional care, - home care (benefits in kind, cash benefits or a combination). 5. Means teasted social assistance when LTC insurance benefits do not suffice. 6. More than 30 % of total LTC costs is covered by out – of - pocket payments.

  6. LTC financing in Luxembourg 1. Universal long-term care insurance. 2. Any person enrolled in a compulsory or voluntary health insurance scheme is fully insured against the risk of dependency (LTC). 3. Eligibility is based on need, with no conditions of income. 4. Contributions to the LTC budget are paid by: - active and retired individuals: 1,4 % of the income (i.e., wages, revenue, pension, income from an inheritance) - the state (cca EUR 140 mio), - electricity sector. 5. LTC budget covers costs of: - institutional care (accomodation costs excluded), - home care (benefits in kind, cash benefits or a combination). 6. Those who cannot afford to pay the full-cost of long term residential care may be eligible to public social assistance (Fonds National de Solidarité).

  7. Present System of Long-Term Carein Slovenia Slovenia does not have a uniformly organised system of long-term care for elderly, chronically ill, disabled and other persons who need help in performing ADL and IADL. LTC is privided by: Services within the social care system Services within the health care system Differenft cash benefits for LTC

  8. Current financing of the LTC services and benefits Partly from taxes (from the state and municipal budgets) – 18,3 %. Partly from social security contributions (provided from compulsory health insurance and compulsory pension and disability insurance) – 56,7 %. Partlyfromtheusers(privat) contribution (long-term care services are covered fullyby public sources only if the user or his/her relatives are unable to pay obligatorycontribution) – 25 %.

  9. What is hindering accessibility of LTC? Inadequatefinancingoflong-term care. The existing services and benefits are not connected into a uniform system. A lackofco-ordination between social andhealthserviceproviders. Inadequateregionaldistributionandlackofprovidersof LTC (urban versusrural). Relativelyundevelopedservices in home(local) environment - which results in additional pressure on the extension of costly hospitalisations and the expansion of institutional forms of LTC. Undevelopedprevention, rehabilitativecareandanduseof IT.

  10. Starting point of the LTC reform Realisationthattheneed for long-term care is the newsocial risk that peopleshould be protected against. Proposalfortheintroductionofa new compulsory insurance scheme, similar to protectionoftheentirepopulationagainst: sickness or injury, disability andold age (pensioninsurance), unemployment and other social risks.

  11. Key goals of the proposed legislation to increase social securityandthequalityoflifeofpeoplewho are in needof LTC byimproving the accessibility andqualityof long-term care services; to introducesolidarityfinancingofthelong-term careareaaccording to theprinciplesof social insurancebyintroductionof thecompulsory social insuranceforlong-term care; to introduce private insurance to cover part ofthecosts, (personal payment, higher standard and »hotel costswithininstitutionalcare«); to achievebetterefficiencyandtransparencyoffoundsinvested in long-term care;

  12. Key goals of the proposed legislation to developprevention in LTC, to promoterehabilitation in LTC and to promotetheuseof modern technologies (IT) in LTC; to encouragetheresponsibilityofanindividualandhis/herfamilyfortheprovisionofanadequatelevelof LTC; to linklong-term careproviders in a functionallyintegrated, rationalandeffectivesystem; to achieveuniformityofrightsamongalleligiblepersons, regardlessoftheplaceofresidence or typeofassistance (institutional or home care);

  13. Beneficiaries and financing of the proposed LTC insurance Allwho are alsocompulsoryhealthinsured in Slovenia; Insurance shouldbe financed by contributions paid by employers and insured persons themselves (or other persons specified by law); New contributionrateswouldresult from merging of shares, which are currentlyaccountedforlong-term carewithinthecontributionforcompulsoryhealthandpensioninsurance; Part of the expenses will be covered by thestatebudget.

  14. Rights of the insured persons Payment of long-term care services within the standards (ADL, IADL, rehabilitation, learning); Cashbenefitforlong-term care; Combination of cashbenefitfor long-term care and services; Right to a personal assistant; Coveringthecostofhousingadjustmenst; Technicalaidforimplementationof LTC;

  15. Entrance, assessment and funding ENTRANCE THRESHOLD - beneficiaries need assistance of another person in the performance of ADL and IADL for more than three months and more than 3,5 hoursperweek. Independanteassessment procedure based on 16 differentcriteria. Part ofexpenseswouldbecoveredthroughcompulsoryinsuranceand part throughprivateinsurance or outofthepocket.

  16. Cost estimate at the beginning of the implementation of the Act It is estimatedthat 45.000 people (according to thesituation in 2010) willbebeneficiariesaccording to proposed LTC Act. In 2010, the total costs of proposedlong-term care systemwouldbeapproximately366.000.000 EUR. 240.000.000 EUR publicfounds (compulsoryinsurance) 126.000.000 EUR privatefounds (privateinsurance or outofthepocketpayment)

  17. KEY DILEMAS Key question is what type of private founding ? Payment out of the pocket or payment based on private insurance; Compulsory or voluntary private insurance; Complementary or suplementaryinsurance; Private LTC insurance combined with health insurance or private insurance for LTC only;

  18. Planned activities regarding preparationof the new proposalofLTC ACT Proposalofthe NEW LTC ACT 2013; Adoption in theParliamentend 2013; Inplementationofthenew LTC Act in 2015;

  19. LTC-Slovenia THANK YOU davor.dominkus@gov.si

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