Long-term care insurance - an idea revived?

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

Long-term care is a long-standing problem in Slovenia. Currently, funding is split between the social care sector, pension insurance and compulsory health insurance. Demographic changes caused a sharp increase in persons needing assistance, which represents a burden both for the public sources of funding as well as for the families. In 2006 a draft law on long-term insurance was ready for submission to the government but then withdrawn due to lack of consensus - currently the debate goes on.

Recent developments

Economic and financial crisis coupled with the quickly developing demographic changes is triggering the need for immediate responses to the most important challenges, also in the social and health sectors. What was previously known about the continued ageing of the Slovenian population will soon develop into a serious challenge for the society. This fact has certainly contributed to the raised awareness of this topic and to its return to the policy agenda. The original idea has been updated with comments, proposals and amendments from the previous public discussion (in 2006/7) (see HPM 9/2007, "Act on insurance for long-term care").

The most important policy change since the proposal of 2006 is that the new proposal, announced publicly by the minister, will now be co-ordinated and submitted by the Ministry of Labour, Family and Social Affairs (MLFSA). The previous proposal was prepared and then submitted for preliminary discussion by the Ministry of Health. As the MLFSA is financially stronger and has a direct interest in relieving the burden on the social sector because of long-term care, it is expected to be a strong actor in the process of its adoption.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

The current ratings are based on the conceptual framework of the previous proposal and on the announced basic outline of the forthcoming one. In the next report, we will be able to report in greater detail.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government: Change of leading ministry from the health to labour, family and social affairs

• Providers

Stakeholder positions

The Ministry of Health in the previous term of the government was unable to achieve consensus around the proposal that they had prepared with the assistance of the participating key stakeholders. With the change of government this topic again achieved considerable policy attention. The main move is in the co-ordination role in the preparation of this law moving to the Ministry of Labour, Family and Social Affairs. The main ideas and approaches remain the same. It remains to be seen whether there will be a continuation of the same outlines proposed in the early texts or if there are going to be some additional solutions proposed.

 

Actors and positions

Government
Ministry of Health	very supportive		strongly opposed
Ministry of Finance	very supportive		strongly opposed
Health Insurance Institute of Slovenia	very supportive		strongly opposed
Providers
Nursing Chamber of Slovenia	very supportive		strongly opposed
Association of Social and Nursing Homes of Slovenia	very supportive		strongly opposed
current    previous

Influences in policy making and legislation

The main development in the preparation of a new law on long-term care insurance is that it moved from the Ministry of Health to the Ministry fo Social Affairs, which means that it may gain in political weight due to the greater influence the the MLFSA has inside the government.

Particular details of the proposal have not yet been revealed. It is expected that the total payroll contribution for this insurance will be 0.5%. There should be the same employer and employee split as with the health insurance. The similarity with the present arrangements in pension insurance would be in the establishment of a second pillar for long-term care insurance, which would act as a private fund with own acquired rights related to the contributions paid. The main uncertainty that needs to be clarified is to what extent this will influence present contributions for health insurance. Should they remain unchanged, this insurance will represent an additional burden on the payrolls.

Actors and influence

Government
Ministry of Health	very strong		none
Ministry of Finance	very strong		none
Health Insurance Institute of Slovenia	very strong		none
Providers
Nursing Chamber of Slovenia	very strong		none
Association of Social and Nursing Homes of Slovenia	very strong		none
current    previous

Positions and Influences at a glance

Expected outcome

It is expected that this proposal will revive the debate on the need for a long overdue legal regulation of this important area of social care and insurance. As this debate has been lingering on for more than a decade and the problem of long-term care for an ageing population has grown to significant proportions, the present proposal should provide a solid ground for a broader public debate. The positive incentive is definitely the present economic and financial crisis, which will strengthen the political side - the proposers of the new law. The negative impact will be in the lack of readiness for the debate both on the side of the employers as well as the employees.

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

The current ratings are based on the conceptual framework of the previous proposal and on the announced basic outline of the forthcoming one. In the next report, we will be able to report in greater detail.

References

Sources of Information

1. Draft proposal of the Law on Long-term Care Insurance, Ministry of Health of the Republic of Slovenia, 2006.
2. Public announcement of the Ministry of Labour, Family and Social Affairs on 29 September 2009 about the future launch of a new proposal of the Law on Long-term Care Insurance.
3. Health Care and Health Insurance Act. Official Gazette of the Republic of Slovenia 9/1992.

Reform formerly reported in

Act on insurance for long-term care Process Stages: Legislation

Author/s and/or contributors to this survey

Tit Albreht

Suggested citation for this online article

Albreht, Tit. "Long-term care insurance - an idea revived?". Health Policy Monitor, October 2009. Available at http://hpm.org/survey/si/a14/2