Agnieszka Sowa

Tax Wedge and Skills: Case of Poland in International Perspective

The project intended to explain the causes of high structural unemployment in Poland. It is generally believed that the high level of unemployment in Poland is determined to a decisive degree by factors such as a restrictive labor code, high degree of unionization and/or the unemployment benefits system. The research provides macroeconomic and microeconomic evidence that the employment consequences of a tax wedge can be more severe for the low-skilled. Consequently, it argues that a high tax wedge can be potentially more harmful in countries abundant in this kind of labour. These results should send a strong message to policymakers, especially those in Central and Eastern Europe. The project was financed by a research grant provided by the Ministry of Education and Science, Poland and conducted by a team of CASE researchers: Marek Gora (coordinator), Mateusz Walewski, Artur Radziwill and Agnieszka Sowa. It was completed in the first quarter of 2006.

Investing in Health Institutions in Transition Countries

This study presents an overview of the health care systems in postcommunist countries with its resources and operations, in addition to proposing steps that should be taken in order to overcome the health crisis associated with transition and increase the effectiveness and efficiency of health care systems. At the beginning of the 90s, the crisis of transition had a significant impact on the low level of funding in health care, declining in proportion to the fall of GDP or even faster. The continued crisis and slow recovery also affect the low political preference for funding the health care sector during the GDP allocation process. There is excessive competition from other important socio-economic goals and health care frequently loses the battle.

Health Status, Functional Limitations and Disability: Changes in Poland

This article contains an overview of the available data and indicators on health status, morbidity and disability in Poland. It also presents the changes in the level of functional and legal disability and aims to show the reasons for these trends.

The System of Long-Term Care in the Czech Republic

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.

Health promotion for older people in Lithuania: Between bureaucratic and financial constraints

The health system in Lithuania has a strong focus on hospital treatment. Overall, there is a lack of sufficient funds explicitly devoted to public health. This country report draws upon several national reports focused on the Lithuanian health system and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Lithuania, specifically for older adults. As suggested in our review, the key problems in public health services in Lithuania, including health promotion for older persons, are the bureaucratic and financial constraints, a lack of intersectoral cooperation, staff shortages and capacity problems. The implementations of public health initiatives greatly depend on the political will and the government’s ability to implement policies, which are still weak in Lithuania. Moreover, the public health legislation lacks clarity and fails to provide an adequate base for local-level evidence-based interventions. Concrete action plans, as those recently developed in the area of healthy aging and health inequalities, are needed to provide guidance for health promotion among older adults.

Health promotion for older people in Hungary: The need for more action

The health status of the Hungarian population is relatively poor, compared to other countries of similar socio-economic development. Unhealthy diet, smoking, alcohol consumption and low physical activity are important risk factors leading to cardiovascular system diseases – the main cause of death in the general population and among people 65+ in Hungary. Yet, the OECD health statistics indicate that Hungary belongs to a group of countries with the lowest per capita expenditure on prevention and public health and that the level of this expenditure is decreasing. In Hungary, there is no legislation specifically dedicated to public health (Public Health Act) and the matters of public health and health promotion are regulated by various legal documents. The directions for public health policy are set in National Public Health Programmes. To address the problem of the ageing population, in 2009 a National Ageing Strategy (2009–2034) was adopted. The Strategy stresses the need to develop programmes for prevention, rehabilitation and health promotion for older people. The main actor in public health policy is the central government, namely its agency the National Public Health and Medical Officer Service. Also, territorial governments play an important role, though they have limited financial capacity to spend on health promotion and they need to rely on external unstable sources of funds when implementing health programmes for older people. NGOs might be important partners for health promotion along with public authorities. However, they require more financial and infrastructural support to be able to perform more activities in the field of health promotion for older people.

Healthy ageing in Germany – common care and insurance funding. Institutional and financial dimension of health promotion for older people

In Germany responsibilities for health promotion and prevention lies with a multitude of different actors and institutions. The institutional arrangement of health promotion is shaped by the German federal structure of the state on the one hand and by a health care system that is characterized by divided responsibilities between governmental organisations, self-administered bodies and non-governmental organisations on the other hand. Although federal-level programs are successfully implemented in the country, the attempt of the Federal government to consolidate and clarify responsibilities in the public health area meets resistance. The Preventive Health Care Act from 2015 is an attempt to strengthen health promotion, its effective impact will be for the future to show. Health promotion activities are initiated and provided by a variety of institutions: governmental, self-administered and voluntary (NGOs) often based on networks form. They cover activities on federal, Lander and local level. The Federal Ministry of Health and federal health agencies (specially BZgA) play an important role in this field. They created a number of health promotion regulation and activities initiatives which added to disease and addiction prevention. In health promotion for older people (HP4OP) programs, there is also a number of regionally and locally oriented initiatives. In this paper, we outline main features of the HP4OP activities in Germany with regard to institutions and financing mechanism. In addition, we describe health-targeting programmes/projects indicated as good practices:(a) established and developed in Germany and (b) provided by the European Commission with significant participation of German institutions. The multitude and variety of HP4OP programs differentiate positively German health system from other health systems in ageing countries.

Political will against funds deficiency: Health promotion for older people in Bulgaria

In Bulgaria, health promotion and health education have received less attention in comparison to other public health areas, which has resulted in a small health promotion budget and consequently, in limited health promotion initiatives. This country report draws upon several national reports focused on the Bulgarian health system, and other country specific sources in order to outline the major institutional and financing challenges for health promotion in Bulgaria, and specifically for health promotion for older adults. As evident from this review, the programs and activities oriented toward health promotion for older adults are inconsistent and incomprehensive. The existing programs are mostly in the form of isolated small-scale projects aimed at enabling older workers to reach the statutory retirement, or supporting retired citizens to maintain their health and well-being. Effective strategic vision, coordination and stable funding in the area of health promotion for older adults is indispensable for helping Bulgarian seniors to live longer and healthier.

A Greek tragedy of our time? Institutional and financial dimension of Health Promotion for Older People in Greece

Despite the numerous legislative documents and public health institutions in Greece, the country lacks a comprehensive and robust long-term policy perspective in the public health area. The traditionally higher priority attached to curative care than to public health actions, is the major reason of the shortcomings. This country report draws upon several national reports focused on the Greek health system, and other country-specific sources in order to outline the major institutional and financing challenges for health promotion in Greece, and specifically health promotion for older adults. The paper is based on the method of narrative literature review. The findings show that health promotion actions for elderly persons do take place in Greece but mainly in urban areas and/or within the framework of EU-funded projects. Government efforts are required to stimulate coordinated public health interventions at the local level focusing on the positive effects of health promotion. The health promotion programs that are successfully implemented, should receive the necessary government support to assure their long-term sustainability.

Health status of older people. Evidence from Europe

The objective of this article is to show the health status of the older population throughout European countries and indicate the data needs for a comprehensive comparative analysis of health status and its risk factors. The article briefly discusses definitions of health status in older age and presents adequate health status indicators. It discusses life expectancy, healthy life expectancy, disability adjusted life expectancy, the main causes of death as well as the prevalence of long-term illnesses, multimorbidity and functional health limitations across European countries, pointing out regional differences of the health status of older people. Next, several behavioural risks of poor health occurring in older age are shown: smoking, alcohol overuse and falls. The article concludes by demonstrating the need for more detailed, comparative and standardized data on the health status of older people across European countries, presenting sex and age-specific morbidity and health limitations as well as health risks.