【世界银行】波兰长期护理服务的战略评估-2025_271页_15mb

Strategic Review of Long-Term Care Services in Poland

Core Content

This report provides a comprehensive analysis of the long-term care (LTC) system in Poland, focusing on its current state, challenges, and strategic recommendations for improvement. It was commissioned by the Ministry of Development Funds and Regional Policy (MFiPR) in collaboration with the Ministry of Health (MZ) and the Ministry of Family, Labour and Social Policy (MPRiPS), with the aim of supporting the development of a more effective and sustainable LTC system in the context of Poland's aging population.

Main Viewpoints

• Demographic Shifts: Poland is undergoing significant demographic changes, including increased life expectancy, a large aging baby boomer generation, and low birth rates, leading to a growing elderly population and higher dependency ratios.
• Current LTC Landscape: LTC is predominantly informal (80% of total provision), with formal care accounting for the remaining 20%. The system is fragmented and lacks coordination between health and social sectors.
• Key Challenges: The LTC system faces challenges in governance, financing, human resources, quality, and infrastructure. These include limited legal definitions, fragmented funding, insufficient workforce, and low quality oversight.
• Strategic Recommendations: The report outlines three main reform areas to accelerate LTC development: a unified legal definition, increased financing, and a quality framework. These are considered the foundational steps for future reforms.

Key Information

Demographic and Social Context

• The 65+ population accounts for 19.5% of the total population, expected to rise to 24.6% by 2040.
• The 80+ population is 4.2%, projected to reach 8.7% by 2040.
• Life expectancy in 2023 was 73.4 years for males and 81.1 years for females.
• The old-age dependency ratio is projected to double from 30 per 100 working-age people in 2022 to 60 in 2060.
• The elderly population is at higher risk of poverty and often lives in substandard housing conditions.
• There is a disparity in life expectancy across regions, with Małopolskie reporting the highest and Łódzkie the lowest.

LTC System Overview

• Formal LTC is provided by both health and social sectors.
• Inpatient care includes DPS (Dom Pomocy Społecznej) and ZOL/ZPO (Care and Treatment Facility, Nursing and Care Facility).
• Day care services are available in the social sector through Dzienny Dom Opieki Medycznej (DDOM) and shelters.
• Community and home-based care is available in both sectors, with the health sector focusing on home-based nursing and mechanical ventilation.
• Cash benefits are provided to seniors, persons with disabilities, and their caregivers, playing a vital role in supporting LTC.

LTC Demand and Supply

• The National Population Census 2021 estimates that 14% of the population is certified as disabled.
• There is a gap between LTC demand and supply, especially in informal care.
• The sandwich generation (ages 45–64) is under increasing pressure to provide care for both children and elderly parents.
• Regional disparities exist in LTC availability and quality, with Wielkopolskie having the highest healthy life expectancy and Lubelskie the lowest.

Key Challenges

1. Governance:

   • Lack of a unified legal definition for LTC.
   • Fragmented funding and poor cross-sectoral coordination.
   • Insufficient data collection and oversight.

2. Financing:

   • Limited public expenditure on LTC.
   • Need for increased sustainability of government programs.
   • Current LTC expenditure as a share of GDP is below the EU average.

3. Human Resources:

   • Shortage of formal and informal caregivers.
   • Limited workforce capacity and skill levels.
   • Increasing demand for care due to aging and chronic diseases.

4. Quality:

   • Low standards and inconsistent service quality.
   • Need for a unified quality framework and monitoring system.

5. Private Sector:

   • Limited engagement and potential for public-private partnerships.
   • Opportunities for expanding LTC services through private investment.

6. Infrastructure:

   • Housing conditions for seniors and persons with disabilities are often substandard.
   • Need for better infrastructure to support LTC services.

Strategic Solutions

• Governance:

  • Develop a unified legal definition of LTC.
  • Enhance cross-sectoral coordination and regulatory oversight.
  • Establish a centralized data system for better planning and monitoring.

• Financing:

  • Increase public funding for LTC.
  • Improve financial sustainability of government programs.
  • Expand EU funding through ERDF and ESF to support LTC development.

• Human Resources:

  • Strengthen caregiver training and retention.
  • Promote informal care support through policy and community engagement.
  • Address the workforce shortage by increasing recruitment and improving working conditions.

• Quality:

  • Implement a national quality framework.
  • Introduce quality indicators and monitoring mechanisms.
  • Enhance consumer quality index (CQ-index) to measure service effectiveness.

• Private Sector:

  • Encourage public-private partnerships (PPPs).
  • Promote private investment in LTC infrastructure and services.
  • Expand care services through private providers.

• Infrastructure:

  • Improve housing conditions for seniors and persons with disabilities.
  • Develop adequate facilities to meet rising demand.
  • Enhance accessibility and safety in LTC environments.

Summary of Recommendations

• A legal definition of LTC is essential to standardize services and improve governance.
• Increased financing is necessary to ensure affordability and accessibility of LTC services.
• A quality framework must be established to monitor and improve service delivery.
• Human resource development should be prioritized to meet the growing demand for LTC.
• Public-private partnerships can help expand and diversify LTC services.
• Infrastructure improvements are critical to support the delivery of LTC services effectively.

Conclusion

Poland’s LTC system is at a critical juncture, facing increasing demand due to demographic changes and socioeconomic factors. The report emphasizes the need for strategic reforms in governance, financing, human resources, quality, and infrastructure to build a more integrated, sustainable, and effective LTC system. These reforms are seen as the foundation for future improvements and align with broader policy goals aimed at supporting the aging population.

Appendix: Methodology

The report uses a combination of statistical data, surveys, expert interviews, and policy analysis to evaluate the current LTC system and propose strategic reforms. It also incorporates SWOT analysis, demographic projections, and cost-benefit assessments to guide the development of recommendations.