世界银行-波兰长期护理服务的战略评估（英）-2025_270页_4mb

Strategic Review of Long-Term Care Services in Poland

Core Content

This report, prepared by the World Bank in collaboration with the Polish Ministry of Development Funds and Regional Policy, presents a comprehensive analysis of the long-term care (LTC) system in Poland. It outlines the demographic, health, and socioeconomic context, the current structure and organization of LTC services, and the key challenges and proposed solutions for improving the system.

Main Viewpoints

• Demographic Shifts: Poland is undergoing a significant demographic transition, marked by increased life expectancy, a large aging baby boomer generation, and persistently low birth rates. By 2040, the 65+ population is expected to rise to 24.6%, and the 80+ group to 8.7% of the total population.
• Health Challenges: The elderly face high risks of chronic diseases such as cardiovascular disease (CVD), cancer, and diabetes, which are leading causes of morbidity and mortality. The pandemic has also exacerbated health concerns among seniors.
• Informal Care Dominance: Approximately 80% of LTC in Poland is provided informally by family, friends, and community members. However, this informal care burden is increasing due to changing family structures and the growing elderly population.
• Formal Care System: Formal LTC services are delivered through both health and social sectors. These include inpatient care (DPS, ZOL, ZPO), day care services (DDOM), and home-based care (home nursing, mechanical ventilation).
• Fragmented Governance: The LTC governance system is underdeveloped, with a lack of cross-sectoral coordination, unclear definitions of LTC needs, and a complex legal framework involving over 70 pieces of legislation.
• Resource Constraints: LTC is constrained by limited human resources, insufficient financial support, and fragmented data systems. These factors hinder the quality and efficiency of care delivery.
• Regional Disparities: There are significant regional variations in LTC demand, supply, and quality, with disparities in life expectancy and healthy life expectancy across regions.
• Need for Reform: The report identifies three key reforms necessary to improve LTC in Poland: legal definition, increased financing, and a quality framework. These are the first phase of LTC development.

Key Information

Demographic, Health, and Social Context

• The 65+ age group accounts for 19.5% of the population, with the 80+ group at 4.2%.
• Male life expectancy is 73.4 years, and female life expectancy is 81.1 years.
• The 65+ population is projected to increase to 24.6% by 2040.
• The 2021 National Population Census estimates that 14% of the population is certified as disabled.
• Life expectancy and healthy life expectancy are diverging, with women facing higher comorbidity risks.
• Regional disparities in life expectancy and healthy life expectancy are evident, with Wielkopolskie reporting the highest and Lubelskie the lowest in 2021.
• The old-age dependency ratio is expected to double from 30 per 100 working-age people in 2022 to 60 in 2060.

LTC System in Poland

• LTC is primarily informal (80%) and formal (20%).
• Formal LTC services are provided in the health and social sectors.
• In the social sector, services include residential homes (DPS) and family care homes (RDP).
• In the health sector, services include ZOL (care and treatment facilities) and ZPO (nursing and care facilities).
• Day care services are available in the social sector.
• Community-based services are part of the social sector's care package, while home-based care is included in the health sector.
• Cash benefits are a critical component of LTC support for seniors, persons with disabilities, and their caregivers.

Key Challenges and Solutions

• Governance: Fragmented and underdeveloped. Needs a unified legal definition and better coordination between health and social sectors.
• Financing: Limited and unsustainable. Requires increased public funding and better financial flows to ensure access and quality.
• Human Resources: Shortage of qualified staff and informal caregivers. Needs better training, recruitment, and support mechanisms.
• Quality: Lack of oversight and standardization. A new quality framework is essential to improve service delivery.
• Private Sector: Limited engagement. Public-private partnerships are recommended to enhance service availability and efficiency.
• Infrastructure: Insufficient housing and care facilities. Needs investment in housing and care infrastructure, particularly for the elderly and disabled.

Summary of Key Challenges and Solutions

Strategic Recommendations

• A legal definition of LTC is required to streamline governance and ensure consistency across health and social sectors.
• Increased financing will support access, quality, and efficiency in LTC delivery.
• A quality framework is essential for monitoring, data use, and improving service standards.

These reforms will lay the groundwork for future improvements and policy development in the LTC system.

Conclusion

Poland faces significant challenges in providing high-quality, affordable long-term care due to demographic shifts, resource limitations, and fragmented governance. The report emphasizes the need for legal, financial, and quality reforms to address these issues and support the development of a more integrated and effective LTC system. The proposed solutions are the first phase of a broader strategy aimed at achieving the LTC vision outlined in the national policy framework.

Appendix: Methodology

The report is based on a strategic review informed by data from various sources, including the National Health Fund (NFZ), GUS (Statistics Poland), and the Ageing Working Group (AWG). It includes a SWOT analysis, data on LTC demand and supply, and an assessment of current and future needs. The methodology also involves interviews, surveys, and analysis of existing legal and financial frameworks.