1. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS LONG - TERM CARE INSURANCE THE CASE OF SLOVENIA November 2012

2. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS LTC NEW SOCIAL RISK POPULATION AGING INCREASED SHARE OF OLD AND VERY OLD PEOPLE INCREASE OF DEGENRATIVE AND CHRONIC DISEASES

3. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS 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. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS 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. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS 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).

6. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS 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 combinat ion). 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.

7. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Present System of Long-Term Care in 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 Differenft cash benefits for LTC

8. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Financing of the LTC services and benefits in 2010 Partly from taxes (from the national and municipal budgets) – 18,3%. Partly from social security contributions (provided from compulsory health insurance and compulsory pension and disability insurance) – 56,7%. Partly from the users(privat) contribution (long-term care services are covered fully by public sources only if the user or his/her relatives are unable to pay obligatory contribution) – 25%.

9. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS What is hindering accessibility of LTC? Inadequate financing of long-term care. The existing services and benefits are not connected into a uniform system. A lack of co-ordination between social and health service providers. Inadequate regional distribution and lack of providers of LTC (urban versus rural). Relatively undeveloped services in home (local) environment - which results in additional pressure on the extension of costly hospitalisations and the expansion of institutional forms of LTC. Undeveloped prevention, rehabilitative care and and use of IT.

10. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Starting point of the LTC reform Realisation that the need for long-term care is the new social risk that people should be protected against. Proposal for the introduction of a new compulsory insurance scheme, similar to protection of the entire population against: sickness or injury, disability and old age (pension insurance), unemployment and other social risks.

11. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Key goals of the proposed legislation to increase social security and the quality of life of people who are in need of LTC by improving the accessibility and quality of long-term care services; to introduce solidarity financing of the long-term care area according to the principles of social insurance by introduction of the compulsory social insurance for long-term care; to introduce private insurance to cover part of the costs, (personal payment, higher standard and »hotel costs within institutional care«); to achieve better efficiency and transparency of founds invested in long-term care;

12. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Key goals of the proposed legislation to develop prevention in LTC, to promote rehabilitation in LTC and to promote the use of modern technologies (IT) in LTC; to encourage the responsibility of an individual and his/her family for the provision of an adequate level of LTC; to link long-term care providers in a functionally integrated, rational and effective system; to achieve uniformity of rights among all eligible persons, regardless of the place of residence or type of assistance (institutional or home care);

13. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Beneficiaries and financing of the proposed LTC insurance All who are also compulsory health insured in Slovenia; Insurance should be financed by contributions paid by employers and insured persons themselves (or other persons specified by law); New contribution rates would result from merging of shares, which are currently accounted for long-term care within the contribution for compulsory health and pension insurance; Part of the expenses will be covered by the state budget.

14. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Rights of the insured persons Payment of long-term care services within the standards (ADL, IADL, rehabilitation, learning); Cash benefit for long-term care; Combination of cash benefit for long-term care and services; Right to a personal assistant; Covering the cost of housing adjustmenst; Technical aid for implementation of LTC;

15. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS 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 hours per week. Independante assessment procedure based on 16 different criteria. Part of expenses would be covered through compulsory insurance and part through private insurance or out of the pocket.

16. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Cost estimate at the beginning of the implementation of the Act It is estimated that 45.000 people (according to the situation in 2010) will be beneficiaries according to proposed LTC Act. In 2010, the total costs of proposed long-term care system would be approximately 366.000.000 EUR. 240.000.000 EUR public founds (compulsory insurance) 126.000.000 EUR private founds (private insurance or out of the pocket payment)

17. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS KEY DILEMAS Key question is what type of private founding ? Payment out of the pocket or payment based on private insurance; Compalsory or voluntary private insurance; Complementary or suplementary insurance; Private LTC insurance combined with health insurance or private insurance for LTC only;

18. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS Planned activities regarding preparation of the new proposal of LTC ACT Proposal of the NEW LTC ACT 2013; Adoption in the Parliament end 2013; Inplementation of the new LTC Act in 2015;

19. REPUBLIC OF SLOVENIA MINISTRY OF LABOUR, FAMILY AND SOCIAL AFFAIRS LTC-Slovenia THANK YOU davor.dominkus@gov.si