MISSOC Secretariat. Ad hoc report on trends and tendencies in selected fields of social protection. July 2014

Transcription

1 MISSOC Secretariat Ad hoc report on trends and tendencies in selected fields of social protection July 2014

2 Introduction This report was written by the MISSOC Secretariat in replacement of the annual MISSOC Info report as provided for in the technical specifications. It builds on a technical assistance assignment completed by the MISSOC Secretariat in January 2014 the framework of the activities within the Social Protection Committee. The main aim of the present assignment is to provide, in the form of tables, detailed information relating to particular aspects of selected social protection branches, covering both the current state of the law (July 2013) and the results of a comparison with the situation five years ago, at the beginning of the financial crisis. The areas of social protection involved in the analysis were unemployment benefits, minimum income support, health care and child benefits. For each of these subsystems of social protection targeted questions were addressed, relating to one or more detailed categories in the MISSOC tables. In this regard, specific attention was dedicated to the level of benefits, the conditions for entitlement and to specific legislation targeted at people who are supposedly most affected by the crisis. For each of the social protection branches covered, a short text highlighting trends and tendencies observed is added, in the form of the present report. Detailed tables are provided in annex. The analysis is based on a comparison of the data available in the MISSOC Comparative Tables Database for 2008 and 2013, and this for the 32 (EU/EFTA) countries included in that database. The results of the analysis rely completely on the content of the MISSOC Database; no further desktop research was performed. The inherent limitations of the exclusive information source used for this report, in particular the lack of contextualisation of the MISSOC information, combined with the challenges stemming from a comparison over time of these data whereby data change/similarity does not necessarily mean regulatory amendment/standstill, resp. warrant a reservation as to the trends described in this report. 2

3 1. Health care Regarding user charges for visits to the GP and specialists, one can observe a variety of measures taken. Overall, the trend that emerges is one of increased cost sharing for patients. In some countries, user charges were increased, whether they concerned co-payments (e.g. FI, LV, SE) or co-insurance rates (e.g. SI). Other countries introduced new user charges. In Greece, a co-insurance is now applied to outpatient examinations as well as a co-payment in case of such examinations taking place in a public hospital. In Italy, next to the existing patient participation for health services in specialist outpatient clinics, an additional fixed amount is now requested for each prescription. In Ireland, the possibility to avail of specialist services in public hospitals free of charge was restricted to persons with full eligibility, as persons with limited eligibility are now are subject to nominal charges. An interesting case is that of Latvia which abolished the reduction of co-payments for outpatient visits to specialists in case of low income pensioners and significantly increased the co-payments in case of out-patient visits to the general practitioner and specialist. At the same time, Latvia took steps to increase the access of vulnerable categories of persons to health care by extending the categories of beneficiaries of reduced charges in case of home visits and by introducing an annual ceiling for copayments in case of inpatient and outpatient treatment. Hungary saw the abolishment of the visit fee (vizitdíj) and hospital daily fee (kórházi napidíj). A similar picture arises insofar as user charges in case of hospitalisation are concerned. Significant increases can be observed in a number of countries, notably in the Czech Republic, Ireland, Luxembourg and Latvia (co-payments) as well as in Slovenia (co-insurance). Estonia introduced a daily fee as co-payment for inpatient services (in standard accommodation conditions) and a co-insurance in case of inpatient nursing care, while Latvia established a co-payment for surgical operations performed in an operating room during hospitalisation. Some countries, such as Switzerland and (markedly) Latvia, also raised patients participation for non-medical costs related to hospitalisation. Several countries took measures to protect vulnerable groups of persons from financial hardship when accessing health care, notably by extending the categories of patients benefiting from reductions of user charges (BE, SE) or user charges exemptions (BG, LV). In the case of Belgium, however, this went hand in hand with an increase of the income ceiling for entitlement to the preferential scheme. In Iceland, the fee reduction enjoyed by pensioners was itself reduced, in particular for those pensioners aged 67 to 69. 3

4 A number of countries have substantially reformed their legislation dealing with user charges for pharmaceuticals. In Latvia, for example, this has entailed the reduction of the reimbursement categories from four to three, the introduction of two additional lists of pharmaceuticals eligible for reimbursement and the introduction of a prescription fee for otherwise fully covered medicines. In Iceland, patients participation is no longer expressed as a percentage of the costs but instead arranged through annual participation ceilings. Also for pharmaceuticals, an evolution towards increased cost sharing for patients can be observed. Both Denmark and Sweden tightened the reimbursement conditions between 2008 and 2013 by adapting (that is to say, increasing) the expenditure ceilings. Spain introduced higher co-insurance rates for pharmaceuticals, depending on patients income. Decreased reimbursement levels (or levels of State participation) were reported in Finland, Portugal and Sweden. In Ireland, persons with full eligibility are now also subject to prescription charges (previously reserved for persons with limited eligibility). In the same vein, the monthly participation ceiling was significantly increased (from EUR 90 to EUR 144). Latvia introduced an annual reimbursement ceiling. Several countries, such as Spain and Lithuania, made changes to the categories of persons benefiting from user charges reductions/exemptions for medicines. In Spain, for example, unemployed persons who have exhausted unemployment benefit now enjoy full exemption, whereas this is no longer the case for (contributory) pensioners. To secure access to pharmaceuticals for disabled citizens and elderly on low income, Slovakia enacted a quarterly participation ceiling ( 30 or 45 per quarter). 2. Child benefits The bulk of MISSOC countries operate universal, tax-financed child benefit systems. Contribution-funded schemes can be found in only six countries (BE, EL, FR, IT, LI, CH). In ca. one third of the MISSOC countries (CY, CZ, ES, HR, IS, IT, LT, MT, PT, RO), child benefits are income-tested. In half of the MISSOC countries, the child benefit amount varies according to the age of the children. First of all, it should be noted that there were no fundamental or structural changes in the child benefit systems within the EEA and Switzerland. The main characteristics such as the residence or social insurance based character of the schemes have remained the same in all countries. It seems that the crisis has not inspired the national governments to change the basis of their systems. In certain countries, the child benefits system for the selected aspects has not been changed at all. Indeed, in a bit less than one third of all countries, the amounts, conditions and calculation methods for child benefits have remained the same, apart from an indexation of the benefit rates in some of these countries (CZ, FI, FR, LU, MT, NO, PL, SK). In other countries, the lack of indexation of the benefit rates is as such remarkable, as this could also be considered as a policy choice that could be related to the economic circumstances. Rates were not indexed in Austria, Bulgaria (benefits for raising a child under the age of 1 year), the Czech Republic, Estonia, Luxembourg, Malta, Norway and the UK (family element of the Child Tax Credit). 4

5 In the concerned five-year period, some countries have decided to decrease the social protection in the event of family burden in the domain of child benefits. The two main ways to introduce such policy change were the reduction of benefits and the introduction of changes with regard to the conditions for entitlement. As to the level of benefits, certain countries simply reduced the amount of the benefits concerned. In most cases, this reduction took place for all categories of beneficiaries (e.g. overall reduction of benefits in IE). Austria decreased the supplement for large families. In Latvia, the variation of the benefits according to the ranking of the children with higher benefits for higher ranked children - was abolished in favour of a flat-rate benefit for all children based on the rate previously applicable to the first child. As to the introduction or adaptation of income-related conditions, the most important changes were the introduction of income tests in certain countries and the tightening of income-related conditions in countries where those already existed. An income test was introduced in Cyprus for the basic child benefit (whereas in 2008 such income test was only applied to supplementary child benefits and not to the basic child benefits), in Iceland (in 2008 only for certain categories of beneficiaries, but generalised in 2013), in Lithuania and in Romania (for the Family Support Allowance, which is the consolidation of two other allowances). Next to this, several countries adapted the income-related conditions in their systems. In Portugal and Slovenia, the income brackets above which no or reduced benefits are granted were lowered. Other countries chose for an adaptation of the income ceilings combined with the introduction of an assets test (NL), thus tightening the entitlement conditions. Another line of countries took measures to increase the social protection for families with children. The changes in the countries policies were quite straightforward and related to an increase of the benefits and the loosening of the income conditions. Some of the increases are targeted (higher amounts for large families in EE; higher income ceilings for families with three or more dependent children in ES; increase of the large family supplement in SE; double benefits for children with disabilities in BG; higher benefits for children of high-school age in SI; higher benefits for the youngest children in DK 1 ), others are general (e.g. overall increase of benefits in DE and PL). Taking all this together, it is striking that the MISSOC countries have reacted in very varying ways to the challenges of the crisis in the area of child benefit systems. 3. Unemployment benefits It is apparent from the information in the MISSOC Tables Database that a minority of MISSOC countries (ca. one quarter) operate dual unemployment protection schemes whereby, next to an insurance scheme, a means-tested assistance system exists, providing benefits to persons who do not qualify for insurance-based benefits or have exhausted such benefits (separate assistance schemes in AT, EE, FR, DE, IE, MT, PT, ES, UK). 1 Combined with lower amounts for children of the highest eligible age group. 5

6 It is relatively common for unemployment benefit payments to start only after completion of a waiting period. Such waiting periods exist in one third of the MISSOC countries (CY, EE, FI, FR, EL, IE, IT, LI, LT, NO, PL, SE, CH, UK).In some countries, waiting periods only apply in case of wilful unemployment (AT, DK, DE, IS, LV, MT) or are they prolonged in that case (NO, LT). Between 2008 and 2013, some countries have taken measures to lengthen waiting periods (CH, SE) or generalise them (LI), whereas Denmark has reduced them (for self-employed). When it comes to the requirements for accessing unemployment benefits, it appears that the repercussions of the crisis have prompted several countries to relax qualifying conditions and thus make it easier for people to draw unemployment benefits. This could be observed in Belgium and France (shorter qualifying periods combined with longer reference periods for assessing their completion) and Portugal (shorter qualifying period). In other countries, the decrease in qualifying periods went hand in hand with shortened reference periods (HU, LV, SI, SK), mitigating somewhat the picture. Sweden had a series of crisis measures in place between 2010 and 2013, facilitating access to unemployment benefits by counting certain periods double or by prolonging the reference period. On the other hand, some countries tightened the qualifying conditions, such as the Czech Republic (shorter reference periods), Liechtenstein (doubling of the qualifying period) and Ireland. Unemployment benefits are typically short-term benefits. With Belgium as notable exception, the duration of unemployment benefits is limited in all MISSOC countries. Leaving aside some isolated case of increased benefit duration, such as in Italy (with the introduction of the new Employment Social Allowance, AspI) and in Slovenia (for older workers), there is clear trend to shorten the period during which unemployment benefit can be received. Between 2008 and 2013, reductions of the maximum duration could be observed in Switzerland, the Czech Republic, Denmark, Hungary, Ireland, the Netherlands (only for short-term benefit), Poland and Portugal. In some cases (e.g. HU, IE, PT) these reductions can rightfully be called drastic. Unemployment (insurance) benefit rates are typically dependent upon previous earnings, although some countries pay flat-rate unemployment insurance benefits (IE, UK). In around a quarter of the MISSOC countries, unemployment benefit rates also vary according to the duration of unemployment (BE, CZ, EE, IS, IT, LV, PT, SL, SE) with benefit amounts generally decreasing as unemployment lasts longer while in ca. 20% of the States they depend on the duration of insurance (BG, HR, DK, EL, LV, RO) with higher rates for persons with longer insurance careers. Between 2008 and 2013, some countries have increased their unemployment benefits whilst others have taken an opposite approach. Among the former are the Czech Republic, Finland and the Netherlands, whilst Ireland belongs to the group of countries that decreased the unemployment benefit amount. It is interesting to note that in several of the countries that modulate benefit amounts according to unemployment duration, benefit increases can be situated in the beginning of the unemployment period (e.g. CZ), while the decreases affect benefits in case of lasting unemployment (e.g. PT). In Belgium and 6

7 Slovenia, both these elements are present, thus resulting in an intensification of the progressive decrease according to the length of unemployment. 4. Minimum income support (general non-contributory minimum) All MISSOC countries, with the exception of Greece, have some form of general noncontributory minimum benefit in cash. Mostly, the benefits are organised centrally, even if it is common for benefits to be paid out at local level. In some countries, the competency for organising and delivering this type of social assistance is devolved to regional entities (ES, IT), while in other, mainly Nordic countries (e.g. SE, NO) both benefit design and delivery is a matter for the local authorities. Also in Iceland, social assistance is at the discretion of the municipalities, but the authorities are encouraged to follow the guidelines of the Ministry of Welfare insofar as the determination of the amount is concerned. In the past few years, some countries, such as Lithuania, have taken steps to decentralise competency with regard the fixing of social assistance entitlement conditions and benefit amounts, to the municipalities. The Tables comparison between 2008 and 2013 reveals several systemic reforms, such as the 2008 reform in Hungary, transforming the regular social allowance until then qualified as a special non-contributory minimum in case of invalidity into the benefits for persons in active age. The employment substituting component of the latter benefits, intended for those needy non-active persons who are capable of work, could rightly be seen as a general non-contributory minimum. In Greece, recent legislation has introduced a pilot programme called Minimum Guaranteed Income". The programme, which starts in 2014 in two regions, is not only aimed at providing an income support for its beneficiaries, but will also be connected to reintegration policies. The identification of regulatory developments between 2008 and 2013 is, however, severely hampered by the 2010 overhaul of MISSOC Table XI, which saw a complete revision of the table structure combined with a full re-entry of the national data. In those circumstances, a comparison over time of these data becomes a perilous task. The analysis has therefore focused on aspects that remained largely unaffected by the overhaul, i.e. requirements connected to job search, vocational training and behaviour modification. In recent years, increased attention was paid to such requirements in connection with gaining and retaining entitlement to general minimum income support. In many Member States, receipt of the general non-contributory minimum cash benefit is contingent upon participation in activation measures (e.g. CY, DE, LU, LV, NL, NO, SE, UK). In several countries, for example Luxembourg, these take the form of individualised contracts spelling out the commitments of the assistance claimants in terms of job search, training or behaviour modification. 7

8 Such measures may also be aimed towards those with reduced working capacity. In Norway, the National Qualification Programme was introduced, designed to integrate more beneficiaries of long-term social financial assistance in work-oriented activities and securing them a minimum income at the same time. There are special requirements to fulfil in order to participate in this programme, such as having a severely diminished capacity for work and the programme must be necessary and relevant for the successful (re) employment of the applicant. In some countries, recipients of social assistance benefits may be obliged to carry out minor community works (e.g. NL, SK). Participation in activation measures is often obligatory and sanctions are linked to noncompliance, typically consisting of the suspension, reduction or even withdrawal of the benefit payment (e.g. BE, BG, CY, CZ, DK, EE, LT, LU, PL, PT, RO, SE). Recently, several Member States have introduced measures that provide for the continued receipt of the social assistance benefit payment following activation, with a view to stimulating (self-)employment and preventing welfare traps. Lithuania, for example, continues to grant benefits as a stimulator to persons who get off social assistance and into employment. Additionally paid Social Benefit (Papildomai skiriama socialinė pašalpa) corresponds to 50% of the average of the previously paid Social Benefit and will be awarded for six months (along with this measure, the legislature also enacted a gradual reduction of the social benefit amount for long-term recipients). In Ireland, the Back to Work Enterprise Allowance was introduced in order to support longterm recipients of jobseeker s payments and recipients of lone parent and disability payments who are taking up self-employment. Annexes: detailed tables 8