How do pension and healthcare systems frame long‐term care policy? Comparison of the Czech Republic and Poland

Abstract

This article compares changes in long-term care (LTC) policies in the Czech Republic and Poland. The article challenges the view that countries from Central and Eastern Europe can be treated as a homogenous group with regard to LTC. To account for the dissimilarity between the countries, the article adopts Ranci and Pavolini's (2015, p. 274) recent recommendation that changes in LTC policies must be analyzed in the context of reforms of traditional and more expensive social policies, such as pensions and healthcare. Using the approach of political institutionalism, the article argues that these two countries' pension and healthcare systems established different opportunity structures and strategic preferences for change in LTC policy. Consequently, the persistent difference between the two countries over the past decade is explained by how their pension and healthcare systems frame LTC policy. The article also finds that "functional equivalents" to social care programs that are instituted either in pensions (i.e., lowering the retirement age, which impacts the supply of informal care) or in healthcare (i.e., increasing the availability of nursing homes) should be included in the analysis of LTC policy development.

When policy entrepreneurs fail: Explaining the failure of long‐term care reforms in Poland

“…This reform attempted to improve the capacity of municipalities to collect the money necessary to finance stays in social assistance homes when the resident's family does not contribute 11 . The resident's assets, including home ownership, would be included in the calculation of the costs of the stay and it could ultimately lead to a foreclosure (Łuczak, 2018, p. 1401). This project also included vouchers that people in need of care could exchange against services (Anon1, 02/12/2019).…”

“…This double architecture opens avenues for fraud and inconsistencies. For example, similar residential care services provided within the healthcare and social assistance systems are subject to different co‐payment rules (and hence less or more expensive for users) (Łuczak 2018, p. 1405).…”

“…As an explanation of the policy inertia in the LTC domain in Poland, Łuczak (2018) previously hypothesized a ‘lock‐in’ effect: as the post‐communist transformation engendered large‐scale reforms in core welfare state domains (such as pensions), political actors are reluctant to reform other sectors (Łuczak, 2018, p. 1397). Up until now, population ageing has been discussed mainly in the context of pension reform—as a threat to the financial sustainability of the pension system, not as a care‐related issue (Duszczyk, Lesińska, & Matuszczyk, 2019, p. 132).…”

“…Up until now, population ageing has been discussed mainly in the context of pension reform—as a threat to the financial sustainability of the pension system, not as a care‐related issue (Duszczyk, Lesińska, & Matuszczyk, 2019, p. 132). Furthermore, the fragmentation of LTC‐related policies across different policy domains makes substantial reform difficult (Łuczak, 2018, p. 1397). This complexity allows the article to identify overarching social policy‐making mechanisms, rather than focus solely on field‐specific dynamics.…”

“…However, the idea did not receive support from the PO‐led government. Cancelling the nursing benefit was considered too risky politically, given public opinion's dissatisfaction with previous changes in the pension system, including the 2011 increase of the legal retirement age (Łuczak, 2018, p. 1403).…”