Inflow and Outflow of Informal Care Workers in the Case of Poland

Labour Market and Public Policy Implications

Aleksander Surdej

Cracow University of Economics

Outline of presentation

Part I - Social Care System in Poland

Part II - Public Policy towards Social Care

Part III - Conclusions

Part I

Social Care System in Poland

• The need of care is felt in every third Polish household;

• The need is particularly strong in families with little children (69%) and among the elderly (65+) - 9%;

Demand for Care in Poland

Public Expenditures on Family and Children (% GDP)

Chart Public expenditure on family and children as % GDP in selected countries and EU 15, 1980-2001

0

0,5

1

1,5

2

2,5

3

3,5

4

4,5

5

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Source: OECD (2004) Social Expenditure

% G

DP

Denmark

Finland

Germany

Poland

Spain

United Kingdom

EU 15

Institutions for Child Care in Poland

Number of crèches and kindergartens

1412

z

591

9350

428

8501

377

7746

15

1028

0

2000

4000

6000

8000

10000

12000

14000

1990 1995 2000 2004 Prywatne 2004

żłobki przedszkola

Kindergartens

Crèches

Number of Children in Crèches and Kindergartens

Year

Crèches Kindergartens

Total

For 1000

children aged

0-3

Total

For 1000

children

aged

3-6

1990 116,500 42 856,600 328

1995 68,400 23 773,200 356

2000 52,800 20 685,400 388

2004 45,900 20 644,100 416

Principles of Institutional Child Care in Poland

● Decentralized − responsibility of local governments for financing and managing child care

● Co-payment − parents pay approx. 30% of the costs of daily care

● Gradual privatization− private entities can create and run crèches and kindergarten

− parents in private crèches and kindergarten can get financial allowance from the local government

● Participatory management − the opinions of parents are an important factor in evaluation of the care performance

Structure of the Polish Society by Sex and Age in 2002 and 2030

Population of Poland will decrease by 2.5m by 2030, that is by 6%

Ageing of Polish Population

Dependency rate (number of persons aged (65+) for 1 person aged between (19-64)

year

Future trend

Forecast:

median

50% range prediction

80% range prediction

Source: Matysiak A., Nowok B., 2006

Number of persons aged 65+ will increase from 5m in 2004 to 8.5m in 2030

Care provision

0

20

40

60

80

100

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

age

%

Women Men

Source: Wóycicka I., Rurarz R., 2007, Ludność sprawująca opiekę, in: Kotowska I.E, Sztanderska U., Wóycicka I. (ed.) Aktywność zawodowa i edukacyjna a obowiązki rodzinne, Wydawnictwo Scholar.

Users of Different Types of Care Provision in Poland

Institutional care Care in Family Network

Care in Nuclear Family

People with higher education

Living in large cities

Living in one generational households (unitary families)

People with at most high education

Living in smaller cities and in the countryside

Living in a multifamily households and having in the household a person aged 50 and more

People living in small cities and villages

People with at most high education

People living in one family households

Current System of Care Provision in Poland

• Polish households (families) provide care in a do-it-your-self style – ¾ of households take exclusive care of children and 4/5 of the elderly;

• External care is provided chiefly by relatives. Members of closer and more distant family provide approx. 4/5 of the amount of child care and almost 95% of the elderly care;

• Voluntary support of non-relatives is of marginal significance;

• The services of care providing institutions account for 12-15% of child care and only 2% of the elderly care;

• Paid market care providers are almost non-existent,

Outflow of Care Workers

• Outflow of Legal and Qualified Care Workers(the monitoring of this type of migration to EU countries is made through registration of number given certificates about professional qualifications.)

Period 2004-2008 – 6,000 medical doctors and approx. 8,000 nurses;

• Outflow of Illegal and Mostly Simple Care Workers

It is estimated that in the care services in old EU-15 works approx. 15% of 1m seasonal, (commuting and temporary) emigrants

Table Occupational situation and education of migrants to Great Britain -2006)

2000-2003 2004-2006** 2000-2003 2004-2006** 2004-2006** 2004-2006**

i 20,5 20,6 19,3 18,6 20,7 20,2

13,4 13,6 12,8 11,9 14,2 14,2Managers/ specialists%) 9,0 10,4 9,2 7,1 42,4 68,3

Średnio- Skilled workers

zawody (%) 43,2 14,9 27,7 15,3 23,2 14,6Semi-routine

occupations (%) 19,8 33,2 17,7 24,5 15,9 9,8Routine

occupations (%) 27,9 41,6 45,4 53,1 18,5 7,3* Czechy, Estonia, Litwa, Łotwa, Słowacja, Słowenia i Węgry.** Obejmuje okres od III kwartału 2004 do III kwartału 2006

Poles Other migrants from Central Europe

Source: Drinkwater et al., (2006)

Age of completing education

Migrants from other Europe

From English speaking countries

Average years of education

Medical and Care Personnel Shortages in Poland (as of 2008)

Free vacancies for care specialists:– 4 113 – medical doctors;

– 3 541 – nurses;– 312 – midwives;– 86 – dentists

Number of nurses per 1,000 inhabitants in 2007

Poland – 4.9;

Norway – 14.84

Great Britain – 12.12

Sweden – 10.24

Ireland – 15.12

Hungary – 8.85

Preferred Care Givers to the Elderly Institution TOTAL For Respondents who do

NOT have children alive For Respondents who

DO have children alive Social Assistance Institutions

57.6 48.9 58.5

Family 54.1 54.0 54.1 Social organisations 21.3 18.4 21.6 Church 15.4 10.4 15.8 Someone else 5.5 4.0 5.6 Difficult to say 7.2 13.3 6.5

Source: Czekanowski, P., Rodzina w życiu osób starszych i osoby starsze w rodzinie (The family in the lives of the elder and the elder in the family) in Synak, B.(ed.), Polska starość, Wydawnictwo Uniwersytetu Gdańskiego, Gdańsk 2003, p.170.

Expectations with Regard to Elderly Care

Institutional Elderly CareInstitutions of Elderly Care in Poland in 1990-2000

1990 1995 1998 2000 Item

Number of stationary care centers in Poland

Elderly Care Center and Houses

(TOTAL):

629 831 960 936

- For the elderly 100 157 201 199

- For durably ill 308 346 259 217

- For mentally ill 218 278 418 405

Inhabitants of the elderly care center

and houses

65,760 76,487 81,950 80,634

Posts for 10,000 persons 17.8 20.7 21.6 21.1

Number of persons on the waiting

list

13,426 10,453 12,378 9,372

Daily Elderly Care Centers

Houses 200 223 191 236

Posts 9,603 11,898 10,032 12,883

Źródło: Rocznik Statystyczny, Warszawa 1998, s 265 Warszawa 1999, s 294, 502: Rocznik statystyczny, Warszawa 2000, s 271-272, 486; Rocznik Statystyczny RP, Warszawa 2001, s 280-281,497 za Trafiałek, 2003, str. 238 .

Immigrants on the Polish Labour Market

• Foreign workers account for less than 1% of all employed;

• Dual labor market:– Legal employment – approx. 20 thousand

(linked to the presence of foreign companies);– Illegal employment – from 50,000 to 0.3m

(concentrated in construction, agriculture, home care and palliative care)

Public Policy towards Social Care

• Sector of child care– Attempts to extend institutional child care to rural

areas;– More generous and longer financing of maternity

leave;

• Sector of elderly care– Failed attempt to introduce an elderly care tax;– Quality control of an increasing number of „elderly

social care houses”– Modest financing of rehabilitation elderly care

Directions of Change in Elderly Care

1. Development of alternative forms of local care especially in rural areas – neighborhood care, social cooperatives etc.),

2. Increasing role of local governments;3. Support for training of nurses and the development of quality

certification system) 4. Subsidizing costs in order to reduce financial access barrier

Care insurance Support for development of local social services

At Crossroads: the Future of Arrangements of Care in

Poland• Uncertainty about the capacity of Polish

families to provide the care (although it is socially preferred care provision model)– Factors of change: ageing of society, transformation of

family, labor market mobility;

• Incomplete institutionalization of (especially) elderly care with confusion about the instruments of public responsibility– Government as provider, government as payer, government

as quality guard.