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Disabilitywelfareen.doc
POLICY BRIEF DISABLED RELATED POLICIES IN MOLDOVA: OPPORTUNITIES AND CHALLENGES
Contents: 1. Summary.2 2. Current aims of policies related to the disabled people of working age.3 3. Review of the disable d related welfare programmes and policies .3 4. Analyses, lessons and benchmarking good practices. 13 5. Conc lusions and Policy options .14 6. References.16
Alexandru Hajdeu 95 "A" str., CHISINAU, MD 2005, Moldova
(373 22) 212 816, fax (373 22) 225 257 [email protected], www.CReDO.md
1. Summary
A more detailed analysis and policy options
is contained in the Romanian version of the
There are numerous barriers that people with
disabilities face as they seek to achieve
The structure and analysis follows the public
daunting, are discrimination, fear, ignorance,
prejudice, accessibility, and equal rights to
The paper reviews the current policies regarding the disabled, evaluates these policies outcomes and the achievement of indented objectives. A comparison with OECD relevant policies is performed with the aim to benchmark good examples and successful policies to learn and provide the comparative basis for the improvement of the portfolio of the disabled related policies in the country. We advise the authorities to: 1. keep this portfolio, considering implementation improvement:
- disability tax credit; - disability pension; - nominative compensation; - work disability benefit; - disabled care benefit; - social care service; - professional trainings ; - medical insurance services.
- institutional treatment; - work disability health rehabilitation; - disability employment preferences; - ban on employment of the
This recommendation is based on the arguments of policies ineffectiveness, contradictory objective and evidence-based outdated character. 3. Introduce new policies:
2. Current aims of policies relat ed to the disabled people of working age
Laws of the country define disability as the
full or partial failure of one or several
human functions: intellectual, physical, and
participation in labour market. The national
policy with regard to the disabled persons of
working age is to create non-discriminatory
living conditions and take active measures to
insure their rehabilitation and integration
into the society and their participation in the
There are t hree generic situations for the
disability [p.161, Social Security Policy,
The legislation creates the framework for the
months evolves into a situation a) or the
3. Review of the disabled related welfare
created over the period of 1996-2002. The
programmes and policies
various forms of disability has continuously
grown. In 2005 it reached 3, 72% of the total
population which is around 190 000 persons.
protection, medical services, rehabilitation, labour market
1 Unless otherwise specified, the graphs have been
developed based on the information from Department
categories (sets criteria for eligibility
of Statistics Annual Reports (‘00, ’01, ’02, ’03, ’04, ‘05), Centre for Public Health and Sanitary Management Annual Reports (‘00, ’01, ’02, ’03, ’04,
% of the population with disability Persons with disability and take up rate
Persons with disability receiving disability pensions
Primary disability per 100 000 population
disability types is not available at the
moment, however a rough estimate provide
for 25% of the disability of the children that
working age (congenital disability). Of the remaining, disability resulted from work
conditions represent around 40% with rest
The disaggregated statistics on the causes of
the permanent disability provides that the
rapidly, as one of the factors for growth
Prof essional illnesses represent a very small
persons living under the poverty line, the
disability benefit is viewed as an income to
Types of primary causes for disability on yearly basis
‘05), Social Insurance Office (CNAS) Annual Reports (’04, ‘05).
- macro - effort and institutional
pension or disability benefit is a part of the
Social insurance budget major expenditure
line is the pensions programme. Disability
Social Insurance Budget, MDL
insurance obligatory contributions and 20%
There are 3 major programmes that are cash
The key principle for the social insurance
- support for care services for the disabled
insurance against the insured risks and 35%
Benefits effort for disability, MDL Pension system
Cash benefit/pension for the disability and
The institutional structure for the disability
welfare delivery services involves central
largest programmes of the Social Insurance
authorities and local authorities, is provided
by public and private institutions and organisations.
Graph 8. Institutional framework for disability related welfare programmes 2
Hospitals, policlinics; CNAM – Medical Insurance Company (contracts medical services), CNAS – Social Insurance Office (cash benefits); Social Assistance Department (SAD) of local authorities; MoHSP – Ministry of Health and Social Protection, Cabinet – the Government , CREMV – Centre for Disability Expertise.
Cash benefit programmes are drafted by MoHSP and administered by central authorities that include CNAS, CREMV and banks; finances come from Social Insurance budget approved by the Parliament;
Medical services are drafted by MoHSP and provided by family health doctors, policlinics and hospitals that are contracted by CNAM; finances come from Medical Insurance budget approved by the Parliament;
Social services are drafted by MoHSP and provided by SAD of the local authorities; finances come from state budget by MoHSP;
Employment and labour market programmes are drafted by Ministry of Economy and Labour administered through Employment Office (financed through CNAS and Social Insurance Budget) and Labour Inspectorate; finances come from Social Insurance budget and state budget approved by the Parliament.
- Overview of disability related programs
to the social insurance. In both cases the
contributions of the employees. The social
insurance budge t contains roughly 8 big
programmes, of which disability benefits is
enhances the income of the disabled. To this
end Tax Code recognises (art.20) that all
recipients, including disability pensions and
Cash payments for the disability as % of all social programmes
Tax Code provides (art.33) that persons with disabilities have tax breaks for the annual
(around average nominal monthly salary),
which is 4 times higher than the tax break
for any other person in Moldova. The tax
breaks create the conditions that if the
persons with disability if relied only on
income from social benefits, no taxes would
Nominative compensations for comunal services
Cash benefits or pensions for disability are
a. Cash benefits/pension for disability. The
programme objective is to compensate the
(Social Insurance Office) in cooperation
income due to the loss of labour ability of
Expertise ) that determines the degree of
disability fitting the qualified individuals
Disability benefit is category based non
into 3 categories and with banks that make
means -tested. It has two forms: contributory
and non-contributory based benefit schemes.
In case of the contributory based benefit the
disability benefits payments. The take up
amount depends on the employment history
and is generally higher by 25-30% as compared to those that have not contributed
Pension programs 2006, thousands MDL
expenditures for gas, electricity and other
driven body it has 33 territorial offices and
communal services. It also contains a cup
examined annually , deciding on permanent
personal files to determine the disability is
the responsibility of the persons that claims
the disability. In case of the person that
holds the medical insurance it is included in
(Social Insurance Office) in cooperation
the insured medical police, whereas, in the
case of the uninsured individual the costs
beneficiaries of the compensations based on
amount for the medical investigations tops
the individual files of the persons with
to the average monthly nominative salary.
disabilities and benefits are paid monthly.
As the figure below shows the disability
different, however generally is comparable
benefit amount is averagely 3 times less than
but less than the disability pension. The take
the subsistence level and is considerably
below the average nominal monthly salary
consider that the disability area confronts
c. Work related temporary disability benefit.
with the moral hazard phenomenon and the
The objective is to provide a benefit during
number of the persons with the disability
Work related disability benefits, MDL Correlation of pension, disability benefits and subsistence
Work related temporary disability benefit is
category based and non means-tested benefit
that is contributory. The Labour Incident
Benefit for temporary work disability, MDL
CNAS. There are two options as relevant:
certain categories, including persons with
disabilities to cope with season related
Benficiaries work related disability benefit Institutionalisation programme
In the last case the amount of the work
related disability benefit is averagely around
which is 3 times higher than the general
The administration of option a) is a joint
of benefits), whereas the administration of
option b) is under the responsibility of
The programme provides for the home care
services through social assistants and nurses.
The programme is administered by the local
authorities. Home care services do not target
specifically the persons with disabilities but
Social services are provided as alternative
depends on the socially vulnerable persons
effort for the persons with disability. Social
authorities. Local authorities request budgets
Protection and hire social assistants as 1 per
10-15 socially vulnerable persons. Generally
it includes the elderly, children and other
categories. More detailed statistics are not
c. Benefit for the care of the disabled. The
a. institutional treatment of the disabled
necessary social care for the disabled within
Ministry of Health and Social Protection
The programme helps a narrow ca tegory of
various forms of severe disability (including
specifically intellectual disabilities. The
treatment. The usually cover persons with
amount is 3 times lesser than the disability
severe forms of disability that need a special
benefit. The programme is category based
based benefit. The compensations are paid
Insured by state budget for obligatory medical services, %
(Social Insurance Office) in cooperation
with banks that make up payments. CNAS supplies banks with the lists of the beneficiaries of the compensations based on the individual files of the persons with disabilities and benefits are paid monthly.
d. Work related disability rehabilitation
For the case of work related disability,
The statistics show that 50% of the persons
administered by CNAS on the basis of the
Government, the rest have other means to
purchase or acquire the medical insurance
the other cash benefits. Persons receive a
sanatorium rehabilitation treatment ticket
Number of persons with disability and covered by state provided medical insurance
rehabilitation programme. The take up rate or the coverage is not known exactly.
Medical services include for the disabled
a. medical services for the work related
distribution of medical insurance policies
employed persons contribute to the medical
Medical insurance policies cover primary
health services (10 generic groups), medical
medical insurance police benefit from a set
of the insured medical services. Persons
investigations) and hospital services for up
with disability who that do not have the
to 10 days (including the medicine). The
medical insurance police, based on their
medical insurance police, therefore, cover
prior employment, are insured by the funds
the most generic medical needs. Opinion of
the experts’ opinions is that the medical
needs for the disabled have special needs that differ in some substantial part.
The implementation of the provision is the
Types of medical services provided to the disabled as % to other groups
responsibility of the employers with the
monitoring and supervision by the Labour
Inspectorate carries out ad hoc inspections
and considers complaints received by the
Law on social protection of the persons with
disabilities, insured individually or through
consultations and ambulatory investigations
with primary health services being least
The implementation of the provision is the
cooperation with the Unemployment Offices
with the monitoring and supervision by the
Inspectorate carries out ad hoc inspections
and considers complaints received by the
facilities that create positive measures for
(training, temporary unemployment benefit,
labour market matching, labour marketing
do not target specifically or particularly
programmes supply training for low skills
professions (bookkeeper, sewing operator,
computer skills, secretary, repair works ,
and/or intellectual disability in private or
absence of disability targeted activation
programmes the unemployment within the disabled must have been very high,
4. Analyses, lessons and benchmarking
comparing that to the maximum 14% of the
good practices - Review of the Disability Policies in Europe
The approach to disability could register an
Disability represents an important part of the
social policy in Europe. Macro expenditures
compensations/entitlements and “social
within the limits at lower edge in case of
medical model develops policies requiring
compensation for the disability generally
classify themselves as disabled with 1/3 of
them with severe disability [p.24, OECD].
The disability rate in Moldova is higher and
provisions for the “mainstreaming”, “equal
opportunity”, “non-discrimination” and
supply activation policies for the disabled
emigration is considered, in both cases the
Policies vary in their approaches towards the
disabled, the comparable data on Moldova is
not available, however judging solely on the
income provided from the exiting sources,
securing their income as compared to the
OECD countries the disabled in 40% to 65%
disability related benefits between 10-35%,
income at 40% and therefore most probably
more than ¾ or more of the disabled must
secure their income from the social benefits.
3 Official statistics states that 27% of the population
live below poverty line, judging on the disabled persons considering exclusively the disabled benefits
provide that all are under the poverty line. The reality
Compensa disability substitute employme
Examples of models of active work-related
supported preference work policy substitute supported work policy 11. Ban on unclear employme disincentive 5 . Conclusions and Policy options - evaluation summary of the existing objective recommenda
A good part of the disabled live under the
comparable to the tax credit. The tax credit
is still below the poverty line. The effect of
considerations should be given to raise the
tax credit to at least above the poverty line.
The policy is the backbone of the welfare for
the disabled. The effect of the policy is
amount of the pension is considerable low
Reduce scope institution
the poverty line, considerations should be
severe forms
given to increase it and be provided for the
treatment need cure, substitute with policy 2,
approach and therefore the social aspects of
Nominative compensations for the disabled.
The policy is important for the disabled
below the poverty line. The exact situation is
compensat
unclear; therefore means -tested principle
disability accident insurance
could be introduced to exclude those who
rehabilitati compensatio
Work related temporary disability benefit.
http://www.dol.gov/odep/archives/fact/supportd.htm
5 http://www.worksupport.com/ and in Appendix 1
The policy is evaluated positively, however
participation in active labour programmes.
advisable to consider the substitution with
The scope of the policy should be reduced to
about the steps that should be taken to tackle
the issues and problems with reference to
supporting the conclusions and factors to be
complementary and in strengthening of the
cash payments for the disabled care services.
The portfolio of current policies has the
approach could be justified in the case of the
contingent disability; however, as evidence
considerations should be given to substitute
shows prove not to be sufficient in case of
with the work disability payment system for
the work-related and illness disabilities.
the sickness, where the persons suffered
could access resources to chose their own
rehabilitation strategy rather than the one
current portfolio contains only one policy
that does not in reality target the disabled
combined with the active labour programme.
(policy 10). In this respect, the evidence and
provides us with a ray of possible options,
specifically applicable to the case of illness
The evidence shows that a combination and
better results for the integration of the
disabled, securing greater income for the
The policy effect is unclear, few examples
considered the alternative policies of the
The ideal policy portfolio would include:
Active employment progra mmes, including
The policy does not specifically target the
- targeted professional training combined
employee gains skills and confidence, the job
coach gradually spends less time at the worksite.
Enclave Model-A small group of people with
6 . References
disabilities (generally 5-8) is trained and supervised among employees who are not
disabled at the host company's work site.
Persons in the enclave work as a team at a single
work site in a community business or industry.
Initial training, supervision, and support are
supervisor, who may work for the host company
Mobile Work Crew-A small crew of persons
with disabilities (up to 6) works as a distinct unit
and operates as a self-contained business that
generates employment for their crew members by selling a service. The crew works at several
locations within the community, under the
supervision of a job coach. The type of work
usually includes janitorial or groundskeeping.
Reports, 2003, 2004, 2005, Chisinau, Moldova.
Small Business Model--Within a small business,
disabilities, but not more than the number of
employees without disabilities. The small
business operates like any business, generating
Ability: Policies to Promote Work and Income Security for Disabled People, Paris, 2003.
Analysis: Concepts and Practice, 4th edition, Pearson, Prentice Hall, 2005.
selection of laws on social protection and disability, www.justice.md.
Appendix 1 Examples and models of active employment programmes Individual Placement Model- A person with a disability is placed in a job in a community business which best suits his/her abilities and preferences. Training is provided on the job site in job skills and work related behaviors, including social skills, by a job coach. As the
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