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This recommendation is based on the arguments of policies ineffectiveness, contradictory objective and evidence-based outdated character. 3.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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