Tài liệu hạn chế xem trước, để xem đầy đủ mời bạn chọn Tải xuống
1
/ 156 trang
THÔNG TIN TÀI LIỆU
Thông tin cơ bản
Định dạng
Số trang
156
Dung lượng
4,59 MB
Nội dung
EconomicImplications
of ChronicIllnessandDisability
in EasternEuropeandtheFormerSovietUnion
Edited by Cem Mete
Economic ImplicationsofChronicIllnessandDisability
Disability is an important issue for the transition countries ofEastern
Europe andtheformerSoviet Union. Not only is a significant portion
of their population either in poor health or disabled—with implications
for labor force participation and productivity—but their aging demo-
graphics project an increase inthe share of disabled people, raising
concerns about the sustainability of social protection programs. Thus,
if these heavily resource-strapped countries fail to deal in an efficient
manner with disabilityand health issues in their population, they could
face serious challenges to their efforts to achieve stronger economic
growth and improved living standards.
Because theeconomic drivers and costs of poor health status and
disabilities in this region are not well documented, Economic Implica-
tions ofChronicIllnessandDisabilityinEasternEuropeandtheFormer
Soviet Union aims to close this gap by leveraging household survey
data from a large number of transition countries, analyzing the poverty-
disability relationship andthe linkages between disabilityand employ-
ment, earnings, children’s school enrollments, and adults’ time-use
patterns.
Altogether, disability appears to have stronger negative effects on
the economicand social well-being ofthe population in these countries
as compared with industrialized countries. The main reasons are the
prevalence of a large informal sector, the relatively weak targeting
performance ofthe existing social assistance programs, andthe lack
of broad-based insurance mechanisms to protect individuals against
loss of income due to unexpected illnesses.
Addressing these weaknesses is the challenge facing policy makers
and the population at large inthe region, through the definition and
enactment of a deep, well-coordinated, cross-sectoral reform agenda.
This book will be useful for policy makers and development officials
working to improve living standards intheEasternEuropeand the
former Soviet Union.
The World Bank
ISBN 978-0-8213-7337-8
SKU 17337
This study is part of a series undertaken by theEuropeand Central Asia
region ofthe World Bank. The series draws on original data, the World Bank’s
operational experience, andthe extensive literature on the Region. Poverty,
jobs, trade, migration, energy, and productivity will be among the topics covered.
This report is part of a series undertaken by theEuropeand Central Asia Region
of the World Bank. The series covers the following countries:
Albania
Armenia
Azerbaijan
Belarus
Bosnia and Herzegovina
Bulgaria
Croatia
Czech Republic
Estonia
FYR Macedonia
Georgia
Hungary
Kazakhstan
Kyrgyz Republic
Latvia
Lithuania
Moldova
Montenegro
Poland
Romania
Russian Federation
Serbia
Slovak Republic
Slovenia
Tajikistan
Turkey
Turkmenistan
Ukraine
Uzbekistan
ECONOMIC IMPLICATIONS OF
CHRONIC ILLNESS AND
DISABILITY IN
EASTERN EUROPEAND THE
FORMER SOVIET UNION
ECONOMIC IMPLICATIONS OF
CHRONIC ILLNESS AND
DISABILITY IN
EASTERN EUROPEAND THE
FORMER SOVIET UNION
Edited by Cem Mete
2008 The International Bank for Reconstruction and Development / The World Bank
1818 H Street NW
Washington DC 20433
Telephone: 202-473-1000
Internet: www.worldbank.org
All rights reserved.
1 2 3 4 11 10 09 08
This volume is a product ofthe staff ofthe International Bank for Reconstruction and Development / The
World Bank. The findings, interpretations, and conclusions expressed in this paper do not necessarily reflect
the views ofthe Executive Directors ofThe World Bank or the governments they represent.
The World Bank does not guarantee the accuracy ofthe data included in this work. The boundaries, colors,
denominations, and other information shown on any map in this work do not imply any judgement on the part
of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such
boundaries.
Rights and Permissions
The material in this publication is copyrighted. Copying and / or transmitting portions or all of this work
without permission may be a violation of applicable law. The International Bank for Reconstruction and
Development / The World Bank encourages dissemination of its work and will normally grant permission to
reproduce portions ofthe work promptly.
For permission to photocopy or reprint any part of this work, please send a request with complete informa-
tion to the Copyright Clearance Center Inc., 222 Rosewood Drive, Danvers, MA 01923, USA: telephone:
978-750-8400; fax: 978-750-4470; Internet: www.copyright.com.
All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the
Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail:
pubrights@worldbank.org.
ISBN-10: 0-8213-7337-4
ISBN-13: 978-0-8213-7337-8
e-ISBN-10: 0-8213-7338-2
e-ISBN-13: 978-0-8213-7338-5
DOI: 10.1596/978-0-8213-7337-8
Library of Congress Cataloging-in-Publication data has been requested.
The Report Team and Acknowledgments xi
Key Findings and Future Research Directions xiii
PART I A REGIONAL OVERVIEW 1
1. Introduction 3
Cem Mete with Jeanine Braithwaite and Pia Helene Schneider
Regional Context 4
Different Definitions, Different Prevalence Rates 5
Main Causes ofDisabilityinthe Region 9
Employment andDisability 9
Heterogeneity among the Disabled 12
Earnings Disadvantage ofthe Disabled Is Larger in Transition Countries 12
Poverty andDisability 14
Does Employment Protect the Disabled from being Poor? 16
Health Shocks, Employment, and Poverty 17
Social Protection Transfers andthe Disabled 17
Disabled Children’s Limited Opportunities to Build Human Capital 19
Other Nonmonetary Costs of Disability: Caring for the Disabled 22
Appendix I: Disability-Related Questions in Available Household Survey Data 25
Appendix II: Basic Information on Time-Use Surveys 28
Appendix III: Proxies for DisabilityandChronic Conditions Used in
the Remaining Chapters 29
Notes 30
Contents
v
vi Contents
PART II COUNTRY STUDIES 33
2. Measurement ofDisabilityand Linkages with Welfare, Employment, and Schooling 35
Kinnon Scott and Cem Mete
Introduction 35
Measuring Disability 36
Incidence of Limited Physical Functioning and Health 41
To What Extent are Disabled Individuals Poor, Less Educated, and
Out ofthe Labor Force? 48
Conclusion 56
Appendix I: Health, Disability, and Physical Functioning Questions in
URPS, Waves 1, 2, and 3 58
Notes 65
References 65
3. The Impact of Health Shocks on Employment, Earnings, and Household
Consumption in Bosnia and Herzegovina 67
Cem Mete, Huan Ni, and Kinnon Scott
Introduction 67
Bosnia and Herzegovina Context 68
Data 70
Empirical Framework 70
Results 72
Conclusions 80
Notes 81
References 82
4. Health Disabilities and Labor Productivity in Russia in 2004 85
T. Paul Schultz
Introduction 85
Institutional Change and Uncertainties ofthe Transition: Mental Disabilities 87
Descriptive Statistics ofthe Russian Survey Population 89
A Conceptual Framework to Guide the Econometric Analysis 98
Empirical Findings 100
Conclusions 108
Appendix 110
Notes 114
References 116
Contents vii
5. TheImplicationsof Poor Health Status on Employment in Romania 119
Cem Mete and Shirley H. Liu
Introduction 119
The Context: Romania in Transition 121
Data and Descriptive Trends 122
Results 123
Conclusions 129
Appendix 131
Notes 135
References 135
Box
Chapter 1
1.1 Defining Disability 6
Figures
Chapter 1
1 WHO Definition ofDisability 7
2 Various Definitions ofDisability Incidence in Uzbekistan 7
3 Prevalence ofDisability by Age Group 8
4 Prevalence ofChronicIllness by Age Group 8
5 Probability of being an Employee/Wage Employee 10
6 Employment Rates of Disabled and Nondisabled Individuals 11
7 Educational Attainment and Employment of Those with
Congenital Disability Versus Other Disability 13
8 Disabled and Chronically Ill Wage Employees Earn Less 13
9 Relationship between Household Wealth andDisability at
Various Life Stages 14
10 Disability Rates by Consumption-Based Poverty Status 15
11 Disability Rates by Asset-Based Poverty Status 16
12 Percentage of Disabled and Nondisabled Individuals inthe Poorest
Quintile ofthe Consumption Distribution 16
13 Persons Receiving Disability Benefits per 100,000, in 2003 18
14 Distribution ofDisability Pension Beneficiaries by Household Consumption 19
15 Distribution ofDisability Pension Beneficiaries by Household Consumption 20
16 Enrollment Rates of 16- to 18-Year-Olds 21
17 Percentage of Individuals Spending Time Assisting Family Adult, and
Time Spent 23
18 Who Takes Care of Disabled Household Members? 24
viii Contents
Chapter 2
1 Incidence ofDisability Using Various Definitions in Uzbekistan 37
Chapter 4
1 Economic Activity of Russian Population, 2004 90
2 Proportion of Russian Population with a Pension, 2004 91
Chapter 5
1 Quality of Water and Public Health Services in 21 Transition Countries 120
2 Quality of Water and Public Health Services in 21 Transition Countries 121
Tables
Chapter 2
1 Indicators of Physical Functioning 38
2 Characteristics ofthe Panel and Full Samples 41
3 Incidence of No and Full Limitations by Domain of Physical Functioning 42
4 Correlation of Scores for Domains of Physical Functioning 43
5 Disabilityand Physical Functioning 44
6 Alternative Measures ofDisabilityand Physical Functioning 45
7 Correlations of Alternative Measures ofDisability to Official
Disability Status 46
8 Probability of Having Official Disability Status 47
9 Consumption and Disability: Log of per Capita Consumption Is
the Dependent Variable, OLS Coefficients, and Standard Errors 49
10 Gross Enrollment Rates by Economic Region in Uzbekistan. 2002 to 2003 50
11 Probability of School Enrollment: Children Age 7–14 51
12 Probability of School Enrollment, Ages 15–18 52
13 Years of Schooling Obtained 54
14 Probability of Being Economically Active 55
Chapter 3
1 Correlation among Indicators of Health andDisability 72
2 Household Heads: Sample Statistics, Means, and Standard Deviations 73
3 The Effect of a Change in Household Head’s Health on His or Her
Hours Worked 74
4 Effect of a Change in Household Head’s Health on Labor Supply
and Earnings 75
5 Comparison of Household Situations before and after Health Shocks 76
6 Effect of a Change in Household Head’s Health on Per-Capita
Household Consumption 77
7 Marginal Effects of Changes in Household Heads’ Health on
their Children’s Schooling 78
8 Effects of Decomposed Changes in Household Head’s Health on Change
in His or Her Hours Worked 79
Chapter 4
1 Russian Longitudinal Monitoring Survey for 2004: Labor Market
[...]... segment ofthe population is employed inthe informal sector (making it difficult to collect insurance premiums from them) 00 -Disability- FM.qxd xvi 1/25/08 8:59 AM Page xvi EconomicImplicationsofChronicIllnessandDisabilityinEasternEurope and the Former SovietUnion Another example is the finding that in Bosnia and Herzegovina, after the onset ofthe disability, the decline inthe number of hours... IllnessandDisabilityinEasternEurope and the Former SovietUnion standing ofthe reasons why various indicators produce the trends that they do, one can improve the way we identify the most vulnerable groups inthe population The cross-country evidence confirms the sharp age gradient inthe reporting of health ailments, especially for the reporting ofchronic illnesses (figures 3 and 4) An interesting... At the beginning ofthe project, a critical issue that the team sought guidance on was how to sharpen the focus ofthe proposed work, since very few (quantitative) papers have xi 00 -Disability- FM.qxd xii 1/25/08 8:59 AM Page xii EconomicImplicationsofChronicIllnessandDisabilityinEasternEurope and the Former SovietUnion been written on the broader topic ofthe economics ofdisability using... insights into our understanding ofthe challenges involved in defining and measuring disabilities Pia Helene Schneider also contributed to the overview chapter, focusing on the main causes ofdisabilityintheEasternEuropeand Central Asian countries, and policy implicationsofthe observed trends Lucian Pop provided useful advice on the nature of social protection programs and data sets inthe region,... ImplicationsofChronicIllnessandDisabilityinEasternEurope and the Former SovietUnionand from formal and informal employment (in addition to dropping out ofthe labor force) determine whether the disabled will benefit from an economic boom.22 Heterogeneity among the Disabled It is useful to recognize the heterogeneity among the disabled population in this context, both because the diverging trends in. .. steeply by age with implications for employment and productivity, as discussed next xiii 00 -Disability- FM.qxd xiv 1/25/08 8:59 AM Page xiv EconomicImplicationsofChronicIllnessandDisabilityinEasternEurope and the Former SovietUnion Linkages with Employment, Earnings, and Poverty The linkages between disabilityandeconomicand social outcomes of interest tend to be stronger in transition countries... 1/23/08 1:32 PM Page 4 EconomicImplicationsofChronicIllnessandDisabilityinEasternEuropeandtheFormerSovietUnion age of 9 percent in 2003, even though employment levels in many transition countries remain below the EU-15 average of 65 percent.1 Failing to deal with disability issues or dealing with them in an inefficient manner can be very costly—especially for the rapidly aging transition countries... to the onset of a new chronic disease At the individual level, considering the evidence that the employment consequences of being disabled worsen over time, there is a need to examine both the duration ofdisability compensation, as well as the capacity (in terms of skills) and incentives for the individual to reenter the labor force Nonmonetary Costs ofDisabilityandChronicIllness There are significant... tackle inthe future The excluded topics include the social integration of disabled individuals, the status and shortcomings of institutionalized care inthe region, alternative home care and community care models, transport and infrastructure, detailed sectoral perspectives,3 discrimination,4 and cost-benefit analysis of prevention against certain types of disability. 5 Regional Context Under the Soviet/ Yugoslav... 6 EconomicImplicationsofChronicIllnessandDisabilityinEasternEuropeandtheFormerSovietUnion BOX 1.1 Defining DisabilityDisability is an umbrella term that can refer to quite different health ailments, depending on the context Alternative approaches to measuring disability include diagnosis-based assessments (e.g., “Does anyone in this household have epilepsy?”); Activities of Daily Living . Republic Slovenia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan ECONOMIC IMPLICATIONS OF CHRONIC ILLNESS AND DISABILITY IN EASTERN EUROPE AND THE FORMER SOVIET UNION ECONOMIC IMPLICATIONS OF CHRONIC ILLNESS AND DISABILITY IN EASTERN EUROPE. Chronic Illness and Disability in Eastern Europe and the Former Soviet Union Another example is the finding that in Bosnia and Herzegovina, after the onset of the disabil- ity, the decline in the. Economic Implications of Chronic Illness and Disability in Eastern Europe and the Former Soviet Union Edited by Cem Mete Economic Implications of Chronic Illness and Disability Disability