评估北马其顿当前和未来的长期护理支出（英）

ASSESSING CURRENTAND FUTURE EXPENDITUREON LONG-TERM CARE INNORTH MACEDONIAPublic Disclosure Authorized SARAH COLL-BLACK • ALI HAMANDI • BOJAN SHIMBOV • MITCH WIENER 1818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. Thefindings, interpretations, and conclusions expressed in this work do not necessarilyreflect the views of The World Bank, its Board of Executive Directors, or the governmentsthey represent. The World Bank does not guarantee the accuracy, completeness, or currency of the dataincluded in this work and does not assume responsibility for any errors, omissions, ordiscrepancies in the information, or liability with respect to the use of or failure to usethe information, methods, processes, or conclusions set forth. The boundaries, colors,denominations, links/footnotes and other information shown in this work do not implyany judgment on the part of The World Bank concerning the legal status of any territoryor the endorsement or acceptance of such boundaries. The citation of works authoredby others does not mean the World Bank endorses the views expressed by those authorsor the content of their works. Nothing herein shall constitute or be construed or considered to be a limitation upon orwaiver of the privileges and immunities of The World Bank, all of which are specificallyreserved. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encouragesdissemination of its knowledge, this work may be reproduced, in whole or in part, fornoncommercial purposes as long as full attribution to this work is given. Attribution Coll-Black, S., A. Hamandi, B. Shimbov, and M. Wiener. 2025. Assessing current and futureexpenditure on Long-Term Care in North Macedonia. Washington DC: World Bank. Any queries on rights and licenses, including subsidiary rights, should be addressed toWorld Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. ASSESSING CURRENTAND FUTURE EXPENDITUREON LONG-TERM CARE INNORTH MACEDONIA SARAH COLL-BLACK • ALI HAMANDI • BOJAN SHIMBOV • MITCH WIENER TABLE OF CONTENTS AcknowledgementsAcronymsSummaryI. Introduction II. Definitions, Data Sources, and Methodology for the LTC Projections 2.1 Defining Long-Term Care Services and Support2.2 Identifying North Macedonia’s Long-Term Care Programs2.3 Data Sources2.4 Projection Methodology 10111214 III. North Macedonia’s LTC Programs3.1 Description of MoSPDY Programs3.2 Descriptions of MoH Programs161717 IV. Analysis of North Macedonia’s 2023 LTC Data 4.1 Demographic Data Analysis4.2 Dependency Rate Analysis4.3 Coverage Rates Analysis4.4 Unit Costs Analysis284.5 LTC Expenditure Analysis4.6 International Comparisons with North Macedonia’s LTC Expenditures181921222323 V. Projecting LTC Expenditures, 2023–20425.1 Population Projections5.2 Dependent Projections5.3 Number of LTC Beneficiaries of Government Programs5.4 Unit Cost Projections5.5 Government Expenditure Projections252526262829 VI. Alternative Design Scenarios6.1 Constant Real Expenditure Scenario6.2 European Union Convergence Scenario313133 VII. Data and Knowledge Gaps VIII. Conclusions and Recommendations8.1 Conclusions8.2 Recommendations424244 ReferencesAnnex 1: Calculation of Dependency Rates in the European UnionAnnex 2: Detailed Description of North Macedonia’s Existing LTC Programs464849 LIST OF TABLES Table 1:Data on Benefits and Services Classified as Long-Term CareTable 2:Number of LTC Beneficiaries and Expenditures in North Macedonia, 2023Table 3:Key Demographic Indicators for North Macedonia, 2000-2023Table 4:Distribution of Recipients of Cash, Home, and Residential Benefits, as a Percentage of Dependent Population13161934 LIST OF FIGURES Figure 1:Actuarial Methodology Used to Calculate Long-Term Care ProjectionsFigure 2:Composition of Population by Age and Sex, 2023 (Number)Figure 3:Composition of Elderly Population by Age and Sex, 2023 (Number)Figure 4:Population in Need of Long-Term Care by Age and Sex, 2020 (%)Figure 5:Dependency Rates in North Macedonia versus EU and Selected Countries (%)Figure 6:Population with Severe Activity Limitations by Age and Income, 2020 (%)Figure 7:Coverage Rates of MoSPDY Programs by Age and Service Type, as a Percentage of the Dependent Population, 2023Figure 8:Distribution of Financial Reimbursement for Assistance and Care Program by Age and Sex of Beneficiaries (%)Figure 9:Unit Costs of North Macedonia’s Long-Term Care Programs, 2023 (MKD)Figure 10:Public Long-Term Care Spending per Country, 2023 (% of GDP)Figure 11:Long-Term Care Spending per Country Income, 2023Figure 12:Population by Age and Percentage of Population Aged 65 and Over, 2023–2042Figure 13:Elderly Dependents by Age and Percentage of Population Aged 85 and Over, 2023–2042Figure 14:Projected Beneficiaries of MoSPDY Long-T