Commission staff working document - Joint Report on Social Protection and Social Inclusion accompanying document to the communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions - Proposal for the Joint Report on Social Protection and Social Inclusion 2009 - Supporting document {COM(2009) 58 final}
Date: 2009-02-13
Institutions: European Commission
Subjects: EU employment policy, health policy, pension scheme, poverty, report, social integration, social policy, social security

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COMMISSION OF THE EUROPEAN COMMUNITIES 

Brussels, 13.2.2009 
SEC(2009) 141 

COMMISSION STAFF WORKING DOCUMENT 

Joint Report on Social Protection and Social Inclusion 

accompanying document to the 

COMMUNICATION FROM THE COMMISSION TO THE COUNCIL, THE 
EUROPEAN PARLIAMENT, THE EUROPEAN ECONOMIC AND SOCIAL 
COMMITTEE AND THE COMMITTEE OF THE REGIONS 

Proposal for the Joint Report on Social Protection and Social Inclusion 2009 

Supporting document 

{COM(2009) 58 final}

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TABLE OF CONTENTS 

Scope and Outline of the Report .................................................................................. 4 

Overview of the Social Situation and Overall Strategic Approach.............................. 5 

Overview of key indicators of Social Protection and Social Inclusion in Europe ....... 5 

Progress towards the overarching objectives ............................................................. 20 

The European Social Fund – major tool for implementation of strategies ................ 25 

Fighting Poverty and Social Exclusion ...................................................................... 26 

Introduction ................................................................................................................ 26 

Promoting Child Well-Being and Breaking the Cycle of Deprivation ...................... 27 

Addressing the needs of other groups at particular risk of exclusion ........................ 34 

Active inclusion – bringing the most excluded back into society and the labour 
market......................................................................................................................... 41 

Access to services to enable social inclusion............................................................. 48 

Enhancing governance of social inclusion policies ................................................... 56 

Annexes to Chapter 3 ................................................................................................. 64 

Adequate and Sustainable Pensions ........................................................................... 76 

Overall strategy for Adequacy and Sustainability of Pensions.................................. 76 

More people in work and working longer: The response of pension policy.............. 82 

Supplementary funded pensions: impact on adequacy and sustainability ................. 93 

Minimum income provision for older people (MIP)................................................ 102 

Ensuring information and transparency ................................................................... 108 

Conclusions .............................................................................................................. 112 

National Strategies on Healthcare and Long-term Care .......................................... 115 

Introduction .............................................................................................................. 115 

Addressing health inequalities and inequities in access to care............................... 122 

Quality of healthcare ................................................................................................ 131 

Sustainability............................................................................................................ 135 

Long-term care services ........................................................................................... 143 

Conclusions .............................................................................................................. 148 

Annex: Indicators ..................................................................................................... 153 

1. 

2. 

2.1. 

2.2. 

2.3. 

3. 

3.1. 

3.2. 

3.3. 

3.4. 

3.5. 

3.6. 

3.7. 

4. 

4.1. 

4.2. 

4.3. 

4.4. 

4.5. 

4.6. 

5. 

5.1. 

5.2. 

5.3. 

5.4. 

5.5. 

5.6. 

6. 

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6.1. 

6.2. 

6.3. 

Definition of the 14 overarching indicators ............................................................. 153 

Data sources ............................................................................................................. 155 

Statistical tables........................................................................................................ 160

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1. 

SCOPE AND OUTLINE OF THE REPORT 

This supporting document prepared by the Commission services accompanies the 2009 Joint 
Report on Social Protection and Social Inclusion [Commission proposal: COM(2009) xx]. It 
provides an in-depth assessment of the renewed National Strategy Reports (NSRs) presented 
by EU-27 in autumn 20081. The NSRs outline each Member State's policy priorities up until 
2011  in  the  second  cycle  of  the  integrated  EU  process  for  Social  Protection  and  Social 
Inclusion. The assessment draws on the material provided by Member States in their NSR, but 
also on analysis prepared by  independent experts and on studies and research carried out in 
the framework of the Social Open Method of Coordination (OMC).  

Section  2  contains  an  overview  of  the  social  situation  in  the  Member  States  and  of  their 
overall  strategic  approach.  A  comprehensive  analysis  is  published  on  the  Commission 
website2 showing where each Member State stands in relation to the common objectives3 of 
the EU process for social protection and social inclusion based on the data available in 2008: 
The NSRs were presented at the end September 2008, and were therefore prepared before the 
fallout  of  the  financial  crisis  on  the  real  economy  took  hold.  Although  these  developments 
could  not  be  anticipated  in  the  NSRs,  Member  States  and  the  Commission  agree  on  the 
reports are still relevant, and that the actions envisaged to strengthen delivery on shared social 
objectives  have  become  all  the  more  urgent.  As  stated  in  the  Joint  Commission/Council 
Report  proper:  "Appropriate  social  policies  will  simultaneously  support  the  goals  of 
mitigating adverse social impact on the most vulnerable and of containing impact of the crisis 
on the economy overall."  

Section  3  below  assesses  the  chapters  in  the  NSRs  dedicated  to  social  inclusion,  in  other 
words  the  National  Action  Plans  for  social  inclusion  (NAP-inclusion).  Section  4  analyses 
national  strategies  for  pensions,  while  section  5  looks  at  national  strategies  in  the  area  of 
healthcare and long-term care. 

The  annex  contains  an  overview  of  the  most  recent  statistical  data  on  the  indicators4 
developed  to  monitor  progress  towards  the  overarching  common  objectives  of  the  Social 
OMC.

1 
2 

3 
4 

http://ec.europa.eu/employment_social/spsi/strategy_reports_en.htm 
Monitoring progress towards the objectives of the European Strategy for Social Protection and Social 
Inclusion : http://ec.europa.eu/employment_social/spsi/joint_reports_en.htm 
http://ec.europa.eu/employment_social/spsi/common_objectives_en.htm 
http://ec.europa.eu/employment_social/spsi/common_indicators_en.htm 

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2. 

OVERVIEW OF THE SOCIAL SITUATION AND OVERALL STRATEGIC APPROACH  

2.1. 

Overview of key indicators of Social Protection and Social Inclusion in Europe 

•  16% of Europeans, or 79 million people, were at risk of poverty in 2007. 

•  Despite overall progress on the labour  markets, 9.3% of working age adults and 
9.4%  of  children  live  in  jobless  households  and  7%  of  the  employed  live  below 
the poverty threshold. 

•  Social transfers reduce the risk of poverty by 36% on average in the EU, but this 

impact varies from 17% to more than 60% across the EU. 

•  The  employment  rate  of  older  workers  reached  45%  in  2007  as  against  37%  in 

2001. 

•  Current  pension  systems  have  generally  reduced  poverty  among  the  elderly,  but 
single  elderly  women  face  a  much  higher  risk  than  single  elderly  men  (28%  as 
against 20%).  

•  In  the  future  for  the  generations  who  have  recently  entered  the  labour  market,  a 
marked  decline  in  pensions  can  be  expected  if  the  number  of  years  worked  and 
contribution rates remain the same. 

•  Life expectancy is now 82 years for women and 76 years for men. This follows a 
gain in longevity of 4 years for women and 5 years for men over the last 20 years.  

•  The gap in life expectancy between European countries is 8 years for women and 

13 years for men. 

•  Total expenditure on health has increased throughout the EU in the last 20 years. 
Today  it  ranges  from  10%  of  GDP  or  more  in  some  countries  to  6%  or  less  in 
others. 

2.1.1. 

16% of Europeans are at risk of poverty 

In  2007,  in  EU-27  16%  citizens  lived  below  the  poverty  threshold  defined  as  60%  of  their 
country's  median  income,  a  situation  likely  to  hamper  their  capacity  to  fully  participate  in 
society. National percentages ranged from 10% in the Czech Republic and the Netherlands to 
21 in Latvia. 

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Figure 1: At-risk-of poverty rate in the EU (%), total and children, 2007 

Elderly 
in CY
 51%

35

30

25

20

15

l

n
o
i
t
a
u
p
o
p
t
n
a
v
e
e
r
e
h
t

l

f
o
% 

10

5

0

EU27 CZ NL SK SE DK HU AT

SI

FR FI

LU MT BE DE CY PL

IE PT EE

LT RO* UK

EL ES

IT

LV

Total population

Children aged 0-17

People aged 65+ 

Source: EU-SILC (2007); income year 2006; except for UK (income year 2006) and for IE (moving income reference period 
2005-06); RO: National Household Budget Survey 2006. BG data missing 

Children are often at greater risk-of-poverty than the rest of the population (19% in the EU-
27).  This  is  true  in  most  countries  except  in  the  Nordic  States,  Cyprus  and  Slovenia.  Child 
poverty  rates  range  from  10%  in  Denmark  to  25%  in  Italy  and  Romania.  The  main  factors 
affecting child poverty levels in the EU are the labour market situation of their parents and the 
effectiveness  of  government  intervention  through  income  support  and  the  provision  of 
enabling  services  such  as  childcare.  This  is  particularly  evident  in  the  case  of  lone  parents, 
who face a risk of poverty of 34%. 

While  on  average  the  elderly  also  face  a  higher  risk  of  poverty  than  the  overall  population 
(19% against 16%) substantial differences exist across countries as illustrated in Figure 1 and 
Table 1. The risk of poverty faced by people aged 65 or more ranges from 5% in the Czech 
Republic to 30% in Lithuania, and the United Kingdom, 33% in Estonia, and Latvia, 31% in 
Spain  and  even  reaches  51%  in  Cyprus.  These  differences  in  the  relative  situation  of  the 
elderly  depend  on  a  number  of  factors  including  the  adequacy  of  the  pension  systems  for 
current  pensioners  and  the  age  and  gender  structure  of  the  elderly  population,  since  elderly 
women and the very old tend to face much higher risks. 

Table 1 gives an overview of the relative situation of the main age groups in the population, in 
terms  of  levels  and  depth  of  poverty.  This  situation  is  assessed  both  in  relation  to  the  EU 
average and in relation to the overall population.  It illustrates the challenges Member States 
need to address to improve the situation of major population groups. 

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Table 1: Overview of poverty rates by age groups 

Poverty rate/gap is ++: well below; +: below; o: around; -: above; --: well above the EU and national average5 

Children (0-17) 

Working age (18-64) 

Elderly (65+) 

2007 

Risk of 
poverty* 

Poverty 
depth** 

Risk of 
poverty* 

Poverty 
depth** 

Risk of 
poverty* 

Poverty 
depth** 

be 

bg 

cz 

dk 

de 

ee 

ie 

el 

es 

fr 

it 

cy 

lv 

lt 

lu 

hu 

mt 

nl 

at 

pl 

pt 

ro 

si 

sk 

fi 

se 

uk 

o 
o 
- 
++ 
+ 
+ 
o 
- 
- 
o 
-- 
++ 
o 
- 
- 
- 
- 
o 
o 
-- 
- 
-- 
++ 
- 
++ 
+ 
- 

+ 
- 
o 
- 
+ 
-- 
o 
-- 
- 
++ 
- 
++ 
-- 
-- 
o 
+ 
+ 
o 
o 
- 
- 
- 
o 
o 
++ 
++ 
o 

o 
o 
++ 
o 
-- 
o 
o 
-- 
+ 
o 
- 
++ 
- 
o 
- 
- 
o 
+ 
o 
-- 
o 
- 
+ 
++ 
+ 
o 
+ 

o 
++ 
+ 
-- 
o 
-- 
+ 
o 
- 
++ 
- 
++ 
-- 
- 
+ 
+ 
+ 
++ 
o 
o 
- 
+ 
++ 
+ 
+ 
- 
o 

- 
o 
++ 
o 
+ 
-- 
- 
o 
- 
+ 
o 
-- 
-- 
- 
++ 
++ 
o 
+ 
+ 
++ 
- 
+ 
o 
++ 
- 
+ 
- 

o 
o 
++ 
++ 
o 
+ 
++ 
-- 
- 
-- 
- 
-- 
o 
+ 
++ 
+ 
- 
+ 
+ 
+ 
o 
- 
-- 
+ 
+ 
++ 
- 

* Risk of poverty: score based on the at-risk-of poverty (EU-SILC), relative level to EU average and to overall population 

** Poverty depth: score based on the at-risk-of poverty gap (EU-SILC), relative level to EU average and to overall population

5 

The  scores  are  calculated  on  the  basis  of  the  at-risk  of  poverty  rates/gaps.  They  are  z-scores  and  are 
used  to  rank  countries  and  to  identify  5  relative  levels,  from  ++  to  --.  Levels  are  defined  so  that 
countries  with  similar  scores  are  grouped  together  and  that  there  is  a  significant  step  between  each 
group.  

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The  standards  of  living  of  “poor”  people  vary  greatly  across  the  EU.  In  the  Baltic  States, 
Hungary,  Poland  and  Slovakia,  people  at-risk  of  poverty  live  on  less  than  €250  per  month, 
whereas in the Nordic countries, as well as in Ireland, Luxembourg, the Netherlands, and the 
UK the poverty threshold is €900 a month. When ta king account of the differences in the cost 
of living (values expressed in purchasing power standards) the monthly income of the people 
at  risk  of  poverty  vary  from  €-PPS  280  to   €  PPS947  (and  up  to  €-PPS1465  in  LU).  This 
suggests that the standard of living of the poor is 3.4 times higher in the richest EU countries 
than  in  the  poorest  countries.  However,  it  should  be  kept  in  mind  that,  in  each  country,  the 
poverty  threshold  (defined  as  60%  of  the  country's  median  income)  represents  the  level  of 
income that is considered necessary to lead a decent life. 

Economic  growth  has  helped  to  improve  overall living  standards  but  the benefits  of  growth 
have not reached everyone at the same pace and to the same extent. In a number of countries 
(CZ,  EE,  ES,  IE,  CY,  LV,  LT,  PL,  SI,  and  SK),  strong  growth  rates  of  3%  or  more  over 
several years have not left the poor behind and have helped to improve their living standards 
while their relative situation either improved or stayed the same. On the contrary, in EL, LU, 
HU and SE, growth rates over 3.5% have not had the same impact on low income households. 
The impact of the deepening economic crisis on living standards and inequalities will need to 
be closely monitored, with a specific focus on the most vulnerable6. 

On average in the EU, the general improvement on the labour market between 2000 and 2008 
has had a limited impact on the people that are most excluded. The number of people living in 
jobless  households  remains  high,  despite  some  recent  improvements.  In-work  poverty  is  a 
matter of growing concern in most Member States, as is the integration of migrants into the 
labour  market.  The  impact  of  the  expected  deterioration  of  labour  market  conditions  on  the 
most vulnerable households will need to be closely monitored. 

In 2007, almost 9.3% of EU27 working age adults (aged 18-59, and not students) were living 
in households where no one was in paid employment. This rate ranged from 4.7% in Cyprus 
to  11%  or  more  in  Belgium,  Hungary,  and  Poland.  On  average,  a  similar  proportion  of 
children  were  living  in  jobless  households,  9.4%  in  the  EU-27  in  2007.  However,  families 
with children are more affected by joblessness in some countries than in others. The share of 
children  living  in  jobless  households  varies  greatly  across  Member  States,  and  ranges  from 
2.2% in Slovenia to 16.7% in the United Kingdom. Living in a household where no one works 
affects  both  children's  current  living  conditions,  and  their  chances  to  develop  their  full 
potential. 

6 

The  SPC  task  force  on  the  mutual  interaction  between  growth,  jobs  and  social  cohesion  policies  will 
address these issues in the first half of 2009. 

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Figure 2: Adults and children living in jobless households, 2007 (%) 

18,0

16,0

14,0

12,0

10,0

8,0

6,0

4,0

2,0

0,0

d
e
n
r
e
c
n
o
c
n
o
i
t
a
l
u
p
o
p

l
a
t
o
t

f
o
%

CY PT SI ES EE LT NL CZ DK MT LV LU AT IE EL SK IT DE RO BG FI FR UK PL HU BE

EU-
27

Adults (18-59 - not students)

Children (0-17)

Source: Eurostat Labour Force Survey, spring results, data missing for SE 

On  average  in  the  EU,  general  improvements  on  the  labour  market  only  started  benefiting 
people living in jobless households over the past two years (-1 percentage point between 2005 
and  2007).  These  improvements  have  not  had  the  same  impact  on  families  with  children, 
since the reduction in the share of children in jobless households was only 0.3 p.p. between 
2005  and  2007.  Unfortunately  the  current  recession  is  likely  to  put  a  halt  to  this  recent 
progress. 

As indicated above, having a job does not always protect people from the risk of poverty. In 
2007,  8%  of  EU-27  citizens  in  employment  (aged  18  and  over)  lived  below  the  poverty 
threshold,  thereby  facing  difficulties  in  participating  fully  in  society.  This  rate  ranged  from 
4%  or  less  in  the  Czech  Republic,  Belgium,  Denmark,  Ireland,  Malta,  the  Netherlands, 
Slovenia,  Slovakia  and  Finland  to  13%  in  Greece  and  10%  in  Poland.  In-work  poverty  is 
linked  to  low  pay,  low  skills,  precarious  employment  and  often  involuntary  part-time 
working. It is also linked to the type of household in which workers live and to the economic 
status of other members of the household. In households with children for instance, the single-
the  risk  of  poverty.
earner  family  model 

longer  sufficient 

to  ward  off 

is  no 

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Figure 3: In work poverty: at-risk-of-poverty rate of people in employment  
aged 18 and over, 2007 (%) 

%

16

14

12

10

8

6

4

2

0

EU27CZ  BE DK MT RO FI NL SI SK AT CY FR HU IE DE SE EE LT UK LU IT LV PT ES PL EL

Source: EU-SILC (2007); income year 2006; except for UK (income year 2007) and for IE (moving income reference period 
2006-07); RO: National Household Budget Survey 2007; data missing for BG 

In 2007, the employment rate of third-country nationals/population born outside the EU was 
2.6 percentage points lower than that of the host population, a similar gap to that recorded in 
2006  (2.7  p.p.).  This  masks  strong  differences  across  the  EU.  In  Spain,  Greece,  Italy  and 
Portugal,  where  migration  is  a  recent  phenomenon  and  mainly  economic,  migrants  have 
higher employment rates than the native-born population. By contrast, in Belgium, Denmark, 
Germany,  France,  Austria,  Sweden  and  the  United  Kingdom,  migrants  have  much  lower 
employment  rates  than  the  host  population,  with  employment  gaps  ranging  from  6%  in  the 
United Kingdom to 16% in Denmark.  

On average in the EU, social transfers other than pensions (such as unemployment, family and 
housing benefits) reduce the risk of poverty by 36%. In the absence of all social transfers, the 
average  poverty  risk  for  EU  Member  States  would  be  25%  (as  against  16%  after  receipt  of 
government  support).  Social  transfers  are  most  effective  in  the  Czech  Republic,  France, 
Hungary,  the  Netherlands,  Austria,  Slovenia  and  the  Nordic  countries,  where  they  reduce 
poverty by 50% or more. Conversely, in Greece, Spain, and Italy, social transfers only reduce 
the risk of poverty by 17% or less. 

The impact of social transfers in reducing the risk of poverty is higher for children, with the 
EU average reaching 42% in 2007. This is true in most EU countries, except in BE, CZ, EL, 
LT, HU, MT, NL, PL, PT and SK, where it is slightly smaller. In the Nordic countries, FR, 
HU, SI and AT, social transfers (other than pensions) reduce the risk of poverty for children 
by more than 55%,  while in EL and ES the  reduction is less than 20% (also for the overall 
population).

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Figure 4: Impact of social transfers (excluding pensions) on the at-risk-of-poverty rate 
for the total population and for children, 2007 (%) 

70%

60%

50%

40%

30%

20%

10%

0%

EU27 EL ES IT BG(1)RO(2)LV CY EE PT LT MT UK PL SK LU DE IE BE SI CZ  FR AT NL FI DK HU SE

Total population Children aged 0-17

Source: EU-SILC (2007); income year 2006; except for UK (income year 2007) and for IE (moving income reference period 
2006-07); BG: National Household Budget Survey 2006; RO: National Household Budget Survey 2007 

2.1.2.  The adequacy and sustainability of pension systems 

Ageing of the population is one of the challenges that the EU is facing. Population projections 
show that the share of people aged 65 years and over in the total population is predicted to 
increase  from  17.1%  to  20.1%  in  2020.  This  means  that  there  will  be  103.1  million  older 
persons  compared  to  84.6  million  in  2008.  The  old  age  dependency  ratios  will  therefore 
increase from the current 4 persons of working age (15-64) for every person aged 65 years to 
a ratio of 3 to 1.7 

The  main  route  to  ensure  both  sustainability  of  pension  systems  and  an  adequate  level  of 
income for pensioners is, therefore, to extend working lives. The EU's target under the growth 
and jobs strategy is to reach a 50% employment rate for older workers by 2010. In 2007, the 
employment rate for older workers in the EU-27 was 45% compared to 37% in 2001, and 12 
countries now exceed the 50% target (Denmark, Germany, Estonia, Ireland, Cyprus, Latvia, 
Lithuania,  the  Netherlands,  Portugal,  Finland,  Sweden,  and  the  UK).  However,  the  target  is 
still  far  away  for  a  group  of  countries  where  the  employment  rate  for  older  workers  is  still 
around  30%-35%.  The  general  increase  in  employment  rates  of  older  workers  results  from 
two main factors: a demographic effect and the increased participation of women. Due to the 
ageing  of  the  baby-boom  generation,  the  relative  share  of  people  aged  55-59  -  who  have  a 
higher employment rate - has grown. In addition, most Member States experienced a higher 
increase in the employment rate for women than for men between 2001 and 2007. 

7 

Source: …  

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Figure 5: Change in employment rate of older workers, 55-64, 2001-2007 

25

20

15

10

5

0

-5

-10

EU27 RO MT DK PT PL SE EL UK ES IT FR CY IE LU SI CZ FI BE HU AT NL EE SK DE LT BG LV

Wom en Men

Total

Source: Eurostat, Labour Force Survey, Annual averages 

How does the income of the elderly compare to the rest of the population? Pension systems 
significantly reduce poverty among older people, and people aged 65+ have an income which 
is around 85% of the income for younger people, ranging from 57% in Cyprus to more than 
100% in Poland. However, single elderly women still face a much higher risk of poverty than 
single men (28% against 20%). 

Figure 6: Relative income of the elderly: Median income of people aged 65+  
as a ratio of income of people aged 0-64, 2007 

120%

100%

80%

60%

40%

20%

0%

EU27 CY EE LV IE LT DK UK BE FI ES SE MT PT CZ SK EL NL DE IT SI RO FR AT LU HU PL

Source: SILC (2007) Income reference year 2006; except for UK (income year 2007) and for IE (moving income reference 
period 2006-2007). RO: National HBS 2007, income data 2007. BG: missing data. 

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Aggregate  replacement  ratios  -  which  are  based  on  gross  individual  income  rather  than 
household disposable income - however, generally show that current average pension levels 
can be rather low compared to current earnings. This can be due to low coverage and/or low 
income  replacement  from  statutory  pension  schemes,  but  can  also  reflect  maturing  pension 
systems and incomplete careers or under-declaration of earnings in the past. In this respect, it 
should  be  noted  that  the  aggregate  replacement  ratio  indicator  is  based  on  gross  income 
figures,  and  that  several  factors  besides  aggregate  replacement  rates  (such  as  differences  in 
household  composition  and  size  and  the  overall  design  of  social  protection  and  taxation 
systems) can have a strong influence on the overall living standards of individuals. 

Figure 7: Aggregate replacement ratio for those aged 65+, 2007 

70%

60%

50%

40%

30%

20%

10%

0%

CY LV DK EL LT UK NL BE SI DE FI EE IE ES PT IT MT CZ SK HU PL BG FR LU AT SEEU25

Males

Females

Total

Source: SILC (2007) Income data 2006; except for UK (income year 2007) and for IE (moving income reference period 
2006-2007); For BG: National HBS (2006) income data 2006. Data for RO not available. 
Definition: the aggregate replacement ratio is the ratio of median personal (non-equivalised) income from pensions of 
persons aged 65-74 relative to median personal (non-equivalised) income from earnings of persons aged 50-59. 

The  future  adequacy  and  sustainability  of  pensions  can  be  assessed  using  theoretical 
replacement rates. Theoretical replacement rates are case study based calculations that show 
the  level  of  pension  income  the  first  year  after  retirement  as  a  percentage  of  individual 
earnings at the moment of take-up of pensions. Results provided here present the difference in 
replacement rates under current legislation (enacted by 2006) and replacement rates in 2046 
reflecting the effects of legislated pension reforms to be implemented gradually in the future. 
They show how changes in pension rules can affect pension levels in the future. The results 
show that most recently enacted pension reforms, while containing future pension expenditure 
do so through lower benefits giving a decrease in future projected replacement rates given a 
fixed age of retirement. 

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Table 2: Change in Theoretical Replacement rates for a worker retiring at 65 after 40 years with average earnings  

Change in Theoretical replacement rates in percentage points (2006-2046) 

NET 

GROSS Replacement Rate 

Coverage rate (%) 

Occupational 
and 
voluntary 
pensions 

Type of 
Supplementary 
Scheme (DB or DC) 

Statutory 
pensions 

Occupational 
and 
Voluntary 
pensions 

Statutory 
pensions ( or in 
some cases 
Social Security) 

Assumptions 

Contribution rates* 
Occupational and 
voluntary 
pensions: 
Estimate of 
current 

Occupational 
and voluntary 
pensions: 
Assumption 

Evolution of statutory pensions 
expenditures between 2004 
and 2050 (source 
EPC/AWG)** 

Total 

Total 

Statutory 
pension 

BE 
BG 
CZ 
DK 
DE 
EE 
EL 
ES 
FR 
IE 
IT 
CY 
LV 
LT 
LU 
HU 
MT 
NL 
AT 
PL 
PT 
RO 
SI 
SK 
FI 
SE 
UK 

3 
15 
-21 
7 
1 
11 
-7 
-12 
-18 
-11 
3 
16 
-12 
-3 
0 
5 
-21 
8 
5 
-19 
-20 
52 
2 
2 
-11 
-13 
-4 

5 
15 
-16 
20 
2 
9 
-12 
-9 
-16 
-10 
-3 
14 
-11 
1 
-1 
13 
-17 
5 
1 
-16 
-20 
39 
-4 
1 
-13 
-13 
-2 

-1 
15 
-16 
-10 
-9 
9 
-12 
-9 
-16 
-2 
-17 
14 
-11 
1 
-1 
13 
-17 
2 
1 
-16 
-20 
39 
-4 
1 
-12 
-11 
-3 

Type of 
Statutory 
Scheme 
(DB, NDC or 
DC) 

DB 
DB and DC 
DB 
DB 
DB 
DB and DC 
DB 
DB 
DB 
DB 
DB and DC 
DB 
NDC and DC 
DB and DC 
DB 
DB and DC 
DB 
DB 
DB 
NDC and DC 
DB 
DB and DC 
DB 
DB and DC 
DB 
NDC and DC 
DB 

5 
/ 
/ 
30 
11 
/ 
/ 
/ 
/ 
-9 
14 
/ 
/ 
/ 
/ 
/ 
/ 
4 
/ 
/ 
/ 
/ 
/ 
/ 
/ 
-2 
1 

DC 

DC 
DC 

DC 
DC 

DB 

DB 
DC 

100 
NA 
100 
100 
NA 
100 
NA 
89 
100 
100 
100 
86 
100 
89 
92 
100 
NA 
100 
100 
77 
81 
NA 
100 
100 
100 
100 
100 

55 
/ 
/ 
78 
70 
/ 
/ 
/ 
/ 
55 
11.4 
/ 
/ 
/ 
/ 
/ 
/ 
91 
/ 
/ 
/ 
/ 
/ 
/ 
/ 
90 
53 (M)/56(F) 

16.36 
NA 
28 
0.9  
19.5 
22 
20 
28.3 
20 
9.5 
33 
16.6  
20 
26 
24 
26.5 
30 
7 
22.8 
36.9  
33 
29 
24.35 
28.75 
21.6 
17.2 
19.85% (17.25%) 

NA 
/ 
/ 
8.8 
NA 
/ 
/ 
/ 
/ 
10-15 
5.7 
/ 
/ 
/ 
/ 
/ 
/ 
9.8 
/ 
/ 
/ 
/ 
/ 
/ 
/ 
13.7 
9 

4.25 

12.7 
4 

10 
6.91 

11.5 -12.5 

13.7 
8 

5,1 
NA 
5,6 
3,0 
1,7 
-0,1 
- 
7,1 
2,0 
6,4 
0,4 
12,9 
1,5 
3,7 
7,4 
6,4 
-0,4 
3,5 
-1,2 
-4,6 
5,5 
NA 
8,3 
4,1 
3,1 
0,6 
2,0 

Source: ISG calculations on Theoretical replacement rates carried out in the OECD APEX model or in national models, AWG. Figures for NL are preliminary. 

EN 

14 

EN 

 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
*Note: Contribution rates used for statutory schemes and also eventually occupational or private schemes included in the base case, thus giving elements on the representativeness 
associated with the base case. Contribution rates correspond to overall contribution rates as a share of gross wages (from employees and employers) used as assumptions for the 
calculation of theoretical replacement rates. Contribution rates may differ from current levels reflecting for instance projected increases in contribution rates, in particular as regards 
assumptions used for second pillar schemes. DK refers to contributions, to the ATP (statutory Supplementary Labour Market Pension, though it should be recalled that the financing 
of the first pillar mainly comes from the general budget. For CY one fourth (4%) comes from the general State budget. For LU one third (8%) also comes from the general State 
budget. For MT this corresponds to a repartition of 10% from the employee, 10% from the employer and 10% from the State. For PL this corresponds to old-age contributions 
(19.52% of wage) and disability and survivors contribution (13% of wage). For PT this corresponds to a general estimate (ratio between overall contributions and aggregate wages 
declared to social security).  
** A number of Member States have carried out national projections that better reflect the effects of recent pension reforms on the evolution of pension expenditure. 

EN 

15 

EN 

 
  
Meeting  the  pension  challenge  is  essentially  about  closing  the  gap  between  shorter 
contributory  lives  (in  terms  of  delayed  first  entrance  into  the  labour  market  as  well  as  low 
employment  rates  among  older  people)  and  the  trend  of  increased  life  expectancy  at 
retirement. The main route to solve the dilemma is to increase the labour market exit age. As 
pension  reforms  increasingly  link  benefits  to  working  and  contribution  years  it  will  be 
important to monitor how the current economic situation will impact on developments in exit 
ages.  

Figure 8: Economic activity by age in the EU-27 (2006) 

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

50

51

53

54
52
employed (full-time)
unemployed
inactive-other
inactive-retired

55

56

57

58

59

60

62

61
63
employed (part-time)
inactive- sick, disabled or injured
inactive-looking after family or home

67

64

65

66

68

69

Source: LFS, SPC study on flexibility in retirement age and early exit pathways 

2.1.3.  Health and long-term care 

Life expectancy in the EU has generally increased over the past two decades: in 2006 the EU-
27 average was 82 years for women and 76 years for men, a gain in longevity of about 4 and 5 
years  respectively  in  20  years.  However,  different  patterns  were  registered  across  the  EU: 
while life expectancy has consistently increased in the EU-15 plus MT and CY, it has dropped 
in Central and Eastern European countries during the economic transition of the early 1990s. 
Life expectancy in these countries has now recovered but it is still below the level of 1986 in 
Latvia and Lithuania (for men only). The gap in life expectancy across European countries is 
as high as 8 years for women and 13 years for men. Some countries are not catching up with 
the EU average: in BG, LT, RO and SK the difference from to the EU average has actually 
increased in the last 20 years. 

EN 

16 

   EN 

 
 
Figure 9a: Life expectancy at birth, men, 1986, 1996 and 2006 

EU27*BE BG CZ DK DE EE IE EL ES FR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK

1986

1996

2006

Figure 9b: Life expectancy at birth, women, 1986, 1996 and 2006 

s
r
a
e
y

85.0

80.0

75.0

70.0

65.0

60.0

55.0

s
r
a
e
y

85.0

80.0

75.0

70.0

65.0

60.0

55.0

EU27*BE BG CZ DK DE EE IE EL ES FR IT CY LV LT LU HU MT NL AT PL PT RO SI SK FI SE UK

1986

1996

2006

Source: Eurostat. LV (1986, 1996): national sources. FR(1986) is for FR Metropolitaine. EU averages are population 
weighted averages. EU27*(2006) based on 2006 except UK(2005) and IT(2004). 

The general increase in life expectancy has been accompanied by a general but small increase 
in healthy life years. However, there is no clear reduction in the gap between life expectancy 
and healthy life years. For the EU-15 the number of healthy life years increased from 64.5 in 
1999 to 66 years in 2003 for women and from 62.8 in 1999 to 64.5 years in 2003 for men. 
Even if they live longer lives, women spend a higher proportion of their lives with a disability 
compared with men. In some countries (UK, FI, PT, NL, EL, IE) the number of healthy life 
years for women has remained unchanged or even decreased. 

EN 

17 

   EN 

 
 
 
Table 3: Life Expectancy and Healthy Life Years8, 2006  

Healthy Life 
Years at 
birth

Life 
expectancy 
at birth

Healthy life 
years as % 
of life 
expectancy

Healthy Life 
Years at 
birth

Life 
expectancy 
at birth

Healthy life 
years as % 
of life 
expectancy

Belgium
Bulgaria
Czech Republic
Denmark
Germany
Estonia
Ireland
Greece
Spain
France
Italy
Cyprus
Latvia
Lithuania
Luxembourg
Hungary
Malta
Netherlands
Austria
Poland
Portugal
Romania
Slovenia
Slovak Republic
Finland
Sweden
United Kingdom

62.8

59.8
67.1
58.0
53.7
65.0
67.9
63.3
64.1
67
63.2
52.1
56.1
61.8
57.0
69.2
63.2
60.8
62.5
57.6

females
82.3

79.9
80.7
82.4
78.6
82.1
81.9
84.4
84.4
84
82.4
76.3
77.0
81.9
77.8
81.9
82.0
82.8
79.7
82.3

75.2

75.0
84.5
66.9
66.4
78.1
82.1
74.8
76.2
80.2
70.3
69.6
70.5
75.8
69.3
85.6
77.0
72.0
83.6
68.9

62.8

57.8
67.7
58.5
49.4
63.3
66.3
63.7
62.7
65.8
64.3
50.5
52.4
61.0
54.2
68.1
65.0
58.4
58.2
59.6

males
76.6

73.5
76.1
77.2
67.4
77.3
77.2
77.7
77.3
78.2
78.8
65.4
65.3
76.8
69.2
77.0
77.7
77.2
70.9
75.5

74.5
70.4
75.9
78.8
77.1

80.5

78.8
89.9
71.2
71.2
81.4
85.1
81.3
80.2
77.4
75.5
77.4
78.4
81.0
75.1
89.0
83.7
74.9
86.0
77.4

75.6
78.0
68.1
81.5
82

73.0
71.9
63.1
75.9
80
Source: Eurostat based on EU-SILC data 2006; IT, UK 2005;  
IT figures for life expectancy at birth are estimates taken from EHEMU database

82.0
78.4
83.1
83.1
81.1

61.0
54.4
52.7
67.0
65

57.6
54.3
52.9
67.1
63.2

Significant gaps in health status (e.g. self-perceived general health and self-perceived activity 
limitations  due  to  health  problems)  across  social  groups  persist  in  the  EU:  i.e.  those  in  the 
lowest  (poorest)  income  quintiles  more  often  report  very  bad  health  and  more  severe 
limitations  than  those  in  the  highest  (richest)  quintiles.  Indeed,  on  average,  less  advantaged 
groups not only have shorter lives and suffer more illness but also feel their health to be worse 
than more advantaged groups. Differences in the availability, quality and use of care services, 
alongside  living  and  working  conditions,  life-styles  and  countries'  socio-economic  situation 
can explain such differences in health between and within countries. As an example, Europe 
is  characterised  by  inequalities  (between  and  within  countries)  in  cancer  screening  and 
follow-up. 

8 

For the years 2004-2006, the disability prevalence data used in the calculation of the healthy life years 
indicator were taken from the Statistics on Income and Living Conditions survey (EU-SILC) covering 
all  EU-25.  Note  moreover  that  the  formulation  of  the  disability/limitations  question  so  far  has  not 
necessarily  been  the  same  across  Member  States.  Answers  may  also  be  prone  to  cultural  differences. 
Hence, cross-country comparisons may not be meaningful. 

EN 

18 

   EN 

 
 
                                                 
Several  barriers  to  accessing  care  are  identified.  In  the  EU  there  remain  significant  gaps  in 
health  insurance  coverage,  i.e.  non-negligible  numbers  of  individuals  are  without  health 
insurance coverage of any sort, or with limited insurance coverage (e.g. only emergency care 
coverage) which deters individuals from seeking necessary health, results in belated care and 
has  significant  financial  consequences  for  patients  and  their  families.  Even  where  rights  to 
access healthcare services are universal they have not necessarily translated into equal access 
for all. Indeed, on average, 3.1% (5%) of those living in the EU, with the exception of DE, 
BG and RO for which there is no accurate data available, report unmet need for medical care 
(dental  care)  because  they  had  to  wait,  or  care  was  too  expensive,  or  too  far  away.  This 
percentage also varies greatly across Member States; from 0.2% (0.5%) in SI and DK to 15% 
(12%)  in  LV  (EE),  and  across  income  groups  in  each  country,  with  the  poorest  facing  the 
greatest unmet need.  

In the last two decades total health expenditure both per capita and as a percentage of GDP 
rose throughout the EU. There are, however, substantial differences across countries. AT, BE, 
DE, FR and PT spend 10% or more of their GDP on health, while the Baltic States, CY, PL, 
and  RO  spend  6  %  of  GDP  or  less.  The  proportion  of  public  sector  expenditure  in  total 
expenditure  on  health  is  in  general  substantial  (more  than  70%).  Nevertheless,  private 
healthcare  expenditure  (mostly  out-of-pocket  payments)  constitutes  a  very  large  source  of 
funding in some Member States: in CY and EL private expenditure represents more than 50%, 
in LV and BG more than 40%, in RO more than 30%. Informal payments are an additional 
direct cost to patients in SK, RO, BG, EL, HU, PL, LT and LV. 

Figure 10: Total health expenditure as a % of GDP (2006 or latest available) 

Total health expenditure as % of GDP, 2006

Public expenditure

Private expenditure

%

12.0

10.0

8.0

6.0

4.0

2.0

0.0

r
f

e
d

t

e p
b

t
a

l

k n
d

l

e e
s

t
i

i

s

s
e

t

m

k
u

i

u f
h

g
b

e

i

x

l

k
s

z
c

Source: OECD Health Data 2008 and WHO, HFA-DB

v p

l

l

y l
t
c

o
r

e
e

Those countries reporting lower life expectancy (BG, LV, RO, LT, HU, EE, SK, PL and CZ) 
are also those reporting the highest proportions of unmet need for medical care and those with 
the lowest expenditure both per capita and as a percentage of GDP. 

EN 

19 

   EN 

 
 
2.2. 

Progress towards the overarching9 objectives 

The overarching objectives of the OMC for social protection and social inclusion are to 
promote: 

(a) Social cohesion, equality between men and women and equal opportunities for all through 
adequate, accessible, financially sustainable, adaptable and efficient social protection systems 
and social inclusion policies; 

(b)  Effective  and  mutual  interaction  between  the  Lisbon  objectives  of  greater  economic 
growth,  more  and  better  jobs  and  greater  social  cohesion,  and  with  the  EU's  Sustainable 
Development Strategy;  

(c)  Good  governance,  transparency  and  the  involvement  of  stakeholders  in  the  design, 
implementation and monitoring of policy. 

2.2.1.  Overall Strategic Approaches 

Many  Member  States  attempt  to  identify  and  coordinate  the  synergies  between  the  three 
strands of the Social Open Method of Coordination in their policies (notably LU, BE, EE, FI 
and  PT).  For  many,  the  overall  strategy  takes  the  ageing  of  the  population  as  the  starting 
point.  Population  ageing  due  to  low  birth  rates  and  increased  life  expectancy  means,  if  not 
accompanied  by  extra  years  in  good  health,  a  larger  share  of  old  and  very  old  people  with 
multiple  and  reinforcing  degenerative  and  chronic  conditions.  Thiscan  threaten  the 
sustainability of social protection because it increases pensions, healthcare and long-term care 
costs.  

The number of active years currently spent on average in the labour market is not enough to 
sustain  the  increasing  number  of  years  in  retirement  or  inactivity.  Hence,  on  the  one  hand, 
Member  States  are  designing  their  reforms  to  make  pension  and  social  protection  systems 
more  sustainable,  notably  by  striving  to  keep  more  people  in  employment  longer  and 
increasing  the  number  of  healthy  life  years  by  encouraging  preferred  paths  of  care.  On  the 
other hand, Member States are striving to support the inclusion of all in society (by education, 
active inclusion, etc.), to ensure a minimum safety net for those that cannot otherwise reach 
acceptable living standards (minimum pensions, minimum income provision and equal access 
for all to quality care. A more integrated vision is present, for example, when Member States 
recognise  explicitly  the  various  social  determinants  of  health,  including  alongside  access  to 
quality  healthcare,  also  living  conditions,  unemployment,  income  inequalities,  poverty  and 
material deprivation, education, the environment, migration and more diverse societies. In this 
context, policies that relate to social inclusion, pensions, healthcare and long-term care have 
an impact on public health just as improved health of the work-force can have major positive 
impact on the long term sustainability and adequacy of these systems.  

Examples of integrated approaches are found in some countries. In Luxembourg, it is clearly 
stated that promoting social cohesion has a key role to play for the country's future, on a par 
with efforts relating to the economy, monetary stability, public finance, taxation, employment 
and acquiring the necessary infrastructure to meet the challenges of globalisation. Under this 
approach,  social  cohesion  is  the  target  of  political  action.  The  Belgian  Federal  government 

9 

EN 

20 

   EN 

 
                                                 
 
agreement  describes  an  action  framework  based  on  five  overall  priorities:  a  global 
employment strategy, policies to reduce fiscal and parafiscal pressure on labour, encouraging 
entrepreneurship,  reinforcing  the  social  protection  system,  and  reinforcing  environmental 
policy  and  sustainable  development.  Estonia  sets  out  to  exploit  the  synergies  between  the 
three strands by adopting the overarching message that enhanced social protection and social 
inclusion  require  an  integrated  approach,  ensuring  coherence  between  the  policy  measures 
taken  in  various  fields.  Within  this  global  vision  some  countries  stress  the  employment 
dimension (UK, NL) while others stress the  social dimension (AT, PT).  In this context it is 
important  to  mention  that  in  the  past  decade  a  number  of  countries  have  carried  out  major 
pension reform where a key aim has been to encourage longer working lives.  

Several  Member  States  (BG,  CY,  ES,  FR,  HU,  SI,  SK,  RO,  FI,  SE,  UK,  IE,  NL,  PL)  have 
made  efforts  to  assess  progress  in  relation  to  the  priorities  selected  in  the  2006-2008  NSRs 
and the challenges identified in the 2007 Joint Report, often in relation to one or more strands. 
In several cases, however, an evidence-based and systematic approach is hampered by a lack 
of appropriate monitoring arrangements. Often, quantified targets and objectives in relation to 
which  progress  could  be  assessed  are  not  at  hand.  Sometimes  the  stock-taking  of  progress 
takes the form of listing the actions taken but without assessment of their concrete impact.  

There  is  a  considerable  degree  of  continuity  in  the  social  inclusion  priorities  selected 
compared  with  the  2006  round,  and  this  seems  in  general  well  justified.  As  in  2006,  active 
inclusion and child poverty are the challenges most frequently selected as inclusion priorities. 
Promoting  the  inclusion  of  groups  at  particular  risk  of  exclusion  also  figures  prominently 
(Roma, migrants, elderly, disabled, young people), although the issues of including migrants 
and ethnic minorities, in particular, seem not to be given due attention in some Member States 
where  they  are  major  challenges.  Other  priorities  quoted  by  several  Member  States  include 
ensuring  access  to  quality  services,  tackling  educational  disadvantage  and  fighting 
homelessness and housing deprivation. Several Reports would benefit from more clarity with 
respect to the allocation of resources and of responsibility.  

During  the  last  decade  Member  States  have  reformed  to  their  pension  systems  to  better 
provide adequate and sustainable pensions in view of population ageing, new societal norms 
and  changing  behavioural  patterns.  Consequently  in  their  national  strategy  reports  of  2008, 
countries  focus  on  the  implementation  of  reforms  and  further  incremental  progress  that  has 
been made. Such progress in many ways involves a delicate balancing of the dual concerns of 
adequacy  and  sustainability:  how  to  secure  sufficient  pensions  for  all  without  jeopardizing 
work  incentives  and  financial  sustainability  and  vice  versa.  Still  a  few  Member  States  have 
legislated more substantial reforms since the last reporting (PT, UK, EL, CY).  

This is the second full reporting exercise under the social OMC regarding the healthcare and 
long-term care strand. As only two years have passed since the previous NSRs, virtually all of 
the  2008-2010  reports  (except  perhaps  BG,  CZ,  SK)  build  on  the  previous  strategies  and 
national health plans with similar priorities and policies and some additions or improvements 
in relation to the strategies proposed in 2006. For all Member States, universality, fairness and 
solidarity,  accessibility,  equity,  equality,  effectiveness,  and  efficiency  are  the  guiding 
principles  of  reform.  Ensuring  access  to  quality  healthcare  and  long-term  care  services  and 
improving  healthcare  systems  efficiency  i.e.  obtaining  better  value  for  money  are  still 
important  priorities  across  all  countries.  However,  there  is  still  scope  to  strengthen  the 
potential  impact  of  policies  by  adopting  a  more  multidimensional  approach,  and  gender 
mainstreaming  is  evident  only  in  rare  cases.  Several  reports  show  that  more  clarity  with 

EN 

21 

   EN 

 
respect to the allocation of resources and the responsibility of the different actors involved is 
needed.  

2.2.2. 

Interaction between economic growth and social inclusion policies 

In  this  round  of  reporting  more  Member  States  underline  the  importance  of  positive 
interaction  between  economic  and  employment  policies  and  social  inclusion  and  social 
protection policies and of the underlying synergies with respect to both goals and measures. 

Many  reports  point  out  that  social  protection  and  social  inclusion  policies  do  effectively 
contribute  to  growth  and  jobs.  Active  inclusion  measures  aimed  at  those  furthest  from  the 
labour  market  figure  prominently  in  the  2008-2010  NSRs.  Increasingly  Member  States  are 
tailoring social services to promote employment (e.g. DK, FR, EE, AT). Equally, policies to 
combat  child  poverty  and  the  inter-generational  transmission  of  poverty,  with  a  specific 
attention  to  high  quality  education,  are  pursued  by  several  Member  States.  Other  policies 
include measures to ensure longer working lives, often featured in reforms of pension systems 
and commonly used early-exit pathways (FR, LV, PL, SE) and policies aiming at debt relief 
to  overcome  over-indebtedness  as  an  obstacle  to  participation  in  the  labour  market  (FI). 
Modernisation  of  social  protection  systems  in  order  to  ensure  their  long  term  both  financial 
and social sustainability in view of population ageing is also mentioned as an essential policy 
intervention by several countries (ES, AT, FR, HU, IE, MT, PT). It is widely indicated that 
social protection policies leading to an increasingly healthy population enable more people to 
participate in the labour market at all ages and lead to increases in productivity. Active ageing 
measures  are  of  growing  interest  as  pension  reforms  require  longer  contributory  periods  to 
ensure  adequate  pensions  and  healthy  life  years  continue  to  increase.  Many  Member  States 
suggest that the health and social sector is a large and growing employer that can be used as a 
tool  to  improve  the  economy  in  disadvantaged  regions  and  increase  labour  market 
participation of women. 

A  wide  range  of  policy  priorities  are  mentioned  by Member  States to illustrate how growth 
and  jobs  can  promote  social  objectives.  In  many  reports  reference  is  made  to  measures  that 
will contribute to facilitating access to the labour market of people that are far from it, such as 
training  and  educational  programmes  aimed  at  vulnerable  groups  (AT,  FR,  BG,  CZ,  SE), 
flexicurity  initiatives  (AT),  specific  active  labour  market  programmes  (ALMP's)  (DK,  NL, 
PL, UK), subsidised employment for various target groups (LV), local employment initiatives 
(LT) and avoiding inactivity and unemployment traps (EE, SK). Reconciliation of work and 
family life also features (FI, FR, LV, NL, DE, ES). Some countries refer to policies aimed at 
the extension of working lives (e.g. AT, DK).  

In  the  area  of  pensions,  the  link  between  better  jobs  and  longer  working  lives  and  better 
pensions is quite clear. In striving for adequate and sustainable pensions and social protection 
systems there is a clear need to  prolong working lives. There is, however, also an observed 
link  between  higher  paid  jobs  and  longer  working  lives,  which  subsequently  lead  to  better 
pensions.  In  order  to  avoid  a  growing  retirement  income  gap,  it  is  important  for  economic 
growth to filter into all segments of the labour market and society. Ample economic growth 
creates  a  clear  forum  for  this,  creating  synergies  between  the  incentives  to  work  longer 
embedded  in  pension  systems  and  job  creation  notably  for  older  workers,  who  are  often 
amongst the first to suffer job losses in strained economic times. 

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Economic growth is also seen as an important determinant of health, both directly through the 
improvement of living conditions, for example, and indirectly as it provides extra resources to 
the healthcare and long-term care sectors.  

Some  NSRs  point  to  areas  where  the  mutual  positive  interaction  between  economic,  labour 
market and social policy is not at hand. Several countries highlight that economic growth (and 
in some cases very high rates of growth) has not benefited all groups of society in the same 
way  and  indeed  social  inequalities  (income  and  health  for  example)  persist  or  have  even 
widened.  

There  is  a  risk  that  the  current  economic  downturn  will  exacerbate  certain  negative 
tendencies,  e.g.  an  increased  segmentation  of  the  labour  market  or  the  occurrence  that 
employment  growth  is  not  reflected  in  wage  increases.  A  contracting  labour  market  can 
ultimately  affect  pension  levels  and  can  lead  to  a  reduction  in  resources  allocated  to  the 
healthcare  and  long-term  care  sectors,  possibly  with  detrimental  affects  on  access.  Much 
needed quality improvements could be postponed. 

Given that the economic context has changed quite dramatically after the preparation of the 
NSRs Member States were solicited in the framework of the Social Protection Committee to 
provide information available at this stage on the social impact of the current economic crisis 
-  already  demonstrated  as  well  as  expected  -  and  on  related  national  policy  actions.  The 
outcome of this initial sounding out is summarised below: 

•  Most Member States expect that the global financial crisis will have a strong impact on the 
real  economy,  although  not  all  of  them  to  the  same  extent.  In  most  countries  the  social 
effects of the downturn are already visible.  

•  Member States underlined that in-built capacities of the social protection systems as well 
as  social  inclusion  policies  in  the  Member  States  are  there  to  fully  play  their  role  as 
automatic stabiliser to cushion the impact of the economic downturn.  

•  A number of Member States indicated that ad-hoc additional measures have already been 
taken  to  protect  the  most  vulnerable  and  to  relax  supervisory  requirements  for  pension 
funds.  

•  Some  areas  are  more  frequently  indicated  as  deserving  special  attention  in  the  present 
context,  notably  access  to  housing,  the  adequacy  of  safety  nets,  and  funded  pension 
schemes. 

•  In  general,  most  countries  re-affirmed  the  commitments  made  in  their  NSRs,  while  not 
excluding the need for special additional measures, which in some cases are already being 
defined or introduced. 

2.2.3.  Governance  

On  the  basis  of  information  provided  in  the  overarching  section  of  the  national  reports  it 
seems  that  in  most  Member  States  there  has  not  been  a  fully  integrated  preparation  process 
covering the three strands and mostly there are separate, different governance arrangements. 
Exceptions  are  AT,  DK  and  IT.  In  AT,  for  the  first  time,  a  joint  meeting  was  held  of  the 
various Federal  Ministries and  umbrella NGOs active in social and environmental affairs to 
discuss the challenges for the national reform programme as well as interaction between the 

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OMC, the strategy of sustainable development and measures in these areas. A consultation on 
the  future  social  model,  covering  overall  social  protection  and  industrial  relations,  has  just 
closed in Italy. 

It  seems  that  in  many  Member  States  there  has  been  progress  as  far  as  the  participation  of 
stakeholders in the policy process is concerned. There is increased attention to the quality of 
participation. Some Member States ensure stakeholder involvement throughout the reporting 
and  policy  cycle.  On  the  whole  there  is  still  much  room  for  better  participation  of 
stakeholders, e.g. representatives of regional and local governments and people experiencing 
poverty,  but  there  are  some  inspiring  good  practices.  In  too  few  cases  has  the  preparation 
process  been  used  as  an  opportunity  for  large-scale  media  attention  and  for  raising  the 
awareness of the public at large. It appears that only a small minority of the Member States' 
Parliaments has discussed the plans. For further details see section 3.6. 

Mainstreaming  and  coordinating  social  inclusion  policies  remains  a  challenge  in  many 
Member  States.  Countries  are  implementing  different  kinds  of  structural  arrangements  at 
national  but  also  at  regional  and  local  level  to  contribute  to  this  (coordination  committees, 
networks of focal points, etc.). A few Member States report on efforts to establish or further 
develop ex ante social impact assessment arrangements.  

As far as monitoring and evaluation are concerned, progress is uneven and many challenges 
remain. Data sources, indicators and analytical capacity need to be developed especially also 
with  regard  to  the  groups  that  are  most  at  risk  and  that  are  seldom  reached  by  surveys. 
However,  examples  of  national  target  setting  have  been  increasingly  observed  in  the  NSRs. 
Effective  monitoring  of  targets  requires  regular  monitoring.  There  are  major  differences 
between  Member  States  in  the  extent  to  which  policies  are  systematically  evaluated. 
Stakeholders  and  external  expertise  are  often  involved  in  evaluation  at  the  start  of  the 
preparation of a new plan. It is good practice to start drawing up a new plan on the basis of a 
report on the results of the evaluation of the previous plan. 

Most  Member  States  have  counted  on  the  input  of  experts  from  social  partners,  ministries, 
institutions involved and scientists for the development of their pension reforms (e.g. DK, ES, 
IE, FI, DE, AT, PT, GR, CZ, SE, UK). These countries also report that the social partners do 
the  job  of  informing  politicians  and  the  public  about  latest  trends  in  social  systems  and 
stimulate  debate  to  foster  a  broad  social  consensus.  Some  Member  States  have  reported  on 
more direct consultations with the public in order to obtain public consensus (UK, IE, MT). 
For further details see section 5.4.1.  

Safeguarding health and translating it into longer working lives are the result of a set of social 
and  economic  factors  and  also  a  means  to  ensure  employment  and  economic  development. 
This holistic approach is reflected in some countries into a broader consultation with various 
sectors, with NGOs on social welfare and health, and with local and regional authorities. It is, 
however,  not  necessarily  clear  how  the  consultation  has  influenced  the  report.  Some  of  the 
reports  were  prepared  in  joint  collaboration  by  more  than  one  ministry.  More  multi-sector 
cooperation  is  necessary  to  ensure  greater  coherence  between  economic,  education, 
employment, environment and social and health policy.  

It should be noted that several European-level civil society organisations active in the social 
field  have  provided  and  made  public  their  assessments  of  the  renewed  Strategic  Reports,  in 
general  drawing  on  contributions  from  network  members  at  national  level.  Some  of  them 
examine  at  the  strategic  reports  as  a  whole,  in  most  cases  focussing  in  particular  on  the 

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National  Action  Plan  for  social  inclusion  (NAPs).  This  goes  notably  for  the  comprehensive 
assessment  carried  out  by  the  European  Anti-Poverty  Network  which  stresses  as  the 
overwhelming  concern  "the  lack  of  progress  on  the  eradication  of  poverty  in  the  EU"10  and 
proceeds  to  assessing  the  NSRs/NAPs  overall  as  well  as  the  policy  responses  to  address 
specific inclusion concerns. The report presented by Caritas Europe examined in particular the 
"Process  and  Quality  of  Policy  Design"  of  Member  States'  preparations  of  the  NSRs  and 
Eurodiaconia's  report  assessed  the  degree  of  participation  in  this  process.11  Depending  on 
their  specific  mission  others  concentrate  on  more  limited,  well-defined  aspects  of  the 
NSRs/NAPs  within  their  area  of  concern  and  interest.  Brief  references  to  the  latter 
contributions are made where appropriate in the following text.  

2.3. 

The European Social Fund – major tool for implementation of strategies 

The  European  Social  Fund  (ESF)  is  the  main  European  financial  instrument  designed  to 
support  Member  States  in  the  implementation  of  their  strategy  as  set  out  in  the  National 
Strategy Reports. In the 2007-2013 programming cycle, the European Social Fund will invest 
approx. €76 billion to support 117 Operational Pr ogrammes (OP) across the European Union. 
Together  with  the  European  Regional  Development  Fund  (ERDF)  and  the  European 
Agricultural Fund for Rural Development (EAFRD), the ESF will make a major contribution 
to  achieving  the  common  objectives  in  terms  of  social  inclusion  and  social  protection.  The 
2008 turmoil on financial markets slowed down economic growth and employment in many 
EU countries, thus posing an extra challenge social inclusion and social protection systems. In 
this context, the ESF can help to respond to emerging social challenges by supporting those 
furthest from the labour market and people made redundant in the economic downturn. The 
current economic outlook underlines the added value of the ESF both as an expression of EU 
solidarity  and  as  a  tool  to  tailor  the  labour  supply  to  a  changing  economic  environment. 
Effective  use  of  ESF  funding  can  cushion  the  effects  of  the  economic  crisis  in  terms  of 
unemployment  and  social  inclusion.  The  role  of  ESF  in  the  various  policy  priorities  is 
highlighted  in  most  NSRs,  in  particular  with  regard  to  the  Social  Inclusion  strand.  The 
Spanish  report  includes  an  annex  on  the  contribution  of  the  2007-2013  strategy  to  social 
inclusion  policies,  focussing  on  the  ESF-financed  OP  'Fight  against  Discrimination'.  The 
linkage  between  policy  objectives  and  ESF  is  clearly  visible  when  ESF  funding  is  more 
substantial in relation to the total national expenditure on employment and social policies (e.g. 
BG, SK, PL, RO, HU, PT, CZ). However, the absence of references to ESF is also notable in 
a number of NSRs (e.g. IE, NL, FI, FR), despite the fact that in some cases the ESF allocation 
to social inclusion is fairly high (e.g. FR, IE). 

There is general evidence of improved coordination between social policies and the use of the 
Structural Funds. However, the broad linkage established by some of the Reports on the one 
hand,  and  some  inconsistencies  between  OP  targets  and  those  set  out  in  the  NSRs  on  the 
other,  leave  some  doubts  as  to  the  depth  and  quality  of  policy  coordination  in  a  number  of 
Member  States.  A  challenge  thus  remains  to  ensure  that  co-ordination  between  policies  and 
funding goes further than formal cooperation between various departments, and to monitor the 
extent to which the ESF contributes to achieving the OMC targets. 

10 
11 

The full assessment Building Security, Giving Hope: http://www.eapn.eu/content/view/678/29/lang,en/ 
http://www.caritas-europa.org/code/en/publications.asp?choix=x2x 
http://www.eurodiaconia.org/files/Anti-
Poverty%20and%20Social%20Inclusion/Eurodiaconia%20report%20on%20members%20involvement
%20in%20social%20omc%202008.pdf] 

; 

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The Joint Report 2008 provided a detailed overview of Member States priorities in terms of 
social inclusion and social protection, which will be supported by use of the Structural Funds 
in the 2007-2013 period. As the implementation of the current cycle of ESF programmes is 
still  in  its  initial  phase,  Member  States  could  not  report  on  the  progress  achieved. 
Nevertheless, some reports (e.g. EL) point out that many of the measures are the continuation 
of previous ESF-funded activities, which have already delivered results. 

With  regard  to  the  overall  common  objective  of  governance,  a  number  of  country-specific 
challenges were identified in the 2007 Joint Report (e.g. CY, HU, LT, PL and SK).Here, it is 
particularly important that Member States make use of the possibilities offered by the ESF to 
promote the effectiveness of social inclusion and social protection policies. Several Member 
States have programmed ESF funding to promote the design, the monitoring and evaluation of 
social  policies  at  national,  regional  and  local  levels  (e.g.  HU,  SK,  RO),  as  well  as  the 
development  of  quality  standards  in  social  services  (PL).  Moreover,  ESF  will  support  the 
capacity  building  of  public  administration  in  all  EU-12  Member  States  and  convergence 
regions, which will also contribute to better governance in the social field. 

3. 

FIGHTING POVERTY AND SOCIAL EXCLUSION 

3.1. 

Introduction 

The Member States renewed National Action Plans for Social Inclusion (NAPs), presented in 
September/October  2008  as  part  of  the  integrated  NSRs  focus  on  a  limited  number  of  key 
priorities deemed particularly important for progress on the Lisbon goal of making a decisive 
impact  on  the  eradication  of  poverty  by  2010.  NAPs  increasingly  take  a  more  strategic 
approach while also reflecting multidimensional nature of poverty and exclusion, and the need 
for integrated policies to address priority issues.  

The NAPs aim to translate into  action  at Member State level the three Common Objectives 
relating to social inclusion, which were adopted by the European Council in March 2006 and 
confirmed  in  March  2008:  access  for  all  to  the  resources,  rights  and  services  needed  for 
participation  in  society,  preventing  and  addressing  exclusion,  and  fighting  all  forms  of 
discrimination  leading  to  exclusion;  the  active  social  inclusion  of  all,  both  by  promoting 
participation  in  the  labour  market  and  by  fighting  poverty  and  exclusion;  and  ensuring  that 
social  inclusion  policies  are  well-coordinated  and  involve  all  levels  of  government  and 
relevant  actors,  including  people  experiencing  poverty,  that  they  are  efficient  and  effective 
and mainstreamed into all relevant public policies, including economic, budgetary, education 
and training policies and structural fund (notably ESF) programmes. 

This  report  mirrors  the  particular  attention  given  in  NAPs  to  the  issues  of  child  poverty 
following  up  on  the  2007  thematic  year  dedicated  to  this  topic,  and  to  active  inclusion. 
Further, it examines Member States' planned policies to improve access to and quality of the 
various services that are key to enabling social inclusion overall, and to combat the persistent 
exclusion of certain groups of citizens. It finally reviews measures taken or planned for better 
governance of social inclusion policies. 

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3.2. 

Promoting Child Well-Being and Breaking the Cycle of Deprivation 

Out  of  the  16%  of  Europeans  at  risk  of  poverty,  19  millions  are  children.  In  most  EU 
countries  children  are  at  greater  risk  of  poverty  than  adults,  a  situation  which  has  not 
improved since 2000. Tackling child poverty and breaking the transmission of disadvantage 
between generations has been a main concern since the launch of the social inclusion process. 
In 2006, the March European Council asked Member States to take decisive steps to eradicate 
poverty among children. Many Member States have taken this invitation to heart.  

In  the  new  round  of  plans,  child  poverty  once  again  emerges  as  a  key  priority  for  Member 
States as more than two-thirds of countries have selected it as one of their key priorities for 
social inclusion. In support of this strong commitment, 20 countries have set quantified targets 
related to policy goals in the area of child poverty and social exclusion, 16 of them using one 
or  more  EU-agreed  indicators  (at-risk-of-poverty  rate  of  children,  children  in  jobless 
households,  low  reading  performance  of  pupils).  A  few  Member  States  have  also  set 
intermediate targets in relation to their specific challenges: jobless households (BE, BG, HU, 
UK),  families  most  at  risk  (BG,  EE,  CY,  LT,SK,  UK),  intensity  of  poverty  (NL),  childcare 
provision (DE, IE, FR, IT, LT, LU, HU, AT, PL, PT, SK, UK, MT). 

The 2007 thematic focus on child poverty was the occasion to explore further the policies in 
place in Member States and deepen the common understanding of the determinants of child 
poverty  in  each  country12.  This  work  helped  identify  common  challenges,  but  it  also  shed 
light  on  the  reasons  why  considerable  differences  in  the  situation  of  children  remain  across 
EU  Member  States.  It  also  highlighted  the  fact  that  among  those  countries  who  had  not 
selected child poverty as a key priority some, like France, Slovenia, Finland or Sweden have 
in fact comprehensive sets of support schemes in place for children and their families. In these 
countries, child poverty is relatively lower than in the EU as a whole. In other countries such 
as  Spain,  where  child  poverty  rates  are  high,  the  support  to  families  is  part  of  a  broader 
political commitment to develop the Welfare State. 

This  assessment  of  the  NAPs  builds  on  the  work  carried  out  in  2007.  It  takes  stock  of  the 
progress  in  implementing  the  policies  announced  in  the  2006-08  plans  and  aims  to  assess 
whether the new measures are in line with the challenges identified in the 2007 and 2008 Joint 
Reports13. 

The supporting documents to the 2007 and 2008 Joint Report analysed in detail the policies 
described by Member States in the 2006-08 plans. The measures adopted by Member States in 
their 2008-10 plans are in continuation of these policies and an increasing number of Member 
States adopt multidimensional and integrated approaches to tackling child poverty and social 
exclusion  (AT,  BE,  BG,  CY,  DE,  EE,  HU,  IE,  IT,  LU,  PL,  PT,  RO,  SK,  UK,  MT).  Such 
integrated  approaches  typically  include  income  maintenance,  reconciliation  of  work  and 
family life, services to families including childcare, housing, education, youth protection and 

12 

13 

Social Protection Committee (2008): "Child poverty and well-being in the EU. Current status and way 
forward." 
http://ec.europa.eu/employment_social/spsi/docs/social_inclusion/2008/child_poverty_en.pdf  
Eurochild's assessment to be published in February 2009: www.eurochild.org 

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support of the most vulnerable children, or as in Finland a specific policy programme for the 
well-being of children, youth, and families. 

3.2.1.  Ensuring sufficient resources for children and their families 

The 2008 Joint Report stressed the importance of fighting child poverty on all fronts through 
the  implementation  of  comprehensive  strategies.  These  involve  a  combination  of  adequate 
and  well-designed  income  support,  quality  job  opportunities  allowing  parents  to  progress  in 
the  labour  market,  and  the  provision  of  necessary  services  for  children  and  their  families 
(especially  childcare).  Below  we  discuss  how  far  the  new  plans  address  the  challenges 
identified for the four groups of countries identified in the supporting document SEC(2008)91 
to the 2008 Joint Report. 

Countries in group A (AT, CY, DK, FI, NL, SE, SI) are characterised by relatively low levels 
of  child  poverty  and  by  existing  comprehensive  support  schemes  for  children  and  their 
families.  These  schemes  often  rely  on  universal  benefits  in  cash  and  in  kind  (childcare) 
primarily aimed at compensating the cost of raising a child combined with measures targeting 
the most vulnerable children. However, some countries report a stagnation or an increase in 
child  poverty  (SE)  and  an  increase  in  benefit  dependency  rates  (SE,  NL),  especially  among 
families  with  a  migrant  background.14  In  these  countries,  the  need  to  sustain  the  current 
comprehensive schemes and to reinforce measures targeting the most vulnerable (increasing 
take-up  rates,  enhancing  the  provision  of  social  services)  is  highlighted.  Austria  and  the 
Netherlands are planning to reinforce income support for low-income families and especially 
lone parents and large families. In the Netherlands special focus is also on families that have 
been on a low income for more than five years and families on low incomes with school-age 
children. 

The main concern in countries in group B (BE, CZ, DE, FR, EE, IE, BG) is to bring down the 
high  number  of  children  living  in  jobless  households  and  help  parents  stay  durably  on  the 
labour market. In most of these countries, further measures are envisaged to make work pay 
for parents while adequately supporting their income. Measures that are often part of a wider 
active  inclusion  strategy  include  tax  rebates  for  low-income  families  (BE,  CZ,  EE)  and 
activation  measures  targeted  at  parents  (BE,  BG,  CZ).  Ireland  is  planning  to  substantially 
increase  child  income  support  and  to  structure  the  payments  to  remove  employment 
disincentives, especially for lone parents (and other low-income families) who are a specific 
target  group  of  the  Irish  active  inclusion  strategy.  The  Irish  government  is  also  striving  to 
increase the low take-up of in-work supplement for low-income families. In France, the newly 
introduced  RSA  (income  support  scheme  designed  to  support  individuals  through  their 
transition  back  to  work)  will  take  account  of  the  size  and  composition  of  the  household. 
Belgium, Germany, Estonia, Ireland and France plan a significant increase in the availability 
and affordability of childcare to help parents back into work. In the Czech Republic, however, 
few  measures  are  planned  to  increase  the  low  provision  of  childcare,  and  the  promotion  of 
longer  periods  of  parental  leave  may  have  an  adverse  impact  on  the  relatively  low  labour 
market  participation  of  mothers  (also  in  EE).  In  the  Czech  Republic  and  Estonia,  the 
employment rate of mothers is 16 and 14 percentage points respectively below that of women 
without children. Bulgaria has launched a "long-term strategy for the child" (2008-18) based 
children.
on  mainstreaming 

families 

specific 

actions 

aimed 

and 

and 

at 

14 

Please see footnote 12 below 

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Countries in Group C (HU, MT, RO, SK and the UK) need to address high levels both of in-
work  poverty  and  of  children  living  in  jobless  households,  notably  by  measures  aiming  at 
making work pay and at enhancing the labour market participation of parents especially lone 
parents  and  second  earners  (MT,  SK).  In  the  UK,  despite  the  substantial  progress  recorded 
since  the  launch  of  the  strategy  in  1999,  the  government  recognises  that  considerable 
challenges  lie  ahead  before  reaching  the  ambitious  target  of  eradicating  child  poverty  by 
2020. Besides reinforcing the existing comprehensive set of measures, the UK is developing a 
strategy  for  the  next  decade  in  close  cooperation  with  stakeholders.  It  includes  the  recent 
requirement for lone parents with older children and who are able to work to be available for 
paid  work  as  a  condition  of  receiving  benefit.  Future  policy  for  lone  parents  with  younger 
children involves an emphasis on work-related activity and skills development to move lone 
parents nearer to the labour market and prepare them for employment. However, measures to 
enhance  further  childcare  provision  overall  (a  Sure  Start  children's  centre  in  every 
community, and every school in England to be an extended school by 2010) risk not meeting 
the  challenge:  if  not  fully  realised  the  very  high  costs  and  provision  mainly  on  a  part  time 
basis can still hamper the labour market participation of low-income parents (especially lone 
mothers). Hungary plans to reinforce further the set of comprehensive measures implemented 
between  2006  and  2008,  by  improving  the  targeting  of  universal  family  allowances  (higher 
for low-income families) and by increasing childcare services provision, the level of which is 
currently  very  low.  While  reinforcing  measures  aimed  at  providing  equal  chances  at  school 
for all children, Slovakia will introduce a childcare allowance for working parents of children 
under three. However, no specific measure is announced to increase the low level of childcare 
provision.  In  Malta,  the  strategy  focuses  mainly  on  access  to  education  and  contains  few 
specific measures to support families' income and encourage the labour market participation 
of  second  earners  (the  main  cause  of  in-work  poverty  among  families  with  children). 
Investments in childcare infrastructure launched in the previous plan need to be enhanced in 
support of the newly introduced childcare subsidy scheme. Romania puts emphasis on income 
support and measures supporting access to employment for parents (childcare, enabling social 
services). 

Countries  in  group  D  (ES,  EL,  IT,  LT,  LV,  LU,  PL  and  PT)  were  those  in  which 
comprehensive  strategies  were  most  needed  to  address  high  levels  of  in-work  poverty  and 
(apart  from  LU)  a  relatively  low  effectiveness  of  social  transfers.  Italy,  Greece,  Lithuania, 
Latvia,  Luxembourg,  Poland,  and  Portugal  had  already  identified  child  poverty  as  a  key 
priority  in  the  2006-08  plans  and  started  implementing  a  wide  range  of  measures  to 
significantly increase income support to families and facilitate the labour market participation 
of parents, especially of the second earner. In most of these countries, the measures taken will 
be  further  reinforced.  Latvia,  Lithuania,  Poland  and  Portugal  in  particular  have  enhanced 
income support to families through a wide range  of  measures  including enhancing the level 
and  coverage  of  family  benefits.  These  countries  also  put  emphasis  on  developing  in-kind 
benefits (free or subsidised lunches at school, free school books, free childcare for children) 
and services for families, especially in the  area of housing (PT). From 2009, Italy will give 
priority  to  the  implementation  of  the  newly  introduced  "social  card"  system,  which  allows 
beneficiaries  to  buy  essential  goods  such  as  food  and  utilities.  Some  countries  enhance 
universal  coverage  by  for  instance  extending  the  coverage  of  existing  benefits  further  to  all 
children (including those over 18 and still studying and living in the parental home). Latvia, 
Lithuania, Luxembourg Poland and Portugal also plan to enhance measures to make work pay 
for  parents,  and  especially  for  lone  parents  (in-work  benefits,  tax  credits,  higher  minimum 
wage,  and  childcare  subsidies).  Significant  efforts  to  develop  affordable  childcare  provision 

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are  notable  in  Hungary,  Italy,  Lithuania,  Luxembourg,  Poland  and  Portugal  in  order  to 
encourage  the  labour  market  participation  of  the  second  earner.  Spain  does  not  explicitly 
report on overall strategies targeted at children and families.  

3.2.2.  Mainstreaming child poverty 

In  addition  to  the  emphasis  put  on  child  poverty  in  Member  States'  key  priorities,  greater 
attention  is  generally  paid  to  children  and  families  in  the  overall  design  of  social  inclusion 
policies, notably in the context of active inclusion policies (especially in ES, FR, LV). 

In addition to the range of income support measures specifically targeted at families (see Joint 
Report  2008)  some  countries  also  highlight  the  important  role  played  by  general  minimum 
wages and minimum income schemes in supporting families' income. Cyprus, Spain, Latvia, 
Lithuania, Austria, and Portugal in particular are planning to improve the level or design of 
minimum  wages,  and  Latvia  and  Portugal  have  set  targets  for  the  planned  increase.  Latvia, 
Lithuania, Austria, Portugal and Spain have reinforced their minimum income schemes (ES: 
harmonisation  of  MI  schemes  across  regions)  and  Romania  will  closely  monitor  the 
implementation of the MI scheme introduced in 2007. Austria announces the introduction of 
minimum income schemes in 2009. A number of countries (LT, ES, PL, UK) also introduced 
or reinforced tax credits and tax rebates for families with children, another way of supporting 
families' income without discouraging labour market participation. 

Measures  to  reconcile  work  and  family  life  are  important  tools  to  foster  the  labour  market 
participation  of  parents  without  affecting  children's  well-being.  This  concerns  both  lone 
parents and second earners, since  the  one-earner  family  model  is not sufficient any more to 
ward off the risk of poverty for children (see 2008 Joint Report). 

The availability and affordability of quality childcare, especially for children under three, are 
still  the  weak  points  of  most  EU  countries.  In  its  report  on  progress  towards  the  Barcelona 
targets15,  the  Commission  highlights  the  fact  that  parents  in  the  EU  face  a  shortage  of 
childcare services16. In half of EU countries 20% or fewer children under three are cared for 
by formal arrangements, well below the Barcelona target of 33%. In several Member States 
(CZ, EL, HU, LT, MT, AT, PL, SK) this percentage drops below 10%.  

Efforts to increase childcare provision are significant in some Member States (AT, DE, HU, 
IE,  IT,  LU,  PL,  PT)  where  governments  have  set  ambitious  targets  for  the  increase  (e.g. 
+100000  childcare  places  by  2015  in  Ireland)  and  allocated  the  necessary  budget.  Other 
Member States (BE, EE, EL, IT, RO, SI) mention their plan to enhance childcare provision 
but it is not underpinned by concrete commitments. France and Slovenia have adopted or are 
planning laws likely to increase the demand for childcare services, and highlight the challenge 
of developing infrastructure at the local level. IT intends to focus its effort in regions where 
childcare provisions is especially low. Austria and Portugal also plan to extend opening hours 
of  childcare  facilities.  Opening  hours  vary  widely  across  EU  countries  and  in  a  number  of 
them  a  particularly  high  proportion  of  childcare  facilities  operate  on  a  part-time  basis  only 

15 

16 

Report from the Commission on the implementation of the Barcelona objectives concerning childcare 
facilities for pre-school-age children {SEC(2008) 2524} 
A  Eurobarometer  survey  also  says that  more  than 1.5  million women in the  EU declare  that  they  are 
forced not to work or to work less because of lack of childcare facilities 

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(e.g. NL, UK). The availability of childcare after school hours is addressed in different ways 
across  countries,  either  through  prolonging  the  school  day  or  through  specific  provision  at 
community level. 

High fees continue to hamper access to childcare for low-income families in many countries 
(especially IE and the UK). In this respect several Member States (AT, EE, IE, LV, LU, SK, 
SI, SE) are planning measures to subsidize further childcare either for all families (e.g. free 
childcare  for  the  second  and  all  subsequent  children  of  the  same  family  (SI))  or  for  low-
income families in particular. 

The quality of childcare is key to ensure that it contributes to the development and well-being 
of the child and that it is not just seen as a way to facilitate parental employment and sustain 
families' income. Promoting quality of childcare involves measures to address staff shortages, 
the qualifications of personnel, quality standards for institutional care and personal services. 
Giving  greater  choice  to  parents  by  supporting  a  wide  range  of  care  arrangements  (in 
institutions  or  at  home,  on  demand,  at  flexible  hours)  in  order  to  meet  their  real  needs  is 
another way of facilitating family life. 

Some  €2.4  billion,  i.e.  3.2%  of  the  total  ESF  budget,  are  aimed  at  measures  designed  to 
increase women's labour market participation and reconciliation of work and private life, such 
as facilitating access to childcare and care for dependent persons. In addition approximately € 
550 million will be invested from the ERDF on childcare infrastructure. 

3.2.3. 

Supporting children's development 

All  EU  Member  States  have  ratified  the  UN  Convention  on  the  Rights  of  the  Child  which 
calls for the best interests of the child to be taken into account in any action affecting children. 
Member  States  are  therefore  committed  to  provide  the  maximum  extent  of  their  available 
resources  to  safeguard  the  economic,  social  and  cultural  rights  of  children.  A  number  of 
Member  States  place  their  action  to  support  the  development  of  all  children  in  this  context. 
Investing in education, healthcare and creating a favourable and safe environment (housing, 
parental counselling, etc.) are essential for the child to grow and develop its full potential. The 
importance  of  early  intervention  continues  to  be  very  strongly  emphasised  by  the  Member 
States.  In  particular,  there  is  a  clear  recognition  that  pre-schooling  can  help  compensate  for 
socio-economic disadvantage and enhance the future learning capacities of children. It plays a 
particular role for children with a migrant or ethnic minority background. The prevention of 
early  school  leaving  is  also  essential  for  the  well-being  of  these  children  and  for  the  full 
participation  in  society  of  the  adults  they  are  about  to  become.  Member  States  efforts  to 
promote early schooling and access to education and measures to prevent early school drop-
out are assessed in Section 3.5.5 of this report. 

An  increasing  number  of  Member  States  emphasise  the  need  to  support  families  in  their 
parenting role (BG, DK, EE, IE, IT, FR, LV, LU, AT, FI). Counselling for parents is designed 
as preventive tool and as a means to strengthen parental responsibility. These measures may 
be  addressed  to  all  parents  and  are  provided  through  the  school  system  or  family  services 
infrastructure. They often target families at risk such as families with a migrant background or 
teen parents (IE), and families in crisis (BG, LU, AT).  

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Poor housing conditions are likely to hamper children's well-being by affecting their health, 
their ability to do well at school and to build social ties. According to EU-SILC data, in two-
thirds of EU countries child deprivation rates in the housing dimension are higher than for the 
overall population. Specific housing policy measures for families include priority in accessing 
social housing for lone parents and large families (most Member States), greater provision of 
housing accessible to low-income families (IT), increased housing benefits for large families, 
specific  attention  to  the  needs  of  families  in  the  training  of  architects,  urban  planners  and 
other  specialists  (EE),  or  mortgage  loan  guarantees  issued  for  purchase  or  construction  of 
housing for families with children (LV). See also Section 3.5.2 on housing. 

Children born into low-income families are more likely to experience unhealthy lifestyles, and 
poorer  access  to  health  services.  A  number  of  Member  States  have  launched  innovative 
initiatives  to  increase  access  to  health  services  for  young  children  and  their  families.  They 
include preventive care such as prenatal and health care for young children, antenatal services 
for vulnerable pregnant mothers, regular check-ups of  children  and free maternity and child 
clinics. Health consultants in schools provide health services (vaccination, dental care, advice 
on  mental  health,  etc)  and  information  on  substance  misuse,  sexual  education  and  healthy 
eating  habits.  Barriers  such  as  the  imbalance  in  professional  expertise  between  regions  and 
additional  costs  of  access  need  to  be  overcome  to  ensure  fair  access  to  health  services.  See 
also  Section  3.5.3  on  access  to  healthcare  for  the  most  vulnerable,  and  Section  5.3.  on 
healthcare in general. 

3.2.4.  Reaching the most vulnerable children 

In  the  design  of  their  strategies  to  support  children,  Member  States  recognise  the  need  to 
combine  a  universal  approach  for  children's  well-being  with  a  more  targeted  approach  for 
children in vulnerable situations. 

Despite the increased emphasis on prevention, a number of children in all European countries 
are  still  deprived  of  parental  care;  being  orphaned,  victims  of  violence  and  abuse,  or  for 
economic  reasons  (e.g.  families  in  financial  distress  who  lose  their  homes).  Most  Member 
States are striving to avoid the institutionalisation of these children and to promote foster care 
arrangements.  Belgium,  Bulgaria,  the  Czech  Republic,  Estonia,  Italy,  Hungary,  Poland  and 
Portugal  set  up  measures  to  improve  the  status  of  foster  families,  and  to  provide  them  with 
financial support or specific training and to improve monitoring systems. In most countries, 
measures are also being taken to raise the standards and quality of institutional care. 

NGOs and MEPs from the Baltic States, Poland, Bulgaria and Romania have highlighted the 
situation of children who are left without parental care after their parents have moved to work 
abroad. Lithuania reports on specific measures to address this issue. 

Cyprus also mentions the specific situation of unaccompanied foreign children who are placed 
under the protection of the Ministry of Social Affairs. 

Measures  to  support  disabled  children  and  their  families  include  supplementary  financial 
support  (EE,  BG,  LV),  access  to  mainstream  schools  through  adapted  infrastructure  and 
dedicated  staff  or  additional  support  staff  (LV,  AT,  BG),  and  specific  social  services 
(transport,  housing,  etc).  The  Czech  Republic,  Estonia,  Latvia  and  Austria  have  adopted 

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comprehensive sets of measures and focus on early detection and intervention to improve the 
situation of disabled children and their families. 

3.2.5.  Other children at risk 

Children and families with a migrant or ethnic minority background receive specific attention 
in several NAPs (CZ, DK, ES, FR, LU). In Austria and Denmark, efforts are made to better 
integrate  children  in  schools  (including  by  involving  the  parents  better  in  school  activities) 
and  by  providing  them  with  specific  training  (language).  In  France,  newly  arrived  families 
receive specific information on the rights and responsibilities of parents as part of the recently 
introduced integration contract.17  

Bulgaria, Cyprus, Hungary, Lithuania report on specific new measures to address the situation 
of  child  victims  of  violence  and  abuse,  including  help  phone  or  internet  lines,  awareness 
raising  campaigns  and  special  training  of  staff  from  social  services  and  schools  in  contact 
with the children at risk. 

A number of NAPs (BG, CZ, EL, ES, IT, HU, LV, PT, RO and SI) refer to measures taken to 
improve access to education for Roma children. However, due to a lack of reliable data, most 
NSRs  do  not  present  a  comprehensive  assessment  of  what  would  be  needed  to  boost  pre-
school  /  primary  /  secondary  education  participation  of  Roma  children.  Where  reasonably 
reliable  data  do  exist,  they  show  that  Roma  children  continue  to  face  educational 
disadvantage. In Spain, several studies have been carried out which show that, although much 
progress has been achieved over the last two decades, 71% of Roma people aged 16 and over 
have  not  completed  primary  education,  and  only  1.3%  have  further  education.  Virtually  all 
Roma children go to school at the compulsory age, and a large part stays through the primary 
school cycle. However, there are major difficulties in getting the young Roma population to 
enrol and remain in secondary and further education, particularly Roma girls. Around 80% of 
Roma students drop out before the end of the last year of secondary school. The illiteracy rate 
among the Roma can be as high as 13%, compared with 2.3% for the Spanish population as a 
whole. In Romania, only 2% of young Roma adults (18–30 years old) have completed higher 
education, compared to 27% of young non-Roma adults. In Slovakia, one-third of Roma aged 
25 years or over did not complete primary school, another third stopped after completing the 
primary school cycle, and only 15% reached secondary school or higher education. 

Ireland  is  expanding  the  Back  to  Education  Initiative  to  the  Senior  Traveller  Training 
Programmes.  In  Romania  and  in  the  Czech  Republic,  school  mediators  are  attempting  to 
improve  the  graduation  rate  of  Roma  children,  as  well  as  increase  the  rate  of  school 
enrolment.  Hungary  has  a  long-standing  desegregation  program  under  way  and,  more 
education.
targets 
recently, 

desegregation 

Bulgaria 

reports 

on 

of 

of 

17 

Please see footnote 12 below 

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3.2.6.  Monitoring arrangements 

It is too early to assess whether Member States have taken significant steps to  act upon the 
recommendations adopted by the SPC in January 2008 for better monitoring and assessment 
of  child  poverty  and  well-being18.  However,  examples  of  new  initiatives  are  worth 
mentioning. Estonia has identified indicators for the monitoring of each priority objectives on 
the  basis  of  the  EU  agreed  indicators,  supplemented  by  national  indicators;  and  for  each 
objective appropriate arrangements are planned for monitoring the actions and assessing their 
impact on achieving the objective. As part of a general effort to strengthen the monitoring of 
the  welfare  system,  Denmark  has  launched  research  to  evaluate  initiatives  to  help  the  most 
vulnerable children (not well covered by standard monitoring tools). 

Growing Up in Ireland: The National Longitudinal Study of Children in Ireland (NLSCI) is 
the most significant study of its kind to be undertaken in the Republic. 10,000 infants aged 9 
months  and  8,000  children  aged  nine  will  be  recruited  to  participate  in  this  study  and  the 
initial contract, spanning almost seven years, will facilitate two major data collection sweeps 
for both cohorts. 

3.3. 

Addressing the needs of other groups at particular risk of exclusion 

3.3.1. 

Inclusion of the Roma in society and the labour market 

Roma  throughout  Europe  tend  to  face  multiple  disadvantages  which  often  result  in  extreme 
social exclusion and severe and persistent poverty, though there is a gaping lack of clear data 
on  the  degrees  of  that  poverty.  Accordingly,  the  new  NAPs  give  increased  coverage  to  the 
situation  faced  by  the  Roma.  In  Portugal,  the  High  Commission  for  Immigration  and 
Intercultural  Dialogue  has  created  an  Office  to  Support  Roma  Communities'  promotion  of 
their social inclusion. Greece has given the issue increased attention. In Hungary beside active 
labour market policy measures, special assistance was provided in cases of discrimination. In 
Spain, the Roma Development Programme in place since 1989, which finances projects, and 
managed by regional and local governments and non-profit organisations working in favour 
of the Roma population, can be mentioned. But the NAPs of countries with significant recent 
influx of Roma do not give details of planned action to promote their inclusion.  

A  number  of  steps  have  recently  been  taken  to  enhance  knowledge.  In  Spain,  numerous 
regional  studies  were  carried  out,  aiming  at  a  better  understanding  of  the  Roma's  social 
situation,  like  the  "Health  and  Roma  community",  promoted  by  the  Ministry  of  Health  and 
Comsumer  Affairs,  or  the  Map  on  Housing  and  the  Roma  Community,  sponsored  by  the 
Ministry of Housing in 2007. In Romania, data on Roma remain scarce but some qualitative 
and  quantitative  analysis  was  made  of  Roma  communities  and  questionnaires  were  sent  to 
local  public  authorities.  The  Czech  Republic  undertook  an  analysis  of  socially  segregated 
Roma  localities  which  showed  that  the  number  of  such  neighbourhoods  has  grown 
dramatically over the last decade. In Slovakia, the UNDP Report on the Living Conditions of 
Roma Households stresses the need for regular evaluation of the social situation of the Roma. 
Virtually no data are presented in the NAPs on the involvement of Roma in adult education 
and lifelong learning or vocational training programmes. 

18 

[Link to website] 

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As to the health situation of Roma people, data provided in the Romanian NSR reported 8 to 
10 years lower life expectancy and a higher incidence of contagious-infectious diseases and 
HIV,  deficient  infant  vaccination  and  poor  diet  and  nutrition,  mainly  among  children.  In 
Spain, alongside the activities of the Spanish National Strategy on Equal Healthcare aimed at 
the  Roma  population  (advice,  training,  a  "Guide  on  assisting  the  Roma  Community  in 
Healthcare  Services),  the  first  National  Health  Survey  on  the  Roma  was  also  conducted  to 
gain  knowledge  of  their  health  status,  lifestyles  and  inequalities  in  healthcare  access. 
Moreover,  the  health  of  the  Roma  community  is  being  mainstreamed  in  relevant  policies. 
Ireland and UK report on the All-Ireland Traveller Health Study which will include a census 
and  an  assessment  of  health  status,  mortality  rates,  and  impact  of  health  services  currently 
provided. 

Segregation remains one main obstacle to Roma inclusion, but no general conclusions can be 
drawn  from 
the  figures  on  de/segregation  presented  by  several  Member  States.A 
comprehensive approach to desegregation is presented in the Hungarian Strategic Plan for the 
Decade  for  Roma  Integration  and  its  related  action  plan  for  2008-2009,  specifying  tasks, 
deadlines,  resources  and  comprehensive  monitoring.  In  Hungary,  drawing  up  and 
implementing  an  anti-segregation  plan  is  a  precondition  for  obtaining  urban  rehabilitation 
development  resources.  An  anti-segregation  network  was  established  by  the  Ministry 
responsible.  

In Spain several programmes, such as the ACCEDER Programme for training and access to 
employment  aimed  to  Roma  population  and  financed  by  the  European  Structural  Funds, 
promote the employability of and jobs for the Roma. In the Czech Republic, the Agency for 
social inclusion in socially excluded Roma localities will implement a pilot programme in 12 
localities. Hungary points to various forms of subsidised temporary employment organised at 
local level. Romania and Bulgaria report on specialised job fairs helping the Roma enter the 
labour  market.  However,  policies  presented  in  most  NAPs  stay  within  the  limit  of  pilot 
actions or have a narrow, workfare type perspective. Member States with a significant Roma 
population should increasingly consider the important untapped potential which this category 
of citizens constitutes in view of labour force shortages and invest accordingly in education 
and training, including preparation for (and support of) legitimate forms of self-employment.  

The 2008 NAPs are more detailed than previously on the discrimination that Roma are facing 
and measures taken. In Spain, the Council responsible for non-discrimination on grounds of 
race or ethnic origin will promote equal treatment in the areas of education, health, benefits, 
social  services,  housing,  access  to  goods  and  services,  as  well  as  to  employment,  self-
employment  and  to  professional  practice,  affiliation  and  participation  in  trade  union  and 
employers’  organisations,  working  conditions,  professional  promotion,  vocational  training 
and on-going training. Hungary's Roma Anti-Discrimination Customer Service Network which 
provides  complainants  with  legal  advice  is  extending  its  network.  In  the  Czech  Republic, 
educational  seminars  were  held  for  900  police  officers  in  all  regions  on  the  right  to  equal 
treatment  and  legal  aspects  of  social  exclusion.  Italy  raises  governance  aspects,  through  the 
improvement  of  social  inclusion  and  anti-discrimination  policies.  However,  no  progress  is 
reported from Romania on the problems in getting ID papers or from Romania and Bulgaria 
on registering in municipalities. 

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3.3.2. 

Inclusion of migrants  

In general, important gaps persist between immigrants and the majority population as regards 
poverty,  income,  health,  employment,  unemployment,  education  and  early  school-leaving. 
The new NAPs largely confirm the issue as a major shared priority with ten Member States 
making  it  one  of  their  key  objectives.  Some  of  them  take  a  comprehensive  approach  to  the 
various  dimensions  of  social  inclusion  (participation  in  the  labour  market  and  access  to 
housing but also in social, cultural and political life) and focus on involving both immigrants 
and the host society19. Still, the non-prioritisation of the issue and absence of details in most 
NAPs comes across as a potentially serious omission.  

Implementation  of  the  Regulation  on  Community  Statistics  on  migration  and  international 
protection20  will  help  ensure  reliable  international  migration  statistics.  Nonetheless,  the  lack 
of  data  on  the  variety  of  profiles  of  immigrants,  ethnic  minorities,  asylum  seekers  and 
refugees remains a problem. Most often there is not distinction made between first and second 
generations  of  migrants  and  long-established  ethnic  minorities.  Breaking  down  social 
indicators by ethnic groups or by country of origin would help to document varying degrees 
of social inclusion and of vulnerability, target the specific, distinct needs of each group and 
assess the impact of policies on them. At present the Member States, with very few exceptions 
(CY,  NL),  provide  no  such  information  in  their  NAPs,  nor  on  whether  and  how  they 
distinguish the beneficiaries of their social inclusion policies from this point of view. 

Notwithstanding this lack of precise data, social inclusion measures targeted at migrants and 
ethnic  minorities  often  aim  to  remove  the  barriers  blocking  effective  access  to  social  and 
health  services,  e.g.  by  developing  the  intercultural  competences  of  service  providers  and 
through  information  campaigns;  targeted  support  for  children  and  their  parents  through  the 
education system; or provision of social services accompanied by language and civic courses, 
often targeted at women.  

Here  are  some  examples  from  the  NAPs  of  holistic  policy  measures  to  achieve  the  social 
inclusion  of  migrants:21  Ireland  focuses  on  three  interlinked  policy  priorities:  integration, 
educational supports and follow-up action arising from the  2005-2008 National  Action plan 
against racism. In Spain, the 2007-2010 Strategic Plan for citizenship and integration provides 
the framework for promoting, inter alia, the social inclusion of migrants into Spanish society, 
while  the  regionally-managed  Fund  for  the  reception  and  integration  of  migrants  and 
educational  support  is  the  main  financial  instrument  used  for  this  purpose.  The  strategy 
developed in Denmark provides that both refugees and citizens of migrant background must 
have  access  to  the  necessary  resources  and  welfare  services  while  making  active  efforts  to 

19 

20 
21 

he Third Commission Annual Report on Migration and Integration, (COM(2007) 512 final) elaborated 
a summary report on integration policies and an annex describing the developments in the EU-27 in this 
field.  The  Commission  Staff  Working  Document  'Strengthening  actions  and  tools  to  meet  integration 
challenges' reports on what has been done on participation and citizenship, as far as measures targeting 
the host society are concerned and how integration policies have helped prevent social alienation 
Regulation (EC) No 862/2007, adopted by the Council and the European Parliament on 11 July 2007 
For a complete account of relevant activities in Member States beyond those that Member States choose 
to highlight in their NAPs-inclusion, see the Third Annual Report on Migration and Integration . The 
European  Integration  Fund  supports  a  range  of  measures  relevant  in  this  regard).  .Best  practices  are 
described in the Handbook on Integration for policy makers and practitioners the next edition of which 
will be published in 2009. when the European Integration Web Site will also be in operation, as the one 
stop shop on integration, collecting relevant information and best practices from all stakeholders 

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enter the labour market and become included in the Danish society. Austria for its part adopts 
a mainstreaming approach for the social inclusion of migrants in its policy priorities, together 
with  more  specific  measures  for  refugees  and  asylum  seekers.  In  the  Netherlands  the  two 
main  points  of  the  policy  are  social  emancipation  and  social  integration  especially  for 
newcomers  with  a  strong  emphasis  on  participation  which  may  take  various  forms  such  as 
voluntary  work  without  neglecting  other  aspects.  Germany  highlights  the  relevance  of  its 
National Integration Plan also from a holistic social inclusion perspective. 

Increasing  efforts  are  discernible  to  create  synergies  between  social  inclusion  policies  and 
anti-discrimination measures. France, for example, relates its actions in favour of migrants or 
people with a migrant background to its policies on non-discrimination particularly as regards 
access to employment for women, social and professional integration of youth and access to 
decent housing for the Gens de voyage. The UK uses the framework of the Equality Public 
Service Agreement for developing its policies in respect of race, ethnic minority employment 
and  'Gypsies,  Roma  and  Travellers'.  Malta  is  developing  its  policy  for  ensuring  the  social 
inclusion  of  non-EU  nationals  as  part  of  its  priority  to  promote  equal  opportunities,  with  a 
specific  focus  on  asylum  seekers,  refugees  and  irregular  immigrants.  Luxemburg  adopts  a 
similar approach, mainly through a suite on legislation on immigration policy.  

Within the ESF, specific action to increase migrants' labour market participation will account 
for some € 1.17 billion (1.5% of total ESF budget). 

3.3.3. 

Inclusion of disabled people in society and the labour market 

With an estimated 50 million European citizens or more having some form of disability22, the 
inclusion of disabled people is frequently mentioned in the 2008-2010 NSRs. For Estonia and 
Austria, it is among their key priorities. Measures in favour of labour market integration are 
strongly  emphasised  in  the  2008-2010  NSRs,  but  less  emphasis  is  placed  on  structural 
accessibility  measures.  Economic  inactivity  is  commonly  seen  as  underlying  disabled 
people’s poverty, yet quantitative evidence is scarce. 

For a number of Member States, an effective policy to promote inclusion of disabled people 
implies a mix of mainstreaming policy (e.g. SE, SI, LV, LT, EE, MT, BG and IE), combined 
with targeted measures where needed (e.g. DE, FI, SE, IR, AT, BE, EE, ES, IE, CY, LT, LV, 
HU, SI, SK, SE, BG and UK), as well as enhanced access to needed resources, (e.g. BE AT, 
EE, IS, LV, HU and UK) and, for the bulk of Member States, quality services. 

The  reports  contain  evidence  of  alignment  and  compliance  with  Directive  2000/78,  the 
Disability Action Plan and to some extent with the UN Convention, but only a few Member 
States make systematic reference to these policy documents. More attention could be paid to 
mainstreaming disability in policies. 

The aim to tackle the use of disability benefits as an early exit route out of the labour market 
is addressed by virtually all countries, some of which address it as a major policy priority (e.g. 
LU,  RO,  UK,  MT,  HU,  NL  and  SI)23.  Inadequate  accessibility  in  society  limits  the 
opportunities  and  choices  of  people  with  consequently  lower  education  levels  and  lower 
labour market participation among disabled people. Nevertheless, some Member States (AT, 
SI,  UK,  DE,  LT  and  CZ)  report  slight  improvements  in  labour  market  participation  among 

22 
23 

LFS ad hoc module on disability 2002 combined with the Eurostat population estimate for 2008. 
On this issue, see also section 4.2.3.6, Restricting access to disability schemes 

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disabled  people.  and  the  Netherlands  even  reports  a  sharp  decline  in  the  number  of  benefit 
recipients. Several reports make a link between increased labour market participation through 
active labour market policy and targeted measures and the need to expand and strengthen the 
workforce.  Ireland  emphasises  that  the  main  objective  is  to  promote  equal  opportunities  for 
people with disabilities in the open labour market, by means of enhanced vocational training, 
employment programmes and further development of support.  

Several  NAPs  treat  the  removal  of  barriers  to  education  and  lifelong  learning  as  key  to 
increase  labour  market  participation  among  disabled  people,  as  well  as  to  enhance  active 
participation in society and overall quality of life (e.g. DE, SK, UK, HU, SI, AT, CZ, LU, EE, 
ES, IE, CY, LT, and LV). However, disabled people’s labour market skills are addressed by 
Member States more often in terms of special vocational rehabilitation programmes than by 
tackling access to lifelong learning in mainstream programmes.  

Social enterprises are highlighted by Lithuania, Latvia, UK, Romania, Bulgaria and Slovakia, 
wage  subsidies  by  Austria,  Estonia,  Lithuania,  Sweden  and  the  Netherlands,  flexible  work 
schemes  by  Spain,  Cyprus  and  Denmark,  job  coaching  services  by  Austria  and  Malta  and 
mentor  schemes  for  mentally  ill  people  by  Denmark.  In  Sweden  wage  subsidies  will  be 
extended by more than 2,000 places in 2008. In the UK, workability assessment measures are 
enforced  and  combined  with  tailored  empowerment  and  skill  support  to  promote  labour 
market participation. In France, an action plan facilitating labour market access for disabled 
people was launched in June 2008. Only rare references are made to barriers to employment, 
wider structural investment and legal protection. 

Synergies  between  different  strands  of  social  inclusion  could  be  shown  more  clearly, 
particularly  with  regard  to  employment  activation  policies  and  policies  for  accessible 
education, transport, housing, information technologies and personal assistance. Accessibility 
to goods, services and infrastructure is a key feature of the EU Disability Action Plan, but is 
not  frequently  mentioned  in  NSRs.  However,  accessibility  to  buildings  and  transport  is 
frequently  cited  (EE,  MT,  LT,  CY,  IE,  LU,  SI,  SK,  SE,  UK,  BG  and  AT).  Lithuania 
acknowledges  the  general  link  between  inclusion  and  mobility,  and  Slovakia  and  Austria 
propose  specific  responses.  Estonia  highlights  Universal  design  and  Hungary  wants  to 
eliminate  discrimination  and  obstacles  to  employment  by  making  public  institutions 
physically accessible. 

As to independent living, Germany and the UK have introduced personal budgets, Cyprus and 
Hungary focus on improvement of services, Ireland and Estonia highlight case management, 
and Austria and Slovenia a personal assistant supplement. Some Member States are looking at 
benefits  to  compensate  costs  related  to  disabilities  in  general,  and  for  disabled  children  and 
their families in particular (e.g. EE, LV, SI, HU, BG and SK). The UK, Romania and Ireland 
seem to have construed income schemes as a matter of human rights. 

There  is  a  trend  from  centralisation  to  de-institutionalisation  and  service  provision  closer  to 
the  citizen.  Many  Member  States  (CZ,  BG  and  RO)  are  making  efforts  towards  de-
institutionalisation of care for people with disabilities and to develop more community-based 
services.  However,  progress  tends  to  be  slow,  and  it  seems  important  to  strengthen  the 
financial resources allocated to support this process. Structural Funds are sometimes used to 
help revamp the crumbling system of residential institutions, and it should be looked at how 
this can be prioritised and strengthened in coming years. Re-organisation and development of 
rehabilitation  services  seem  to  be  at  the  forefront  in  several  Member  States.  In  Sweden,  a 
rehabilitation guarantee has been introduced, aimed at facilitating participation in the labour 

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market,  and  in  the  UK,  a  "One-touch  service"  has  been  introduced  to  simplify  access  to 
services. 

Several Member States focus on measures to promote mental health and well-being (e.g. MT, 
SI, SE, AT, BE, DK, FR, CY, IE, LT and LV). Some Member States recognise mental health 
problems as one of the main reasons for exclusion from the labour market and society, closely 
linked  to  and  re-enforcing  substance  abuse  and  homelessness.  Accordingly,  measures  to 
combat mental health  problems  are  included on the agenda, aiming to enable people to live 
active  and  dignified  lives,  and  recognised  as  underpinning  well-being,  social  cohesion  and 
economic growth in society. In Finland, mental health problems and prevention are targeted in 
both  the  entire  population  and  groups  at  risk,  including  in  the  work  place.  In  Slovenia,  day 
care places are increased for mentally and physically disabled people. 

Sweden  is  implementing  major  initiatives  to  promote  mental  health.  Psychiatric  care  is  a 
priority for the Government, with SEK500 million allocated in 2007 and 2008. The aim is to 
raise  skills  levels  for  personnel  in  psychiatric  care  and  social  services  dealing  with  people 
with  mental  disabilities,  and  to  improve  access  to  psychiatric  care  for  children  and 
adolescents. A development centre for children's mental health has been set up with the aim of 
increasing knowledge of preventive measures, early detection and early support. 

Several  Member  States  highlight  a  need  to  develop  more  knowledge-based  policy (e.g.  DK, 
EE,  LV,  MT,  HU,  RO,  SI,  SE,  UK,  IE  and  AT),  using  indicators,  targets,  monitoring  and 
evaluation.  Good  examples  of  target  setting  are  available  from  Ireland.  Looking  at 
governance, some Member States (SE, EE, MT, FR, HU, SK, UK, AT, BE, IE, CY and LV) 
are improving the participation of people with disability in policy-making processes. 

3.3.4. 

Inclusion of young people in society and the labour market 

Many NAPs focus on strategies aimed at young people, given that some sub-groups, such as 
early school leavers and lone parents, are particularly at risk of poverty. Young people are a 
priority  in  Finland,  where  a  cross-administrative  programme  on  children,  young  people  and 
families was launched for 2007-2011. The social inclusion of young people is also a priority 
for the UK, with substantial funding.  

In  France,  measures  are  taken  in  the  areas  of  non-formal  education,  social  inclusion, 
counselling,  housing,  health  and  policy  governance.  Germany  is  developing  strategies  to 
overcome  child  poverty,  early  school  leaving  and  youth  unemployment.  Measures  in  Spain 
and Estonia focus on entrepreneurship, validation of non-formal learning and identification of 
new job opportunities, even if a global strategic approach is not always detectable. Cyprus is 
planning  measures  to  enhance  youth  entrepreneurship  and  prevent  juvenile  delinquency.  In 
Romania, several plans target young people - the National Programme for the employment of 
socially excluded people, programmes for homeless children and young people, measures to 
increase  the  quality  of  life  for  young  families,  as  well  as  health  prevention  programmes. 
Sweden  is  set  to  better  include  young  people  in  the  national  fund  programme  for 
competitiveness and employment. Measures in Luxembourg include the "voluntary vocational 
orientation" and protective and preventative measures in the field of youth health care. Malta 
put  forward  a  number  of  measures  aimed  at  consolidating  the  personal  development  of 
children  and  young  people  (through  education,  training  and  employment  initiatives), 
enhancing  their  well-being  (through  improved  housing  and  quality  of  services),  and 
safeguarding  their  rights  and  responsibilities  (through  more  awareness  and  a  more  effective 
juvenile justice system). 

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3.3.5. 

Inclusion of older people in society and the labour market 

Older  people,  especially  elderly  women  and  the  very  old,  on  average  face  a  greater  risk  of 
poverty than the overall population in EU-27 (19% as against 16% in 2006; in BE, EE, EL, 
PT, IE, UK, LV, ES, MT, FI, CY older people still face a poverty rate of 25% or more). The 
NAPs pay increasing attention to older people. Some Member States even make the issue as 
one of their priority objectives (EE, EL, LU, PT, ES and SE) or as a cross-cutting issue (e.g. 
AT, LT). Most NSRs  focus on  active ageing  policies with the aim to increase the length of 
working  lives,  raise  the  employment  rate  of  older  people,  and  maintain  and  promote  their 
capacity for work. Alongside this, the increasing need of accessible quality services was also 
emphasised to promote better coping by the elderly and longer independent living. Moreover, 
the  NAPs  highlight  the  need  to  ensure  sufficient  income  for  elderly  people  and  improve 
pension adequacy. See also Chapter 4 on pensions, and more specifically Section 4.2.3.7. 

3.3.6.  Rural poverty and deprived urban areas 

Rural  poverty  tends  to  receive  less  attention  than  poverty  in  urban  areas.  E.g.  in  Romania, 
with at-risk-of-poverty in rural areas  three  times higher than in urban areas, the NAP is not 
very specific on how to foster social inclusion in rural areas. Addressing rural disadvantages 
figures are comparatively prominent only in the reports from Hungary. On the one hand the 
programme  ‘For  a  more  liveable  village’  will  provide  opportunities  for  the  600  most 
disadvantaged  settlements  to  catch  up  through  programmes  of  employment  creation, 
community  development,  environment  protection  and  culture,  while  on  the  other  hand  the 
programme  ‘No  one  left  behind’  aims  at  catching-up  by  the  33  most  disadvantages  micro-
regions  of  the  country  through  the  coordinated  application  of  EU  resources.  Each  micro-
region  will  draw  up  their  development  plan  and  will  then  implement  infrastructure, 
employment,  social  and  community  development  programmes  in  a  coordinated  way  (About 
10% of the population live in these 33 micro-regions with a significant proportion of Roma 
people). Ireland reports on measures for improved access to services in disadvantaged areas 
(transport,  rural  enterprise,  rural  tourism,  recreation,  sustainable  housing  and  broadband 
access),  and  Lithuania  on  coordination  between  measures  related  to  labour  market,  social 
policy,  education,  rural  development,  business  support  and  infrastructure  development  to 
stimulate  the  development  of  rural  areas.  The  UK  is  improving  access  to  employment  and 
skills  services  (Jobcentre  Plus)  through  innovative  outreach  strategies  including  the 
installation of 'jobpoints' in libraries, partnering in local authority outlets and mobile services.  

Some  NAPs  address  the  problem  of  disadvantaged  urban  areas  and  refer  to  specific 
regeneration programmes that tackle housing, social and economic problems in an integrated, 
bottom-up  and  participative  way.  The  Czech  Republic  stresses  its  regional  and  local  NAPs 
and  a  community  approach  for  the  integrated  planning  and  provision  of  social  services. 
Germany  highlights  the  Soziale  Stadt  programme  supporting  500  urban  micro-regions 
complemented  by  ESF  support  to  employment  and  training  measures.  In  Denmark's  “Our 
Collective Responsibility II” programme satellite offices are established in deprived areas for 
easy  access  to  support  from  public  authorities.  In  France  urban  renovation  is  a  key  priority 
that  must  reach  the  most  disadvantaged  residents  and  'Mixité  sociale'  insists  on  facilitating 
equal  access  to  housing  for  people  facing  multiple  economic  and  social  problems.  The  UK 
City  Strategy  tests  an  area-based  partnership  approach  to  tackling  worklessness  in  the  most 
disadvantaged  communities.  In  Poland  a  pilot  social  revitalisation  programme  will  be 
implemented in rural and urban local communities in the period of 2008-2010. Nonetheless, 

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the specific urban problems or the more complex deprivation issues that are present in cities 
could be more adequately reflected in the NAPs24. 

Among those countries with the highest regional dispersion of the regional employment rates 
(IT, HU, SK, ES and FR), only HU expresses concerns about its regional cohesion. But other 
NAPs (CZ, DE, FR, IE, LT, LV, PT, UK) refer to territorial challenges and report efforts to 
improve social services in rural areas and/or to promote access to employment and targeted 
services in a disadvantaged urban environment25. 

3.3.7.  Use of ESF to support inclusion of excluded groups 

Member  States  apply  different  approaches  and  focus  on  various  target  groups  in  their 
Operational  Programmes,  in  line  with  those  identified  in  the  NSRs.  Nonetheless,  actions  to 
promote social inclusion are an essential part of ESF interventions in all Member States and 
are  generally  programmed  as  a  separate  priority  within  the  programmes.  For  the  2007-2013 
period, Member States have allocated more than €10 billion, representing some 13.1% of the 
total ESF funding available to promote social inclusion of disadvantaged groups. 

3.4. 

Active inclusion – bringing the most excluded back into society and the labour 
market 

Despite  developments  since  the  2006-08  NAPs,  persistent  rates  of  poverty,  long-term 
unemployment  and  inactivity  show  that  much  still  needs  to  be  done.  Access  to  quality 
employment  is  a  sustainable  way  out  of  poverty  and  social  exclusion.  There  is  a  need  to 
design  and  implement  integrated  and  comprehensive  active  inclusion  strategies,  and  ensure 
social  protection  systems  able  to  mobilise  people  capable  of  working,  while  providing 
resources  that  can  make  it  possible  to  live  in  dignity,  together  with  support  for  social 
participation, for those who cannot. 

Although most Member States refer to "active inclusion" in their NAP, they tend to treat the 
issue  mainly  as  a  means  to  integrate  people  into  the  labour  market.  A  few  Member  States 
construe  "active  inclusion"  as  a  holistic  strategy  that  combines  adequate  income  support, 
inclusive labour markets, and access to quality services. 

Bulgaria  and  Malta  made  active  inclusion  a  priority  objective  for  2008-2010,  while  a  few 
other Member States reported priority objectives that simultaneously include reference to all 
three elements of the comprehensive active inclusion policy (LV, SI, ES, FR). Other Member 
States selecting active inclusion refer to all three pillars with varying degrees of coordination 
(AT, BE, BG, LV, NL, SI, ES, PL, PT, DK, FI, IE and MT). 

3.4.1.  Adequate income support 

Adequate income support is an important element of active inclusion policies given that for 
those  excluded  from  the  labour  market  minimum  income  schemes  can  be  the  only  way  to 
escape extreme poverty; yet, the NAPs give limited attention to the issue. A balanced active 
inclusion  policy  provides  minimum  resources  at  a  sufficient  level,  with  appropriate  work 
incentives to encourage job search and labour market (re)integration. 

24 

25 

See  "EUROCITIES  analysis  of  National  Action  Plans  on  social 
(http://www.eurocities.eu) 
See also Chapter 5 on healthcare, and more specifically section 5.2.6 

inclusion  2008-2010" 

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Some  Member  States  did  in  fact  outline  policies  to  better  link  social  assistance  benefits  to 
labour market (re)integration and social support. In France, the "Revenu de solidarité active" 
(RSA),  already  mentioned  in  3.2.1.,  is  designed  to  create  a  bridge  between  out-of-work 
benefit  and  in-work  financial  support,  to  improve  incentives  to  (re-)enter  the  labour  market 
and fight in-work poverty. This is combined with personalised employment and social support 
programmes.  In  Spain,  the  "Active  Income  for  Insertion"  (RAI)  aims  to  make  it  easier  for 
unemployed workers with special economic needs and difficulty in finding work to return to 
the  labour  market,  by  combining  income  support  with  active  labour  market  policies.  In 
Portugal, the Social Integration Income (MTSS) has been combined with programmes aimed 
at the social and professional integration of beneficiaries. Austria reported on the introduction 
of  the  means-tested  guaranteed  minimum  income.  In  Germany  the  previous  separate 
approaches  to  assistance  for  the  integration  were  brought  together  by  combining  social 
assistance  for  employable  people  with  unemployment  assistance  as  basic  social  security 
benefits  for  jobseekers  (ALG  II).  Following  the  "rights  and  duties"  approach,  benefit 
recipients  are  required  to  actively  participate  in  schemes  designed  to  integrate  them  into 
working life and to do all in their power to reduce or end their reliance on benefits. 

Cyprus  reported  on  amendments  to  the  revised  Public  Assistance  and  Services  Law  that 
financially  support  public  assistance  recipients,  especially  for  persons  with  disabilities  and 
lone  parents,  and  encourage  their  integration  into  the  labour  market.  Bulgaria  emphasised 
adequate  guaranteed  minimum  income  for  people  in  need  while  maintaining  incentives  for 
labour market participation. 

Other  Member  States  also  reported  on  further  plans  to  modernise  or  reform  the  current 
system.  The  Czech  Republic  pointed  out  that  a  new  conception  of  the  living  minimum,  a 
subsistence  minimum  and  fundamental  change  in  terms  of  benefits  (assistance  in  material 
need)  was  introduced  in  2007.  Luxembourg  is  planning  to  complement  its  guaranteed 
minimum income scheme, an important moderating factor in poverty risk since 1986, through 
adoption  of  a  law  on  the  modernisation  of  social  assistance  at  local  level.  Romania 
emphasised  that  the  major  challenge  lies  in  the  permanent  endeavours  to  redistribute 
resources  to  specific  categories  of  beneficiaries,  and  develop  an  assessment  and  monitoring 
system to measure the efficiency of granting assistance. Finland reports that the minimum and 
last-resort  benefits  will  be  retained  at  a  level  that  safeguards  a  reasonable  quality  of  life. 
Latvia  is  about  increasing  the  guaranteed  minimum  income  for  needy  families  and  persons, 
while  Slovenia  will  review  minimum  income  schemes  to  assess  their  adequacy.  Belgium 
plans  to  maintain  a  certain  level  of  purchasing  power  by  raising  minimum  benefits  and 
awarding decent minimum incomes. 

The  Netherlands  encourages  the  use  of  income  support  and  aims  to  reduce  non-take-up  of 
support schemes. It aims to achieve this by informing people about their opportunities, by the 
active poverty policy of municipalities and by simplifying the application procedure. 

3.4.2. 

Inclusive labour markets 

Member  States  reported  on  a  wide  range  of  measures  aimed  at  promoting  inclusive  labour 
markets  in  the  areas  of  a)  education,  training  and  lifelong  learning,  b)  active  labour  market 
policies, c) financial incentives, d) non-financial incentives and e) demand side initiatives. 

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Expanding and Improving Investment in Human Capital 

As  highlighted  above,  Member  States  are  giving  increased  attention  to  inclusive  education 
possibilities for children and young people in a bid to improve their future opportunities and 
reduce  the  number  of  early-school  leavers  and  drop-outs  (e.g.  AT,  BE,  BG,  DE,  DK,  HU, 
LU). Most Member States are introducing more possibilities for young people with regard to 
training and apprenticeship programmes in the transition from school to work (e.g. AT, BG, 
CZ,  DE,  DK,  EL,  IE,  ES).  Alongside  the  previous  measures,  some  Member  States  put 
emphasis on the need to improve cooperation between employers and educational and training 
institutions (DE, NL, RO). 

Almost all Member States underline the need to ensure access to lifelong learning in order to 
secure  sustainable  employment  and  longer  working  lives,  and  also  the  need  for  a  system  of 
occupational certification and of skills accreditation and recognition (e.g. EL, ES, PL). 

Member  States'  education  and  training  policies  often  address  the  specific  needs  of 
disadvantaged  groups,  including  older  workers  (AT,  CZ,  DE,  EE,  IE,  PL,  SE),  disabled 
workers  (AT,  CY,  DE,  FI,  EE,  IE,  UK),  migrants,  ethnic  minorities  and  refugees  (AT,  BE, 
BG,  CY,  CZ,  DE,  EL,  IE,  LU,  MT,  NL,  PT,  SK,  SL,  SE,  many  of  them  offering  language 
courses),  persons  with  low  educational  levels  (AT,  BG,  DK,  HU,  MT,  SK)  and  inactive 
people (EE, MT, NL). However, only a few Member States reported the adoption of measures 
to strengthen in-work and on-the-job training possibilities or IT skills (e.g. DK, MT). 

Active and Preventive Labour Market Measures 

In  most  Member  States,  reforms  of  the  Public  Employment  Services  centre  on  functional 
restructuring, decentralisation and strengthened cooperation between local authorities, private 
actors, non-governmental organisations and employers. They also aim to develop personalised 
approaches  to  support  job  search,  notably  including  services  for  specific  target  groups  (AT: 
"occupational diagnostics"; CY: individualised counselling guidance, DK: "mentor schemes", 
"marginalised-people team" in local authorities, "satellite offices" to offer personalised help to 
disadvantaged  people,  EL:  customised  intervention,  EE:  individual  action  plans,  case 
management, IE: new active case management; UK: Jobcentre Plus to help disabled people to 
get  into  paid  work  and  to  get  on  at  work,  partnership  approach  FI;  MT:  Social  Inclusion 
Partnership Programme; SK, ES). 

As part of the reforms, Member States are improving and adopting more efficient counselling 
services (e.g. AT: early intervention; IE: early engagement ; FI and MT: online employment 
services;  FR:  reinforced  mentoring,  including  for  job  retention),  and  more  comprehensive 
ones (DK: Job Plan, EL, EE, SK: Local social inclusion partnership, ES, UK: Jobcentre Plus, 
Flexible New Deal), but also more targeted job counselling activities (HU: Start Programmes; 
SE:  New  start  jobs,  Job  guarantee  for  young  people,  UK:  Work  Related  Activity  Group). 
However, just a few report on measures to extend the programmes beyond the unemployed to 
include inactive people (e.g. EE, BG, HU, MT) and on schemes to raise awareness of career 
choices, programmes and other services (EE). 

Financial Incentives to Work 

Active inclusion policies need to ensure a balanced interaction between tax and benefits, both 
providing  adequate  work  incentives  and  making  work  pay.  In  many  Member  States 
entitlement to benefits has been made conditional on active job search, availability for work 

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or  participation  in  training  (CZ,  BE,  BG,  DE,  EE,  ES).  Hungary  mentioned  that,  as  from 
2009, those who are capable of working and receive regular social allowance will increasingly 
be required to participate in public employment and to cooperate with employment centres. 

All NAPs indicate that Member States are implementing or planning reforms of their tax and 
social benefit systems. (AT: reduction of unemployment insurance contribution, and in some 
cases  non-payment  of  this  contribution  by  low  income  earners,  increase  of  unemployment 
insurance benefits for the long-term unemployed, coverage of more people by unemployment 
insurance and occupational retirement schemes; BE: increase tax-exempt income, tax-exempt 
quota, limit tax scales; CZ: decreasing the overall tax burden; FI: revision of the dual income 
tax  system;  FR:  the  RSA  –  see  3.4.1;  LU:  transforming  employees',  pensioners'  and  single 
parents'  tax  allowances  into  tax  credits,  9%  adjustment  to  income  tax  scales  in  2009;  SI: 
gradual abolition of payroll tax; UK: greater support through tax credits system, such as the 
"Better  off  in  Work  Credit"  programme  to  ensure  that  work  pays,  and  for  lone  parents  the 
national  roll  out  of  In-Work  Credit,  In-Work  Advisory  Support  and  In-Work  Emergency 
Discretion Fund). 

In the same spirit some Member States introduced measures to make it possible to work and 
receive benefits at the same time. The Netherlands introduced a statutory scheme for working 
while  retaining  benefits;  Latvia  implemented  a  new  regulation  in  2007  entitling  employed 
persons who take care of a child aged up to one year to work and receive the full childcare 
benefit.  Member  States  also  report  initiatives  to  introduce  and  increase  the  minimum  wage 
(AT,  BE,  CY,  LV,  ES,  UK)  as  a  tool,  for  instance,  to  supporting  women  in  seeking 
employment and working, and narrowing the gender pay gap. 

Non Financial Incentives to Work  

In  order  to  get  people  into  quality  and  sustainable  work  and  avoid  poverty  and  social 
exclusion, effective active inclusion policies should address other social factors that can also 
represent  obstacles  to  labour  market  participation,  e.g.  offering  solutions  for  those  who 
cannot  become  economically  active  or  increase  work  intensity  due  to  inadequate  care 
facilities for children, for older persons and persons with disabilities or due to health-related 
issues.  Helping  people  to  obtain  or  retain  quality  jobs,  also  entails  promoting  supportive, 
healthy and non-discriminative working environments. Despite this, just a few Member States 
mention measures that would offer job retention and progression and the reduction of in-work 
poverty (EE, UK, IE). 

One of the main issues addressed by Member State is support for reconciling work and family 
life, offering family-friendly measures and workplaces (e.g. with flexible working hours and 
flexible  forms  of  work)  better  and  more  comprehensive  childcare  facilities  with  a  special 
emphasis  on  expanding  women's  opportunities  to  enter  the  labour  market  (AT:  increasing 
capacity  of  childcare,  enhancing  day-school  services;  BE,  BG;  CY:  services  for  the  care  of 
children,  elderly,  disabled,  other  dependents;  DE:  extension  of  care  availability,  modular 
parental leave; DK: public day-care facilities; EL: parental and other leaves, combining work 
with motherhood; EE: right to use paid leaves (maternity leave, parental leave) and additional 
childcare leave without pay, development of flexible and accessible childcare; HU: Sure Start 
programmes; IE: additional childcare places and provision for care of older family members 
and those with disabilities; LU: more childcare centres, quality care and affordable prices with 
flexible opening hours, increase in number of parental assistants, LT, MT, PL, PT: increase 
parental  leave  and  childcare  facilities;  RO,  SK,  ES,  UK:  New  Deal  for  Lone  Parents,  Sure 
Start Children’s Centres). 

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A few Member States also put emphasis on the importance of the health and well-being of the 
workforce  (AT,  DK,  EE,  FI:  also  paying  attention  to  age  management  and  mental  health  at 
work, SE), and on measures to reduce sick leave and increase return to work (AT, DK, SE). 

Supporting the Demand Side 

An  integrated  and  comprehensive  approach  should  also  focus  on  the  demand  side  of  the 
labour  market,  including  financial  incentives  for  employers  to  recruit,  developing  new 
sources of jobs and providing support for the social economy and sheltered employment (see 
subsection below). 

One issue mentioned below by the National Strategic Reports concerned financial incentives 
for employers to hire disadvantaged people through subsidised employment. (AT: subsidised 
employment for different vulnerable groups, increased financial aid to enterprises by granting 
pay subsidies and subsidies for safeguarding jobs, “Action 500” and “Disability Flexicurity”; 
BE:  employment  bonus;  CY;  DE:  employment  subsidy  for  recruiting  long-term  and  older 
long-term  unemployed  and  younger  workers,  50  plus  Initiative;  EE  and  IT:  subsidised 
employment  for  disabled  people;  HU:  employment  policy  programmes  based  on  reduced 
contributions for employers employing disadvantaged employees (START programmes), LT: 
subsidy-based employment for people aged over 50, pregnant women, mothers, fathers, foster 
parents; NL: temporary wage cost subsidy to employers when they employ people in a step-
up  job,  micro-credits  for  entrepreneurs  starting  up;  PT;  PL:  suspending  contributions  to  the 
Labour  Fund  and  Guaranteed  Employee  Benefit  Fund  pertaining  to  employers  employing 
persons  returning  from  maternity  or  childcare  leave;  RO:  employers’  subsidies  for  lone 
parents and people aged 45 or more, and those who are 3 years away from reaching the legal 
retirement  age;  SI:  for  long-term  unemployed  beneficiaries;  SE:  subsidised  employment 
through  step-in  jobs  for  newly  arrived  immigrants,  new-start  jobs  for  elderly  people,  job 
guarantee for unemployed young people). 

Another issue relating to the demand side of the labour market is support for labour market 
flexibility  to  increase  job  creation  and  thus  –  as  mentioned  above  –  address  the  needs  of 
disadvantaged groups for which full-time or regular work is not always suitable (CY, CZ, DE, 
EE, FI, HU, LT, LV, PT, SK, ES, UK). 

Some Member States encourage special forms of employment addressing primarily the most 
vulnerable groups (e.g. HU and RO), while considering the higher level of in-work poverty of 
self-employed  workers;  others  provide  support  for  entrepreneurship  and  self-employment, 
especially  among  disadvantaged  people  (CY,  DE,  EL,  LT,  LV,  NL,  ES:  approval  of  the 
Charter  for  the  Self-Employed,  PT:  micro-credits  for  self-employment).  The  UK  plans 
another type of project for bringing the economically inactive into work: the "Homeshoring" 
project enables call centre staff to work from home by using the Voice over Internet Protocol 
and broadband. 

As  an  important  element  related  to  the  demand  aspects,  all  Member  States'  strategies  also 
focus  on anti-discrimination. Since discrimination is one of  the main determinants of social 
exclusion,  Member  States  have  either  enhanced  their  anti-discrimination  legislation  or 
reinforced  their  instruments  to  deal  with  it,  mainly  focusing  on  the  field  of  mainstreaming 
gender  equality  and  reducing  the  wage  gap,  thus  targeting  women  as  one  of  the  most 
vulnerable  group  (e.g.  AT,  CY,  DE,  EL,  IE,  LU,  MT,  SK,  ES,  UK).  Some  Member  States 
also focused on the issue of age equality (e.g. AT, CZ, PL, SE, UK). On the issue in relation 
to Roma, migrants and ethnic minorities, see 3.3.1 and 3.3.2. 

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The Role of the Social Economy 

Almost  all  NSRs  emphasise  the  increasing  role  of  the  “social  economy”,  as  it  continues  to 
provide  employment  and  a  path  for  re-entry  into  the  mainstream  labour  market  for  the 
disabled  and  other  groups  with  difficulties  in  finding  jobs.  In  addition  to  strengthening 
governance  and  social  capital,  social  enterprises'  close  ties  to  and  knowledge  of  local  areas 
also contribute to regional development objectives. For these reasons, several Member States 
have set the promotion and support of social enterprises as a policy priority (BG, CZ, FR, LT, 
NL, SK, SE, UK). 

Examples of such initiatives include: increased support for placement in social enterprises of 
people with health-related placement handicaps (AT); establishment of an inter-departmental 
commission  to  steer  investment  in  socially-oriented  entrepreneurial  initiatives  (CZ);  state 
support targeted at creating enterprises providing jobs for the disabled; (LT, see box below); 
pluriannual plan for reforming the governance of social enterprises; creation of a committee to 
investigate how labour market participation of people with an occupational disability can be 
encouraged  (NL);  increased  budget  assistance  and  easing  of  rules  for  setting  up  social 
enterprises  (PL);  the  “Establishment  and  Networking  and  Social  Enterprises”  project, 
intended  to  create  favourable  conditions  for  the  development  of  social  enterprises  (SK); 
establishment  of  centres  that  employ  a  group  of  at  least  four  benefit  claimants  who  have 
problems  other  than  unemployment  and  integrate  the  work  in  the  enterprise’s  normal 
operation  (DK);  and  the  national  roll-out  of  the  Pathways  to  Work  service  utilising  mainly 
private and voluntary providers (UK). 

In Lithuania, the Ministry of Social Security and Labour and the Labour Exchange have taken 
national measures to provide support for the creation of social enterprises. With the disabled 
as beneficiaries, 15 new enterprises were established in 2007, eleven of which were granted 
the  status  of  a  social  enterprise  for  the  disabled;  87  new  workplaces  were  created  and  20 
workplaces renovated for the disabled. The initiative is intended to counter a 23% increase in 
2007 in the number of registered disabled unemployed people in Lithuania. 

Examples  of  measures  providing  social  services  and  assistance  include:  creation  of  an 
association for the priority development of community-based social services (BG); the Money 
Matters Financial Learning Project providing vulnerable groups with counselling on financial 
capability  and  management  of  their  finances  (UK);  projects  under  the  EQUAL  framework 
with  an  emphasis  on  non-governmental  organisations  providing  community  public  services 
(SK); municipal cooperation with organisations of the 'National Empowered Neighbourhoods 
Alliance'  on  sports  programmes  aimed  at  disadvantaged  children  (NL)  and  a  formal 
agreement between government authorities and various NGOs to support the emergence of a 
substantially greater diversity of providers and suppliers in healthcare and social care (SE). 

3.4.3.  Access to quality services for active inclusion 

As  disadvantaged  people  tend  to  suffer  from  several,  interconnected  problems,  such  as 
unemployment, inadequate skills, poverty, health problems, poor housing, family breakdowns 
and  social  isolation,  current  policies  and  programmes  may  lack  the  necessary  holistic 
approach. The multiple problems disadvantaged people face outside the labour market require 
coordinated action from different public services in order to ensure their social participation 
and (re)entry into the labour market. Access to social services of high quality has an essential 
role  to  play  in  enhancing  the  employability  of  inactive  individuals  who  are  also  at  risk  of 
social exclusion. 

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While  few  NAPs  describe  policies  for  service  provision  which  fully  take  into  account  how 
they  may  complement  and  be  reinforced  by  the  other  two  active  inclusion  pillars,  Member 
States nevertheless identify a variety of dimensions in the provision of social services which 
are part of active inclusion strategies. One of the chief priorities touched upon is the need to 
coordinate  provision,  not  only  between  public  authorities  and  private  providers,  but  also 
between central, regional and local levels of government. Other priorities include the delivery 
of personalised social services, not least employment services, and the involvement of users in 
both  the  design  and  provision  of  these  services.  Assuring  quality  in  services  is  also 
highlighted in the NAPs, which also frequently identify equity of access as a prerequisite for 
quality.  Finally,  services  in  specific  areas  receive  attention,  especially  housing,  healthcare 
and,  to  a  lesser  extent,  financial  services.  The  objective  of  active  inclusion  strategies  is  to 
(re)integrate people in society and, where possible, into the labour market: social inclusion is 
not  only  the  key  objective  of  social  policies,  but  also  a  pre-requisite  for  a  sustainable 
integration  in  the  labour  market.  This  section  focuses  on  services  designed  to  enhance  the 
employability  of  individuals  while  Section  3.5  covers  access  to  services  more  broadly  and 
those essential to support active inclusion strategies.  

Examples  of  efforts  to  improve  coordination  of  social  services  related  to  labour  market 
participation:  In  Finland  the  city  of  Turku  is  promoting  an  intersectoral  welfare  policy 
programme  on  children  and  young  people  to  help  reconcile  work  and  private  life,  which 
includes enhanced service coordination and provision; in Spain the governance process in the 
2nd Regional Plan for Social Integration (2nd PRIS) of the Community Board of Castilla La 
Mancha emphasises cooperation between regional and local authorities and NGOs and other 
partners in achieving better access to employment for vulnerable groups. 

Examples of personalised employment and social services include: In Austria a project of the 
City  of  Vienna,  'Basic  vocational  guidance  in  the  mother  tongue'  which  is  addressing  the 
labour  market  integration  of  migrants  and  persons  entitled  to  asylum  with  counselling, 
provided  on  an  individual  basis,  offering  basic  vocational  guidance  in  the  mother  tongue, 
attempting  to  identify  previous  qualifications  and  work  experience  and  offering  information 
about official recognition of qualifications in Austria. In Denmark the action programme 'Our 
Collective Responsibility II' aims at improving the inclusion of socially disadvantaged groups, 
partly through training and educational initiatives. 

There are some national examples of measures aimed at assuring quality in service delivery 
with  regard  to  labour  market  participation:  in  France  the  quality  of  services  offered  by  the 
PES will be improved, notably by simplifying access and improving reception of vulnerable 
groups; in Slovakia “Modernisation of Employment Services by means of Education for Staff 
of Offices of Labour, Social Affairs and the Family”, funded outside Bratislava county by the 
ESF,  is  aimed  at  providing  innovative  education  for  civil  servants  and  employees  in  the 
employment services sections of labour offices. 

Examples of initiatives aimed at improving access to social services related to labour market 
access: in Cyprus the programme 'Expansion and Improvement of Care Services for Children, 
the  Elderly,  Disabled  persons  and  other  Dependants'  to  improve  and  expand  social  care 
services at the local level, and promoting programmes of open social care in order to facilitate 
the  activation  and  access  of  inactive  and  unemployed  women  to  the  labour  market;  in  the 
Czech  Republic  the  government  is  reenergizing  the  vocational  rehabilitation  system.  This 
initiative will facilitate effective communication between all partners involved, and attempt to 
broaden  the  system  of  vocational  rehabilitation;  in  Ireland  an  additional  100,000  childcare 
places (of all types), by 2016 is a key target under the social partnership agreement Towards 

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2016;  in  Lithuania:  the  'Integration  of  Hearing  Impaired  Persons  into  the  Open  Labour 
Market'  initiative  funded  under  EQUAL  is  opening  up  access  to  employment  placement 
services for this group  of people  which has traditionally been reluctant to make use of PES 
facilities due to their handicap. 

Housing,  as  related  to  improving  employability,  is  the  focus  of  the  following  measures:  in 
France  an  inter-ministerial  committee  (CIDOL)  aims  to  increase  the  number  of  homes 
available to young people with a special focus on those requiring housing in order to follow 
their  chosen  occupation.  In  Hungary  independent  housing  outside  institutions  is  being 
provided to homeless people by two public foundations under a government decree; in Malta 
the  HEADSTART  initiative  funded  under  Equal  is  aimed  at  smoothing  the  transition  from 
residential  care  to  society  and  gainful  employment  of  young  people  by  helping  them  find 
affordable housing. 

Specific labour market measures related to health include: in Sweden the government intends 
to  introduce  measures  for  the  insured  that  strengthen  sick-leave  reform  including  a 
rehabilitation guarantee. 

Finally these initiatives focus on financial services in connection with gaining a foothold on 
the labour market: Austria is setting up bank accounts for poor people / persons without cash, 
including the unemployed. The programme is aimed at countering a lack of access to banking 
services for the disadvantaged; in the United Kingdom the 'Money Matters Financial Learning 
Project'  is  providing  vulnerable  groups  with  counselling  on  financial  capability  and 
management of their finances on a range of topics including 'Employment and Money'. 

3.4.4.  The ESF contribution to active inclusion 

Most NSRs acknowledge that the ESF plays a key role in promoting active inclusion. While 
income  support  schemes  fall  outside  the  scope  of  ESF,  it  can  contribute  significantly  to  the 
other  two  pillars  of  active  inclusion  by  enhancing  inclusive  labour  markets  and  access  to 
quality  services.  In  this  context,  the  main  focus  of  ESF  interventions  is  on  developing 
pathways to integration and re-entry into the labour market for disadvantaged people. Actions 
in  this  field  include  providing  access  to  vocational  training,  the  development  of  the  social 
economy, improving access to social and other services, and fighting discrimination. 

In  addition  to  the  €  10  billion  directly  targeted  at  social  inclusion  mentioned  above,  it  is 
estimated that around € 21.6 billion (28. 4% of  total ESF budget) will be spent on improving 
access to employment and sustainability. 

3.5. 

Access to services to enable social inclusion 

3.5.1.  Access to services overall 

Services play an essential role in preventing exclusion and helping people at risk of poverty to 
come out of it and regain autonomy. This is why access to services is a priority on a par with 
access to resources and rights in the common objectives of the social inclusion strand of the 
open  method  of  coordination.  Yet,  issues  such  as  availability,  adequacy,  accessibility  and 
quality are much less frequently mentioned in the NAPs than in relation to long-term care or 
healthcare, whether they apply to social or non-social services. 

The  availability  of  services  may  depend  on  their  geographical  location,  but  also  on  their 
ability to respond to users' needs. A proper share of services is a key component of regional 

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equality, but when services are handled by decentralised bodies, they rely on local resources, 
likely to be scarcer in areas with greater needs. Planning strategies and proper allocation of 
funds, help to address this challenge. Reports contain less information on the responsiveness 
of  services,  although  this  clearly  influences  their  impact  and  can  be  monitored  (e.g.  time 
needed to make an appointment). Greater complementarity between different types of answers 
may  be  achieved  through  a  variety  of  means  (e.g.  by  using  ICT  for  providing  remote 
assistance or by sharing premises between different public services). 

The  European  Social  Network  in  its  contribution  to  the  assessment  of  the  NSRs  and 
preparation  of  the  2009  Joint  Report  stresses  the  need  to  fully  recognise  the  role  of  local 
public social services.26  

The  ability  to  check  that  services  match  users'  needs  is  very  much  dependent  on 
acknowledging that users have a say in the matter, and a right to assess what is delivered. In 
this respect, all categories of vulnerable people do not seem to be treated equally. While older 
or  disabled  people  are  very  often  seen  as  customers,  the  unemployed  or  the  poor  are  more 
likely to be considered as more passive recipients. 

The  non-take-up  of  benefits  is  very  much  linked  with  accessibility  of  services,  and  several 
Member  States  have  reported  on  initiatives  aimed  at  targeting  better  those  who  do  not 
spontaneously  claim  for  help  (through  targeted  information  campaigns  or  merging  of 
databases). 

Proper funding is a pre-requisite, but service quality also relies on personnel and processes. A 
shortage  of  qualified  staff  is  an  issue  for  a  few  Member  States,  while  others  give  details  of 
training strategies (e.g. intercultural competences to deal with migrants). Standards for quality 
are  obviously  less  developed  than  in  the  area  of  long-term  care  and  healthcare.  Integrated 
services addressing multi-dimensional problems which vulnerable people may face contribute 
to a higher quality of delivery. They require adequate coordination. Some €17 billion will be 
invested  from  the  ERDF  on  social  infrastructure  (including  some  €7  billion  on  education, 
and  some  €3  billion  on  other  social 
€555  million  on  child-care,  €809  million  on  housing 
infrastructure), which will enhance access to high quality social services. 

Services  of  general  interest  are  also  relevant,  notably  in  the  context  of  the  high  fuel  price 
increasse in 2008: measures are being taken to help at-risk-of-poverty households access fuel 
and  energy  are  detailed  (e.g.  specific  allowances,  social  tariffs).  Social  tariffs  in  public 
transportation  are  also  widespread.  Nevertheless  a  lack  of  availability  of  public  transport 
services in some areas may prevent people not only taking up a job, but also o participating in 
society. 

3.5.2.  Access to housing and fighting homelessness 

Homelessness is one of the most severe forms of social exclusion. It was highlighted as a key 
priority in the previous reporting round and most countries continue to develop or consolidate 
actions  to  tackle  it.  In  the  current  economic  context,  access  to  affordable  housing  and 
preventing evictions are particularly crucial in fighting poverty and social exclusion. 

The first NAPs showed that homelessness was often under-researched, with a focus mainly on 
the  most  visible  and  severe  forms  of  homelessness,  i.e.  sleeping  rough.  Social  policies  now 

26 

http://www.esn-eu.org/ 

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increasingly  approach  homelessness  in  an  integrated  manner  by  looking  at  people  who  are 
experiencing  various  forms  of  homelessness27,  and  policy  priorities  increasingly  include 
access to decent and affordable housing. Housing inclusion policies are also linked to urban 
regeneration  schemes,  or  other  locally-based  measures  aimed  at  promoting  sustainable 
communities. 

Homeless  people  often  face  multiple  disadvantages.  To  promote  full  reintegration  into 
society,  a  set  of  coordinated  policies  are  needed  in  the  areas  of  housing,  social  assistance 
services,  employment  and  health.  While  in  most  Member  States,  programmes  are  being 
implemented  within  separate  policy  frameworks,  some  Member  States  are  promoting  more 
integrated strategies (IE, UK) e.g. in housing where independent accommodation comes hand-
in-hand with offering adequate social support (AT, FI, DK, PT). 

Member  States  put  forward  different  strategies  to  promote  access  to  affordable  and  quality 
housing.  These  include  increasing  the  housing  supply,  with  specific  attention  to  social 
housing  (UK,  AT,  FI,  FR,  IE,  IT,  BE,  LU,  MT,  PL);  financial  support,  such  as  housing 
benefits and allowances, rent guarantees and tax rebates (UK, FI, SE, SK, EE, IE, LU, MT, 
BE);  and  appropriate  regulatory  instruments,  such  as  rent  controls  (AT,  BE,  MT).  Several 
Member  States  have  also  put  in  place  policies  to  promote  decent  housing  and  energy 
efficiency  (HU,  FI,  DK,  FR,  IE).  The  issue  of  preventing  eviction  has  received  renewed 
attention in relation to the current financial crisis (AT, DK, FR, SE, BE). 

Housing  is  also  one  of  the  main  components  of  area-based  policies,  and  the  fight  against 
regional disadvantages often goes hand-in-hand with the fight against housing disadvantage. 
These  policies  are  targeted  at  urban  development  and  sustainable  communities,  in  order  to 
fight ghettoisation and promote a social mix (FI, DK, HU, FR)28. 

Reporting on housing policies for Roma refers to some measures for Roma neighbourhoods or 
travellers groups. In Slovenia, municipalities received €2.7m in 2007–2009 (€1.5m for 2008–
2010)  to  co-finance  basic  public  utility  infrastructure  in  Roma  settlements.  The  UK  is  also 
making funding available for 2006-2008 through the Gypsy and Traveller Sites Grant for new 
sites and the refurbishment of existing sites. France reported about improvements made to the 
‘aires d’accueil’ for travellers.  

As  to  governance  issues  relating  to  homeless  policies,  local  stakeholders  play  a  key  role  in 
promoting innovative and more effective solutions. Moreover, there is now more reinforced 
cooperation  between  government  social  and  housing  departments  (FI,  SE,  PL,  DK,  PT,  SI) 
and  between  different  levels  of  government  that  take  into  account  the  central  role  of  local 
authorities in housing inclusion policies (e.g. "Municipal Compass" plans in NL). 

In France, the right to housing is becoming legally enforceable. Some Member States have set 
specific  targets  for  reducing  the  number  of homeless  people  (FI:  halve  the  number  of  long-

27 

28 

For  example  people  sleeping  rough,  people  in  emergency  accommodation,  people  living  in 
accommodation for homeless people, people living in institutions (due to lack of shelter), people living 
in  non-conventional  dwellings,  or  people  living  with  family/friends.  See  ETHOS  classification 
http://www.feantsa.org/files/indicators_wg/ETHOS2007/general/EN_2007EthosLeaflet.pdf. For a more 
complete assessment of homelessness strategies in the NAPs 2008-2010, see also FEANTSA position 
paper 
framework  on  homelessness" 
"Paving 
(http://www.feantsa.org) 
On place-based policies and the role of cities, see also the EUROCITIES position paper on the analysis 
of the NAPs inclusion 2008-2010 (http://www.eurocities.eu) 

a  European 

consensual 

the  way 

for 

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50 

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term  homeless  by  2011;  UK:  reduce  the  number  of  rough  sleepers;  IE:  eliminate  long-term 
occupancy  of  emergency  homeless  accommodation  by  2010;  DK:  reduce  and  ultimately 
eradicate  homelessness),  while  other  targets  relate  to  increasing  the  supply  of  services  and 
housing  support  (e.g.  FR:  developing  12,000  places  in  "maisons  relais";  SI:  increase  the 
capacity of admission centres and shelters for the homeless). Here, there is a need for more 
reliable  data  on  the  extent  of  homelessness,  and  on  the  social  characteristics  of  homeless 
people, and the causes and geographical spread of homelessness. 

3.5.3.  Access to healthcare 

Although  overall  life  expectancy  in  the  EU  has  increased  over  the  past  two  decades, 
substantial  disparities  still  remain.29  The  reduction  of  inequalities  between  socio-economic 
groups  and  regional  differences  in  health  is  mentioned  as  the  most  important  health  policy 
challenge for Finland and the UK, and as a major goal for some other countries (LT, IE, AT, 
EE, SI, SK), and as part of the Belgian, Hungarian and Spanish strategy. Some, such as the 
UK,  have  allocated  extra  funding  for  direct  action  to  reduce  health  inequalities.  As  part  of 
their strategies to address health status inequalities, countries are endeavouring to improve the 
take-up rate for healthcare insurance, eliminate barriers of access to healthcare and break the 
cycle  of  transfer  of  ill-health  from  one  generation  to  the  next,  by  focusing  on  vulnerable 
groups.  Amongst  the  vulnerable  groups  identified  by  Member  States  are,  for  example, 
children  and  families,  immigrants,  Roma30,  disabled  people,  people  with  mental  health 
problems31, homeless people, vulnerable elderly people, and substance abusers. Countries are 
also targeting specific deprived areas and regions in removing barriers to access. 

Ensuring  equal  access  to  healthcare,  notably  by  enhancing  primary  and  preventive  care 
provision,  and  implementing  policies  to  promote  healthy  behaviour,  are  key  policy  areas. 
Health promotion and disease prevention activities include: programmes focusing on breast-
feeding,  vaccination  and  screening  system  (HU);  subsidised  school-meals  (SI);  promoting 
healthy eating and access to healthy food and physical activity among adults in disadvantaged 
areas  (IE).  To  reduce  financial  barriers,  France  provides  free  care  to  people  with  chronic 
conditions. To increase insurance coverage, Germany established mandatory health insurance 
that  has  given  public  or  private  health  insurance  to  an  additional  120,000  people.  Cyprus 
gives attention to the high co-morbidity and health risks of people with mental disorders, thus 
addressing stigma as a major access barrier affecting this group of people. 

The reports show that there are many sources of social inequality in health in the EU, such as 
income disparities, differences in living conditions, lifestyles and risky behaviour. Evidence 
suggests  that  low  levels  of  income  and  education  are  strongly  correlated  with  ill-health.  A 
multifaceted strategy covering health promotion and disease prevention actions in a number 
of  policy  fields  are  deemed  necessary  by  several  Member  States.  Accordingly,  reports 
mention the development of cross-sectoral policies. Some Member States (FI, IE, AT, SI, EE, 
SK  and  UK)  use  specific  action  plans  to  tackle  health  inequalities  by  encouraging  health 
protection  in  other  policy  sectors  (e.g.  education,  employment,  working  conditions,  housing 
conditions, social work, rural development, environment). Finland has adopted an action plan 
against  health  inequalities  for  2008-2011,  whose  objectives  are  1)  to  impact  on  poverty, 

29 
30 
31 

See also the healthcare chapter of this report for further information 
For further details see the part on Roma 
Mental  Health  Europe  assessed  the  treatment  of  this  issue  in  the  2008-10  NSRs:  http://www.mhe-
sme.org/assets/files/MHE%20members%20Analysis%20of%20National%20Strategic%20Reports%202
008-2010.pdf  

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education,  employment,  working  conditions  and  housing  conditions  through  socio-political 
measures,  2)  to  promote  a  healthy  lifestyle  in  general,  and  among  those  in  a  weaker  social 
position in particular, and 3) to improve the availability and use of social and health services. 

3.5.4.  Access to financial services / fighting financial exclusion and over-indebtedness 

The study Financial Services Provision and Prevention of Financial Exclusion32 published by 
the  European  Commission  in  May  2008  highlighted  the  close  interaction  between  financial 
and  social  exclusion.  On  the  one  hand,  groups  facing  poverty  and/or  exclusion  encounter 
specific  difficulties  in  accessing  financial  services,  with  negative  consequences  for  their 
personal  finance  or  ability  to  find  a  job.  Denial  of  access  to  financial  services  on  the 
mainstream  market  may  lead  people  to  turn  to  more  costly  and  risky  alternative  financial 
products. On the other hand, for the general population, an improper use of financial services 
may, when combined with a critical life event, lead to over-indebtedness. 

7%  of  the  population  in  the  EU-15  and  34%  in  the  EU-10  can  be  considered  as  financially 
excluded.  This  is  why  financial  inclusion,  defined  as  everyone’s  capacity  to  access  and 
properly use the financial services required to participate fully in economic and social life, is 
to be recognised as a dimension of the broader social inclusion objectives. In this perspective, 
financial inclusion covers several areas, in which those latter goals are to be mainstreamed: 1) 
effective,  adequate  and  affordable  access  to  basic  banking  services;  2)  prevention  and 
rehabilitation  of  over-indebtedness;  3)  promotion  of  professional  and  personal  microcredit 
and 4) development of financial information and education for vulnerable consumers. 

Several Member States did not mention this issue in their report (BG, CY, DK, EE, EL, IE, 
LT, LU, RO, SK, SI), illustrating a discrepancy between social needs and the current crisis, 
and  the  national  policies  as  reflected  in  the  NAPs.  Very  few  countries  claim  to  have  a 
comprehensive  policy  as  regards  financial  inclusion  (AT,  BE,  FR,  NL,  UK).  In  the  UK  an 
action plan for financial inclusion 2008-2011  was  published, with an  associated  fund.  More 
Member States acknowledge that the situation is worrying. In FR and BE, indicators relating 
to the level of access to banking as well as over-indebtedness are used in the monitoring of the 
NAPs. But the Netherlands is the only Member State where addressing over-indebtedness is 
one of the specific NAP objectives (as already in 2003 and 2006) consistently encompassing 
regulatory measures and initiatives agreed with stakeholders. 

A  consistent  over-indebtedness  policy  requires  both  prevention  (encompassing  responsible 
borrowing and money management; responsible lending; and responsible arrears management 
and debt recovery) and measures to alleviate over-indebtedness and rehabilitate debtors (debt 
advice  and  counselling  services;  judicial  processes,  including  bankruptcy;  and  non-judicial 
procedures for debt settlement)33. Debt advice is the dimension of over-indebtedness which is 
most commonly mentioned (FI, PT, UK). In the Netherlands, where it lies within the remit of 
municipalities, it will be further developed, with a special target for early detection. Several 
groups of the population require specific attention, namely young people (AT, NL), migrants 
(AT, NL), and Roma (HU). 

32 
33 

EN 

http://ec.europa.eu/employment_social/spsi/financial_exclusion_en.htm  
Study 
http://ec.europa.eu/employment_social/spsi/docs/social_inclusion/2008/leaflet_overindebtedness_en.pd
f  

overindebtedness, 

operational 

European 

definition 

Common 

on 

of 

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In  Austria,  in  order  to  ensure  actual  access  to  a  bank  account,  a  specific  account  has  been 
developed  by  Sparkassen,  already  with  2,000  recipients  out  of  a  potential  target  of  50,000 
customers. In the UK, the Government agreed in 2004 a shared goal with the banking sector 
to halve the number of adults living in households without access to a bank account. 800,000 
people have already been brought into banking, but 1.3 million households are still unbanked. 

Social credit in Belgium, and personal microcredit in France (3000 beneficiaries) help people 
without  access  to  the  mainstream  credit  market  to  restore  a  borrowing  capacity  that  can  be 
used  for  investing  in  mobility,  home  equipment,  training  or  health.  Spain  and  Portugal 
mention measures to develop microcredit as a support to active inclusion of people excluded 
from the labour market thanks to self-employment. 

Financial exclusion is often linked with housing problems: unsustainable mortgage credit may 
put  families  at  risk;  unpaid  utility  bills  rise  among  at-risk-of-poverty  people;  evictions  are 
very  often  caused  by  situations  of  over-indebtedness,  and  over-indebtedness  seems  more 
widespread among homeless people. Sweden implements municipal rent guarantees. Denmark 
has  been  experimenting  since  2004  with  a  remission  of  public-sector  debt  for  socially 
disadvantaged groups who have received social assistance for four years or longer. 

3.5.5.  Access to Education/training 

Most NAPs recognise the importance of education, but only a few integrate it in a coherent 
long-term strategy to tackle social exclusion. However, there is a general lack of assessments 
of progress and clear evaluation mechanisms, based on targets and indicators. 

Pre-school education is seen as fundamental in most strategies, both to provide a firm basis 
for competence from the start, and to help families reconcile work and private life, especially 
beneficial for the most disadvantaged. As mentioned under 3.2.2., some NAPs (AT, EE, ES) 
address childcare facilities for 0-3 year-olds, as well as (LT) disparities in provisions between 
regions and rural and urban areas. Germany has decided to considerably increase the places in 
crèches  for  children  under  3  (750,000  by  2013).  In  Belgium,  enrolment  in  pre-school 
education will be possible from the age of 2.5. Ireland launched a National Childcare Strategy 
for  early  childhood  development  and  care.  Hungary  prioritises  pre-school  attendance  for 
children  with  multiple  disadvantages,  also  by  providing  attendance  allowances.  Other 
countries (SI, SK) are issuing allowances and subsidies to support enrolment of children from 
disadvantaged backgrounds. In Poland, ESF intervention will support pre-school education in 
rural  areas.  Some  countries  (e.g.  NL)  are  giving  priority  to  reducing  backlog  in  language 
learning by expanding and strengthening pre-school education. Sweden has targeted support 
to children who do not have Swedish as their mother tongue. 

Targeted resources for improving access to education and training for specific groups at risk 
of exclusion: Germany focuses on young people with a migrant background. The Netherlands 
and Belgium focus on the acquisition of basic skills and job coaching for young migrants. The 
French  community  of  Belgium  also  intends  to  facilitate  enrolment  in  schools  for  irregular 
migrants, to improve social heterogeneity in schools and re-establish teaching of language and 
culture  of  origin.  Austria  promotes  early  language  support  in  kindergarten  and  provides 
remedial  lessons  in  German.  Denmark  strengthens  advisory  units  for  bilingual  pupils  in 
vocational  training  programmes,  through  mentors,  optional  classes  and  support  for  parental 
involvement. In Ireland, English language training is offered to migrant workers. The Swedish 
plan  includes  a  number  of  strategic  initiatives  for  the  education  of  migrants.  In  Poland  the 
extensive measures are undertaken to support students from rural areas and help them to reach 

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higher  levels  of  education.  In  Slovakia,  a  new  law  on  education  prohibits  all  forms  of 
discrimination and segregation in education, and is supported by financial mechanisms. Spain 
focuses  on  developing  key  competences  and  taking  better  account  of  the  needs  of  students 
with  an  immigrant  background  and  improving  the  quality  and  attractiveness  of  vocational 
education  and  training,  and  on  grants  and  study  allowances.  Estonia,  Germany,  Slovakia, 
Lithuania  and  Slovenia  are  reviewing  or  extending  grants  and/or  loans  for  students  from 
financially  disadvantaged  families.  Portugal  facilitated  access  to  higher  education  for  older 
learners by making enrolment more flexible. For a complete account, please refer to the Third 
Annual Report on Migration and Integration (COM(2007) 512 final). The Annex provides a 
full description for all 27 Member States of the implementation of Common Basic Principle 
number  5  'Efforts  in  education  are  critical  to  preparing  immigrants,  and  particularly  their 
descendants, to be more successful and more active participants in society''. 

Combating  early  school  leaving:  While  Member  States’  ESL  rates  differ  considerably,  the 
link with disadvantage is clear. According to the EU benchmark, by 2010 no more than 10% 
of young people on average should leave school early – but in 2007 the average EU rate for 
18-24 year-olds was still 14.8%. Many Member States are implementing preventive measures. 
For instance, Estonia is developing career counselling and guidance; in 2006 the Netherlands 
established an "Offensive on drop-outs" strategy, aiming to halve the number of new school 
drop-outs  by  2012,  also  focusing  on  smoothing  transitions  between  school  types.  France  is 
developing mentoring for pupils with difficulties and disseminating knowledge about jobs in 
various sectors of industry and services among young people. Austria is introducing a right to 
education up to the age of 18 and endeavours to offer more places in vocational schools, while 
new educational pathways are under discussion. Denmark established an overall goal of 95% 
of  a  youth  cohort  to  complete  qualifying  education  by  2015,  and  addresses  drop-outs  from 
VET  through  mentor  schemes  and  practical  training  programmes.  In  Finland,  measures  to 
combat ESL include the increase of apprenticeships and possibilities for a flexible completion 
of  compulsory  education  ('JoPo').  Ireland  is  investing  additional  resources  in  education 
support programmes. Portugal is creating alternative curricular paths and increasing the range 
of courses for young people. Slovakia introduced grants to access education and training from 
pre-primary to tertiary level. England has legislated to raise the participation age so by 2015 
all young people will be in education or training until at least 18. Spain promotes measures to 
ensure  success  at  school  for  all  students,  such  as  PROA  Plan  to  reduce  school  failure  in 
primary  and  secondary  education  centres  in  social  deprived  areas,  the  Initial  Vocational 
Qualification programmes to offer a new educational alternative for young people who have 
not obtained the qualification of graduate in obligatory secondary or to establish a programme 
of pay-grants to encourage those at risk of leaving school for financial reasons. 

Several  EU-8+2  Member  States  are  concentrating  their  efforts  on  improving  educational 
opportunities and access to the labour market for Roma (see further in section 3.3). 

Most plans address the need to improve access at all levels for learners with disabilities and 
special  needs.  A  trend  can  be  observed  toward  inclusive  education  as  opposed  to  special 
education  in  separate  settings.  Estonia  will  develop  counselling  networks  to  achieve  early 
identification  and  treatment  of  special  education  needs,  and  will  foster  e-education 
programmes  and  flexible  education  opportunities.  The  Portuguese  “Novas  oportunidades” 
plan  provides  for  a  review  of  the  national  Special  Education  system,  including  new  units 
specialised  in  multiple  disabilities  and  autism,  and  an  increase  in  the  number  of  special 
education teachers in mainstream schools. Austria is planning to adopt measures to improve 
special  pedagogical  support  in  mainstream  primary  and  lower  secondary  schools.  Bulgaria 
hopes  to  induce  a  change  in  public  attitude,  even  though  issues  persist  in  relation  to 

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institutional care for mentally disabled people. In Latvia, concrete targets have been fixed to 
accommodate  special  education  needs  in  mainstream  education.  In  Hungary,  the  number  of 
disabled students enrolled in higher education increases year-on-year, and the state provides 
supplementary  state  subsidy  for  these  students,  though  numbers  still  seem  low.  Germany 
refers to an ESF-funded initiative to train people with disabilities and sensitise employers. 

In the area of vocational training, France plans to modernise VET and to increase its labour 
market relevance. The Netherlands put in place obligatory work/schooling for young people 
without basic qualifications, and aims to make education more relevant to the labour market. 
Germany  is  improving  access  to  VET  for  people  at  risk,  as  is  Portugal  through  the  Novas 
Oportunidades initiative. Poland is adapting VET programmes to labour market requirements, 
and  focusing  on  training  and  qualification  standards  for  trainers.  Both  Latvia  and  Lithuania 
are  modernising  VET,  and  set  ambitious  national  targets  on  participation.  Ireland  aims  to 
improve  the  quality  of  training  for  low-skilled  workers.  Hungary  continues  to  establish 
regional integrated training centres. 

Some  NAPs  address  the  validation  of  prior  learning  as  a  means  of  facilitating  inclusion 
through  better  access  to  employment  or  further  learning.  (Accreditation  of  Prior  Learning 
processes  (NL),  a  network  of  specialised  centres  on  recognition  and  certification  of 
competences (BE, PT), and initiatives for recognition of prior learning of migrants (LU, SE)) 

The digital divide is mentioned in only a few reports. Measures to ensure access to ICT for 
disadvantaged  groups  (PT,  SK),  supported  access  to  ICT  for  young  people  (BE,  Wallonia), 
improved  school  infrastructure  with  over  98%  of  schools  having  high-speed  Internet  access 
(BG), a network of public Internet access points, and promotion of software development for 
learners with special needs (SI). 

As to adult participation in lifelong learning (LLL) the Czech Republic has established plans, 
including  networking  of  adult  education  providers,  using  structural  funds.  Finland  plans  an 
overall  reform  of  adult  training.  Portugal  promotes  adult  participation  in  LLL  through  the 
Novas  Oportunidades  initiative.  The  Flemish  Community  of  Belgium  launched  a  strategic 
plan  to  tackle  illiteracy,  also  in  companies.  In  Luxembourg,  training  leave  has  been 
introduced  for  workers.  In  Lithuania,  at  least  one  LLL  centre  has  been  established  in  each 
municipality.  As  mentioned  above,  some  NAPs  describe  measures  to  facilitate  access  to 
education and training for parents. 

The  ESF  will  provide  substantial  support  to  reducing  inequalities  in  access  to  high  quality 
education and training. A significant part of the above measures will also be co-financed by 
the  ESF.  In  the  2007-13  period,  Member  States  will  spend  some  €20  billion  on  the 
introduction  of  reforms  in  education  and  training  systems,  including  measures  aimed  at 
improving  the  labour  market  relevance  of  initial  and  vocational  education,  increasing 
participation  in  education  and  training  throughout  the  life-cycle,  combating  early  school-
leaving,  and  reducing  gender-based  segregation  of  subjects.  In  addition,  €7  billion  will  be 
invested from the ERDF on education infrastructure. 

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3.6. 

Enhancing governance of social inclusion policies 

3.6.1.  Mobilising actors/raising awareness  

Preparation process 

Increased  involvement  of  stakeholders  in  the  preparation  of  the  national  reports  of  many 
Member States should contribute to better social inclusion policies.  

In some cases, participation of stakeholders was organised for the preparation of the National 
Strategy  Report  as  a  whole  (all  three  strands)  (e.g.  AT,  DK),  but  more  often  as  a  separate 
process  for  the  NAPs,  reflecting  the  differences  between  the  three  strands,  as  regards  the 
characteristics of the policy area and the stakeholders traditionally involved. 

Depending  on  whether  the  NAP  is  the  result  of  a  strategic  decision-making  process  or  a 
reporting  exercise,  participation  of  stakeholders  can  mean  different  things.  In  the  first  case, 
participation can lead to direct impact on decision-making. In the latter, it can be an occasion 
to exchange information, discuss social inclusion policy in an integrated framework, review 
implementation and put subjects on the agenda for later decision-making. Assessing whether 
participation has made a difference is key. 

In  most  Member  States,  a  working  group  consisting  of  several  ministries,  led  by  a 
coordinating ministry (often a ministry of social affairs and labour) drew up a draft NAP that 
was discussed by a NAP or social inclusion committee including stakeholder representatives 
and/or  was  discussed  at  ad  hoc  events  (hearings,  conferences,  seminars).  Sometimes  it  was 
presented  to  existing  permanent  consultation  forums  (e.g.  social  partners  forum).  Often, 
NGOs,  social  partners  and  service  providers  were  involved  in  preparing  the  plans.  Their 
participation  is  easier  to  arrange  if  umbrella  organisations  exist.  Since  policies  are  often 
implemented  at  the  regional  and  local  level  a  strong  involvement  of  regional  and  local 
authorities in the preparation of the plan is needed. In this respect there is considerable room 
for  improvement  but  some  countries  have  tried  to  better  involve  municipalities  and  regions 
(municipalities (e.g. BE, BG, NL, PL); provinces (e.g. AT)). Although there are some good 
practice  examples  (BE,  LU,  UK  (e.g.  meeting  organised  to  ensure  participation  of  children 
living  in  deprived  areas))  in  many  countries  there  is  room  for  increasing  involvement  of 
people experiencing poverty and social exclusion. People who are suffering from poverty and 
social exclusion should be listened to when policies are developed to address their situation. 

Quality of participation 

As  to  quality  of  participation  there  have  been  some  positive  developments.  Some  Member 
States started early with the preparation of the plan informing and involving stakeholders at 
an early stage (e.g. AT, FR, NL). Several Member States opened up the preparation process 
and invited the public at large to send in comments and proposals. Sometimes a draft of the 
plan was put on a website (BG, PL) and a broad and open consultation took place (DK, FI, 
HU, MT). Some countries organised a survey (ES, LT) or used consultation techniques such 
as focus groups (NL, MT). 

Some Member States ensured that high level decision-makers, e.g. ministers, participated in 
the seminars and conferences, thereby, highlighting the importance of these events (e.g. AT, 
LU).  Several  Member  States  are  providing  or  intend  to  start  providing  capacity-building 
support to stakeholders so that their participation is facilitated and supported (BE subsidises 

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organisations  where  people  experiencing  poverty  can  speak  out,  PT,  LT).  Participation  is 
often more fruitful when adequate consultation documents are produced, e.g. an early draft of 
the plan and a report on the results of policies in the previous planning period (e.g. BG, ES, 
PT,  HU).  An  important  aspect  of  quality  is  the  provision  of  feedback  on  the  results  of 
participation.  Some  of  the  plans  refer  to  participation  results.  The  Dutch  plan  includes  an 
annex describing the results of consultation and the plan itself indicates how consultation has 
impacted  on  it.  The  Spanish  plan  also  contains  an  annex  that  reports  on  the  results  of  the 
consultation.  For  each  of  the  main  objectives  of  the  NAP  and  for  all  target  groups  /  policy 
areas,  effective  measures  in  the  previous  plan  are  highlighted,  new  problems  and  needs  are 
identified,  proposals  for  the  new  NAP  are  put  forward,  and  actions  developed  by  the 
stakeholders  consulted  are  described.  Luxembourg's  plan  indicates  how  the  results  of  the 
consultation  have  been  taken  into  account.  The  UK  NAP  includes  quotations  from  a 
stakeholders' participation event.  

In  several  Member  States  codes  on  minimum  quality  standards  for  participation  or 
consultation have been adopted (e.g. UK: Code of Practice on Consultation; AT: Standards of 
Public Involvement (also inspired by the UK code); EE: Good engagement practices; Wales: 
National  Children  and  Young  People's  Participation  Standards).  The  European  Commission 
has  its  own  minimum  standards  on  consultation.  These  examples  can  be  a  good  basis  for 
mutual learning. 

Insufficient attention to the quality of participation ultimately risks leading to 'consultation' or 
'participation fatigue'. 

Stakeholder involvement over the reporting and policy cycle 

Because  major  decisions  on  social  inclusion  policy  are  taken  in  between  OMC  reporting 
deadlines  and  because  stakeholder  involvement  in  the  implementation,  monitoring  and 
evaluation  stages  of  the  policy  process  can  help  make  the  policies  more  effective,  it  is 
important  that  participation  in  the  preparation  of  the  NAPs  be  embedded  in  a  continuous 
process  of  stakeholder  participation  throughout  the  reporting  and  policy  cycle.  Although 
many of the plans contain a general commitment to uphold stakeholder involvement, on this 
subject  they  are  often  not  very  specific.  In  several  Member  States  more  or  less  permanent 
social  inclusion  or  NAPs  committees  will  ensure  continued  involvement  of  stakeholders 
throughout  the  policy  process.  The  Belgian  report  indicates  that  the  actions  working  group 
met  ten  times  during  2006-2008  to  follow  up  implementation  of  the  report.  In  the  UK  a 
stakeholder  working  group  meets  regularly  and  a  social  policy  task  force  grouping  NGO's 
participating  in  the  OMC  process  meets  frequently  with  a  social  inclusion  unit  (ministry)). 
The Swedish report indicates that there may be room for improving stakeholder participation 
in  the  preparation  of  the  NAP,  but  it  is  considered  more  important  that  stakeholders  are 
continuously  involved  in  the  work  of  state  agencies  and  bodies  like  the  Service  Users 
Commission. Hungary mentions several permanent consultation councils (on Roma inclusion, 
elderly people, disabled, gender equality). Germany set up a "Permanent Council of Advisors 
on  Social  Integration"  and  organised  a  series  of  seminars  ("FORTEIL").  In  some  Member 
States conferences or seminars marking the start of the implementation of the NAPIncl have 
been planned (e.g. UK, SK, EE). 

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Awareness raising 

In general, it seems that only a few Member States have used the preparation of the reports as 
an opportunity for broader awareness-raising activities in the media and society at large. Only 
on rare occasions has there been a real broad public debate. Parliament seems to have debated 
the  NAP  in  only  some  countries  (NL,  DE,  MT).  The  Spanish  plan  announces  that  the 
intention  is  to  promote  a  debate  in  the  Parliament.  In  Luxembourg  some  members  of 
Parliament  participated  in  a  preparatory  meeting  with  people  experiencing  poverty.  In 
Portugal Parliament has decided that an annual social inclusion implementation report should 
be presented to it. Several Member States announce that dissemination measures will be taken 
in the future (publish plan on paper, organise seminar, e.g. EE, PT). An increasing number of 
Member  States  put  the  NSR/NAP  documents  on  the  internet  on  dedicated  web  pages  and 
announce that follow up information (e.g. monitoring data) will be added. Regular updating of 
such web pages is an important challenge. 

3.6.2.  Mainstreaming social inclusion / horizontal coordination  

In the national reports many Member States acknowledge the need for mainstreaming social 
inclusion concerns across different policy areas but often only limited or partial information 
on  mainstreaming  arrangements  is  provided.  Several  countries  quite  openly  admit  that  this 
still remains a challenge. Inadequate mainstreaming will result in less effective and efficient 
social  inclusion  policies.  The  extent  of  mainstreaming  is  directly  linked  to  the  level  of 
political  priority  that  is  given  to  the  issue  in  the  Member  States.  Mainstreaming  is  a 
'characteristic'  of  policy  that  should  be  analysed  for  specific  policy  areas  and  policies.  An 
analysis of the extent of mainstreaming of social inclusion objectives in the Growth and Jobs 
Strategy  (National  Reform  Programmes),  the  Sustainable  Development  Strategy  and  the 
structural funds, in particular the European Social Fund is included elsewhere in this report. 
Mainstreaming  of  specific  thematic  issues  like  child  poverty  has  also  been  touched  upon  in 
the  thematic  sections  of  this  report.  In  the  good  governance  part  of  the  NAPIncl's  Member 
States report on structural measures in place to facilitate mainstreaming and horizontal policy 
coordination. Such measures have been implemented at the national, but also at the regional 
and local level of government. 

One  important  way  of  ensuring  mainstreaming  is  by  coordinating  policies  through 
coordination committees within the government (at the political level) or at the level of public 
administration (see also above: the preparation process) e.g. Belgium, Lithuania and Cyprus. 
Some Member States attach a long detailed list of ministries involved in these committees in 
an  annex  to  the  report  (e.g.  BG).  In  many  cases  such  committees  are  coordinated  by  social 
ministries.  Potentially  the  effective  mainstreaming  impact  may  be  bigger  when  they  are 
composed  of  high-level  representatives,  when  they  are  coordinated  by  the  prime  minister's 
office (e.g. IE) or when they are 'horizontal', overarching entities within the administration.  

The active involvement of stakeholders working on the issue of social inclusion from different 
perspectives  in  the  policymaking  process  for  different  policy  areas  (see  above)  can  also 
contribute significantly to social inclusion mainstreaming. 

Mainstreaming at the regional and local level is encouraged by the development of regional 
and local action plans. Some Member States mention a Progress-funded project to develop a 
methodology  for  developing  these  plans  (CZ,  ES).  The  challenge  will  be  to  implement  the 
results  on  a  permanent  basis.  Regional  plans  have  been  developed  in  Belgium.  The 
Netherlands  gives  an  example  of  social  inclusion  policy  coordination  at  local  level:  the 

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Groningen poverty pact. Bulgaria intends to provide methodological support to regional and 
local authorities for developing regional and municipal social inclusion plans (The goal is that 
at  least  half  of  all  municipalities  should  have  a  social  inclusion  plan  by  2010).  In  Portugal 
local  social  networks  and  supra  district  (regional)  territorial  platforms  aim  to  take  an 
integrated  approach  to  social  policy.  In  Poland  a  more  flexible  framework  for  cooperation 
between  public  administration  and  civil  society,  including  new  institutions  such  as  public-
social partnership and local initiatives, is to be implemented in 2009. 

Another  way  of  ensuring  that  social  inclusion  concerns  are  taken  on  board  across  different 
policy  areas  is  by  developing  a  network  of  focal  points.  In  Bulgaria  a  network  of  social 
inclusion  focal  points  in  all  relevant  departments  has  been  established  at  national  level  and 
networks at regional and local level are also being put in place. The importance of capacity 
building  is  highlighted.  Belgium  announces  that  the  pilot  project  on  mediators  in  the  field 
(federal level) will be rolled out and given a structural framework. Also in Portugal there is a 
network  of  focal  points,  antennas  for  monitoring  and  evaluating  different  ministries' 
contribution to social inclusion policy. Also, a platform has been created for national sectoral 
plans  (16  such  plans  are  mentioned)  to  ensure  integrated  policy.  In  Ireland  social  inclusion 
units  have  been  established  in  many  government  departments.  At  the  local  level  the  social 
exclusion unit programme is being extended. 

Another interesting way of integrating social inclusion concerns in different policy areas is by 
putting  in  place  ex  ante  social  impact  assessment  arrangements.  This  means  the  potential 
social inclusion impacts of proposed measures can be assessed before the measure is adopted. 
The process provides an opportunity to increase the transparency of decision-making and to 
involve  stakeholders  early  in  the  policy  process.  In  Ireland  Poverty  Proofing  /  Impact 
Assessment  has  been  around  for  a  long  time.  It  has  been  mentioned  in  several  previous 
editions  of  this  joint  report.  Revised  guidelines  have  been  adopted.  There  is  increased 
attention  to  supporting  departments  in  implementing  them.  In  a  number  of  other  countries 
social impact assessment is mentioned as part of a more integrated impact assessment system 
that also looks at other impacts (on the economy, the environment etc.) In Belgium the federal 
government  announces  that  it  intends  to  strengthen  the  poverty  aspect  of  sustainability 
development impact assessment (put in place at the start of 2007). In Slovakia an integrated 
impact assessment system (with a social impact component) is currently being tested (a pilot 
is  ongoing  and  the  system  is  to  be  rolled  out  in  2009).  The  LT  plan  announces  ex  ante 
assessment of the impact of all proposed laws on social exclusion and poverty.  

3.6.3. 

Involvement of regional and local authorities / vertical coordination 

Despite  some  progress,  there  is  still  a  big  discrepancy  between  the  actual  role  that  regional 
and  local  authorities  play  on  social  inclusion  and  their  uneven  involvement  in  the  NAPs. 
Indeed,  the  reports  mention  a  large  number  of  concrete  achievements  in  which  these 
authorities have a key role, when delivering social services on the basis of national regulations 
or within their own schemes, contributing to social innovations or embedding social inclusion 
needs  into  broader  local  development  requirements.  But  in  general,  the  governance 
arrangements needed to ensure that they contribute and pay attention to the NAPs have yet to 
be  developed.  Many  reports  (e.g.  CY,  ES,  NL,  UK)  emphasise  that  these  authorities  were 
consulted  when  preparing  the  national  strategies  but  do  not  show  whether  it  was  done 
systematically and in a strategic manner. The various specificities of particular stakeholders 
are  seldom  emphasised.  Consistency  between  national  policy  and  local  planning  seems  to 
remain  a  challenge.  That  is  why,  when  national  strategies  come  to  be  implemented,  local 

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action  plans  (PT)  can  help  to  make  the  objectives  effective  and  adapt  them  to  local 
specificities. 

The Council of European Municipalities and Regions (CEMR) provided its assessment of the 
involvement  of  its  members  in  the  preparations  of  the  NAPs-inclusion34  (EUROCITIES' 
contribution was referred to above).  

3.6.4.  Gender mainstreaming 

Efforts made by Member States to mainstream gender issues in policy priorities show a mixed 
picture.  Some  make  explicit  commitments  to  improve  equality  between  genders  across  the 
plan  (e.g.  BG,  ES,  FR,  IE,  LT  and  PT)  or  refer  to  the  government's  gender  equality 
programme (e.g. CY, DK, EL, FI, SK and the UK), but how specific measures will take this 
into account is not always reflected throughout the plans. While a number of measures tackle 
gender-specific problems (such as labour market integration, child poverty, lone parenthood, 
and  flexible  forms  of  work)  which  are  likely  to  benefit  women,  a  general  tendency  is  that 
these are not always analysed from a gender perspective or said to aim at increasing gender 
equality. 

Assessing the gender impact of policies 

Spain: The Spanish Government prepared a report on the gender impact of policies contained 
in  its  National  Report  on  Strategies  for  Social  Protection  and  Inclusion,.  As  set  out  in  the 
report,  "learning  about  gender  impact  in  the  use  of  Strategies  for  Social  Protection  and 
Inclusion is also becoming a way to make a balanced inclusion of both men’s and women’s 
different interests, wishes and needs, thus ensuring greater efficiency of public services, better 
governance and a fairer and equal treatment for both sexes." 

UK:  The  UK  Government  prepared  a  gender  impact  assessment  of  pension  reform.  This 
concluded  that  the  state  pension  reforms  will  narrow  the  gender  pension  gap  and  remove 
discrimination  for  carers  in  the  pension  system.  The  private  pension  reforms  will  ensure 
equality of access to a workplace scheme of a minimum standard, giving 3.5 to 4 million of 
women access for the first time. 

Labour  market  integration  of  disadvantaged  groups  is  a  priority  objective  in  most  plans. 
Almost half of the Member States acknowledged the specific problems faced by women, and 
proposed measures aimed at directly helping them (e.g. AT, CY, EL, ES, FR, HU, IT, IE, LT, 
MT, NL, RO, SI, UK). Measures to improve reconciliation of work and family life are often 
seen  as  the  way  to  help  women  (re-)integrate  into  employment.  More  than  one  third  of 
Member  States  expressed  their  commitment  to  increasing  the  availability  of  childcare  (e.g. 
AT,  BE,  DE,  DK,  EE,  EL,  FR,  HU,  IT,  IE,  LU,  MT,  PT,  RO,  UK),  which  should  be 
considered  a  positive  development.  However,  it  is  less  frequently  for  measures  to  pay 
attention  to  the  role  of  men:  Bulgaria  will  introduce  leave  of  absence  for  fathers  and  child-
raising; Estonia noted that fathers can take leave in the case of childbirth; Sweden created a 
gender equality bonus as an incentive for parents to share parental leave as evenly as possible, 
and  the  UK  is  proposing  to  give  a  new  right  to  fathers  to  take  up  to  26  weeks  Additional 
Paternity Leave before their child’s first birthday to allow mothers to return to work earlier if 
they wish. 

34 

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Only a handful of MS have taken on board the need to combat the gender pay gap (e.g. BG, 
CY,  DE,  FI,  LT,  SK  and  the  UK)  and  even  fewer  expressed  a  commitment  to  eliminate 
gender-related  stereotypes  (e.g.  BG  and  LT).  However,  a  number  of  Member  States  have 
expressed a commitment to promote gender equality in training and education (e.g. AT, EL, 
ES,  FR,  IE,  LT,  PT,  SE  and  SK).  Individual  measures  directed  specifically  at  women  also 
include  the  promotion  of  female  entrepreneurship  (e.g.  CY,  EL,  FR,  LT  and  PT)  and 
commitment to improve women's representation in decision-making positions (e.g. BG, DK, 
EL, FI and LT). 

Some MS have designed specific measures to help immigrant women (e.g. AT, DE, DK, ES 
and FR), but only one proposes to improve the specific situation of Roma women (BG). 

Social inclusion measures targeted at immigrant women* 

Austria:  The  Report  highlights  as  an  important  element  in  promoting  inclusion  of  migrants 
the emphasis placed in integration programmes on women-specific measures, with language 
and  health  being  prioritised.  Child-minding  services  are  provided  while  migrant  women 
attend  vocational  guidance  and  qualification  programmes,.  In  2007,  the  inter-ministerial 
working  group  “Migrant  Women"  was  set  up  aiming  to  develop  demand-oriented  measures 
for  women  with  a  migrant  background,  with  cooperation  by  all  ministries.  About  30 
counselling  centres  for  migrants  and  women’s  service  centres,  predominantly  active  in 
counselling  migrants,  were  funded  in  2008.  Denmark  -  Special  actions  for  women  with 
immigrant backgrounds and their families: A Women’s Programme has been launched, with 
the  general  purpose  of  helping  more  women  with  migrant  backgrounds  to  become  active 
citizens in Danish society. It comprises 11 specific initiatives to strengthen women’s chances 
of  finding  work,  getting  an  education  and  participating  in  sports  and  association  life.  They 
also aim to enhance women’s ability to support their children’s integration and development 
in the wider sense.  

*A  range  of  relevant  activities  are  carried  out  in  the  framework  of  the  European  Integration  Fund;  targeting 
specific  groups,  including  women  and  children,  is  a  specific  priority  and  many  national  programmes  foresee 
information: 
activities 
http://ec.europa.eu/justice_home/funding/integration/funding_integration_en.htm 

respect. 

further 

this 

For 

in 

Improved measures to combat violence are cited in many NAPs (AT, CZ, DK, EL, ES, HU, 
FR, LT, LV, PL, RO, SE, SI, SK, UK), but proposals to combat trafficking are less frequently 
mentioned (e.g. DK, EL and LT). 

A few plans (e.g. AT, BE, DK and IE) pay specific attention to the need for a gender sensitive 
approach into measures to improve the situation of homeless people but actions designed for 
disabled people seldom take specific account of disabled women (e.g. AT and EL). 

There  is  very  little  evidence  that  gender  equality  actors  are  involved  in  the  consultation 
process,  with  some  exceptions  (CY,  ES,  HU,  PT,  UK),  but  a  number  of  countries  intend  to 
allocate funding for capacity building of bodies responsible for promotiing equality between 
genders. 

3.6.5.  Monitoring and evaluation 

There are substantial differences in the amount of detail Member States have provided in the 
national reports on monitoring and evaluation arrangements. Often, the information given is 
not sufficient to allow an adequate assessment. Some Member States have developed specific 

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OMC  monitoring  systems.  Others  rely  on  regular  national  reporting  tools  (reports  from 
ministries  and  statistical  institutes)  (e.g.  FI,  DE),  or  produce  reports  in  line  with  other, 
sometimes longer-term national strategies (e.g. IE NAPs 2007-2016). 

Where  specific  monitoring  systems  have  been  developed  in  the  context  of  the  OMC,  it 
appears that in most Member States there are separate arrangements for the social inclusion 
strand  (NAPs).  Only  some  Member  States  have  planned  fully  integrated  monitoring  and 
evaluation arrangements covering all strands of the OMC (e.g. SI). 

Two  kinds  of  monitoring  systems  can  be  distinguished:  indicator  sets  that  can  provide 
quantitative  information  on  input,  output  and  outcome  of  policies,  and  monitoring  systems 
that  provide  information  on  the  implementation  of  measures.  Typically,  the  latter  type  of 
system  gives  a  description  of  measures,  who  is  responsible,  to  what  extent  measures  have 
been  implemented,  what  resources  have  been  committed  etc.  (annex  to  ES,  PL,  PT,  HU 
report). 

Only  few  Member  States  continuously  update  their  monitoring  systems  (some  are  available 
on-line).  In  most  cases,  annual  reports  are  produced  or  reports  are  updated  in  line  with  the 
OMC or national strategy reporting cycle. 

From the reports, it is not always clear how monitoring reports are to be used or who will be 
examining them. In the case of PT, the Parliament has decided that a NAPIncl implementation 
report  will  have  to  be  presented  to  it  on  an  annual  basis.  Also  in  LV,  each  year,  ministries 
have to report on the implementation of the plan. The report is to be presented to the Cabinet. 

Concerning the use of indicators overall, the NSRs show how common EU indicators can be 
used to assess the situation in the wider EU context and in relation to all dimensions of the 
objectives.  Most  Member  States  draw  on  the  EU  lists  of  overarching  and  social  inclusion 
indicators to describe the social situation, often focusing on the key indicators that are most 
relevant to their strategy. A number of countries also base their assessment on a full review of 
the overarching and social inclusion indicators agreed in the framework of the Social OMC. 
The  EU-based  indicators  are  often  supplemented  by  national  outcome  indicators,  mainly  to 
cover  populations  such  as  specific  vulnerable  groups  (immigrants,  ethnic  minorities,  the 
disabled, people living in deprived areas, the homeless), or to reflect dimensions that are not 
yet  covered  by  EU  indicators  (housing,  persistent  poverty,  socio-economic  gaps  in  life 
expectancy, etc).  

Member  States  use  EU  indicators  to  a  lesser  degree  to  monitor  progress  towards  the  policy 
objectives they have set. A number of countries have nevertheless adopted targets based on 
EU outcome indicators, especially in the area of child poverty (see Section 3.1). Some (AT, 
BE,  BG,  DE,  EE,  ES,  FR,  HU,  IE,  SK)  have  also  enhanced  their  use  of  indicators  for 
monitoring  purposes.  To  this  end,  Member  States  more  often  use  national  input  or  output 
indicators that are timelier and directly related to specific policy measures, such as the number 
of  childcare  places,  the  number  or  percentage  of  beneficiaries  of  a  given  programme,  the 
number of homes built in the social housing sector, etc. In many cases, these policy-related 
indicators are accompanied by targets. 

Most  but  not  all  Member  States  have  developed  monitoring  arrangements  for  each  policy 
priority  as  suggested  in  the  guidance  note  for  the  national  reports.  Many  of  them  frankly 
acknowledge that in this respect much work still needs to be done. Although specific issues 
have been singled out as policy priorities, sometimes data sources and indicators still need to 

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be  developed  to  allow  monitoring  of  progress.  Especially  when  targets  have  been  set, 
effective  monitoring  will  only  be  possible  if  regular  measurement  and  time  series  are 
available. 

Some  countries  have  set  up  indicator  working  groups  that  are  tasked  with  systematically 
developing  data  sources  and  monitoring  indicators.  See  e.g.  Ireland  good  practice  on 
'technical advisory group and data matrix', Spain, Belgium. Sometimes the priority issues the 
groups will be working on in the near future are indicated. 

If the idea is to move to more evidence-based policies, investment in basic data and analytical 
capacity are a sine qua non. A so-called evaluation culture needs to be fostered. In Romania a 
social observatory will be established. In Greece, a new social protection national council is to 
be  created  that  should  support  a  network  consisting  of  observatories,  study  centres  and  the 
National Statistical Institute. It is often mentioned that there is a specific need for developing 
data  sources  and  indicators  on  the  most  vulnerable  groups  that  are  not  covered  by  standard 
surveys (BE is developing surveys to reach population groups that are not covered under EU-
SILC).  One  example  of  an  area  that  is  particularly  challenging  is  the  issue  of  the  social 
inclusion  of  migrants  and  ethnic  minorities.  Another  example  of  a  priority  issue  that  is 
mentioned in the reports is the development of an absolute poverty measure (SK). 

An  additional  challenge,  which  became  clear  again  with  the  sudden  economic  downturn,  is 
the need to develop short-term indicators of poverty and social exclusion. Several of the most 
important  commonly  agreed,  survey-based 
indicators  only  become  available  with 
considerable  delay.  In  fact,  sometimes  data  in  the  plans  refer  to  2006,  i.e.  the  start  of  the 
previous planning period. There seems to be no obvious solution to this problem, but in some 
cases one could consider developing proxy indicators that are available much faster. 

A common problem is that monitoring is often organised at the national, aggregate level, even 
though important social inclusion competences are situated at the regional or local level and 
important  territorial  disparities  exist.  Some  Member  States  have  developed  monitoring 
instruments that allow the government to keep an overview of what is happening and that at 
the  same  time  allow  municipalities  or  regions  to  compare  or  benchmark  their  performance. 
Examples of such systems are: the Work and Benefits Core Card in the Netherlands and the 
social  map  website  in  Lithuania.  The  choice and  development  of  appropriate  indicators  and 
context variables is especially challenging in these monitoring systems. Portugal mentions a 
database social network programme (local level).  

Various  institutional  monitoring  arrangements  have  been  put  in  place.  In  some  Member 
States, a specific NAPs Committee is involved in the preparation of the plan, its monitoring 
and  evaluation  (often  also  coordination).  Some  of  these  committees  consist  mainly  of 
representatives  from  the  different  ministries  involved  in  social  inclusion  policy.  A  broad 
composition  will  ensure  more  effective  monitoring.  In  Portugal  and  Ireland,  monitoring 
involves  focal  points  in  different  ministries  relevant  for  social  inclusion  policy.  Some 
committees are open to stakeholders and non-governmental experts: NGOs, service providers, 
academics,  representatives  of  regional  and  local  government,  etc.  For  instance,  Italy  is 
planning to create a body of this kind on a permanent basis. Monitoring will be more effective 
if  there  is  high-quality  involvement  of  non-governmental  experts  and  also  people 
experiencing poverty and social exclusion. 

Several  Member  States  have  started  the  preparation  of  the  new  NAPs  with  a  review  or 
evaluation of the previous plan. E.g. in ES, an evaluation seminar was organised. For this, a 

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detailed implementation report and a report on the diagnosis of poverty and social exclusion 
in  Spain  were  prepared  (annexed  to  the  plan).  In  the  guidance  note  for  this  report  Member 
States were asked to include a progress report and to indicate how lessons have been drawn 
from the evaluation of the previous action plan. Member States have done this to a different 
extent. Some Member States report briefly on the way in which the plan will be evaluated but 
generally  little  detail  is  provided.  In  many  Member  States  it  seems  to  be  assumed  that 
permanent  social  inclusion  or  NAP  Committees  will  be  involved  in  monitoring  and  that 
evaluation will take place when preparing the next action plan. More detailed information is 
provided in the Slovenian plan. Here it is announced that a special evaluation group is to be 
set up the end of 2008. The composition of the group is described in detail. It will meet twice 
a year to discuss implementation and an annual evaluation report will be produced. 

3.7. 

Annexes to Chapter 3 

GOOD PRACTICE EXAMPLES OF SOCIAL INCLUSION POLICIES 

IN THE 2008 NAPs-INCLUSION 

To support evidence-based policy development, the examples selected below aim to cover key 
policy areas evenly and to highlight projects that take a comprehensive approach, to tackling 
the multiple facets of social exclusion and accumulated disadvantages. The examples covered 
are:  tackling  child  poverty,  access  to  services,  addressing  social  inequalities  in  health, 
housing/homelessness,  migrants  and  minorities,  addressing  financial  exclusion  and  over-
indebtedness,  active  inclusion/labour  market  integration  and  fighting  poverty/  minimum 
income support, Roma, governance, and mainstreaming. The aim has been to select examples 
of projects that have received a positive evaluation and seem to have a lasting impact. In some 
cases,  however,  projects  are  promising  but  a  full  evaluation  still  remains  to  be  carried  out. 
Some examples of good practice provided by Member States are shown in boxes in the main 
text instead. These are listed at the end of this Annex for ease of reference. 

Tackling child poverty 

UK: Family Nurse Partnership programme. 

Target group: Single-parent families. 

Objective:  Improving  outcomes  in  pregnancy  and  birth,  enhancing  child  health  and 
development, improving parent’s life course and economic self-sufficiency. 

Actions / what they do: Family Nurses visit parents from early pregnancy until the child is two 
years  old,  building  a  therapeutic  relationship  with  the  mother-to-be  and  guiding  parents  to 
change  their  health  behaviours,  improve  care  given  to  the  infant  and  become  economically 
self-sufficient. 

Monitoring and evaluation: External evaluation by Birkbeck College, London. The evaluation 
will  focus  on  implementation,  deliverability,  take-up  and  costs,  while  looking  at  the  short-
term impact on mothers' and children's health. The evaluation is expected to report in 2009. 

Outcome  /  result:  Early  signs  are  promising.  Early  learning  suggests  that  the  FNP  has  high 
take  up,  that  it  is  welcomed  by  practitioners,  and  that  it  can  lead  to  positive  changes  in 
behaviour, relationships and well-being. 

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CZ: Introducing multidisciplinary teams into Youth Court practice. 

Target group: Children, their families and other relevant stakeholders. 

Objective: Map out a system of care for children at risk or in danger in the locality, optimising 
the coordination of solutions to cases and carrying out strategic work with children at risk or 
in danger and with their parents; regular evaluation and proposals for new measures. 

Actions  /  what  they  do:  Creation  of  multidisciplinary  teams  including  representatives  from 
PMS, the courts, the public prosecution office, the Police of the Czech Republic, institutions 
providing  social  legal  protection  for  children,  city  councils,  criminality  prevention 
coordinators, service providers (social, healthcare, educational) and other stakeholders. 

Monitoring  and  evaluation:  Monitored  and  evaluated  by  the  Czech  PMS  Headquarters, 
Department of Methodology, Conception and Analysis, on a regular basis. 

Outcome / result: Multi-disciplinary Youth Teams have been introduced in almost all judicial 
districts  and  have  been  integrated  into  the  practice  of  the  Early  Intervention  Centre,  greatly 
increasing the number of cases resolved in preparatory proceedings. 

Active inclusion: Minimum income support 

ES: The minimum income system of the autonomous communities. 

Target group: The  socially disadvantaged  including single-parent families, the unemployed, 
the  elderly,  young  people,  the  disabled,  immigrants/refugees,  Roma,  the  homeless  and  drug 
abusers.  

Objective: To guarantee minimum resources and social and labour market integration. 

Actions / what they do: Creation through legislation of last-resort and basic minimum income 
guarantee system in the Autonomous Communities. 

Monitoring and evaluation: Control and follow-up by each community and an annual report 
by central government detailing regulations, access requirements, benefit composition and an 
analysis of the results. 

Outcome / result: Introduction of schemes in all Autonomous Communities except the City of 
Ceuta  (currently  being  implemented)  resulting  in  total  expenditure  in  2007  exceeding  €415 
mio.  

Active inclusion: Inclusive labour markets 

UK: National roll-out of the Provider-led Pathways to Work service. 

Target group: Disabled people and others of working age receiving incapacity benefit. 

Objective: Reducing the number of people receiving incapacity benefits by 1 million over the 
ten years ending 2015/2016 by moving people into sustained employment. 

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Actions  /  what  they  do:  Building  on  the  service  provided  by  18  Jobcentre  Plus  districts  by 
contracting  providers  nationwide  to  conduct  work-focused  interviews  and  provide  tailored, 
job-focused support for IB and voluntary customers. 

Monitoring  and  evaluation:  Quality  review  process  for  all  products,  user  assurance  groups, 
quantitative assessment on exits from benefits and process evaluation. 

Outcome / result: Roll-out accomplished in all 31 Jobcentre Plus districts on time with quality 
and performance objectives being met. 

LT: Integration of hearing-impaired persons into the open labor market. 

Target group: Individuals with a hearing impairment. 

Objective: The implementation of an innovative and effective job-seeking programme for the 
hearing-impaired. 

Actions  /  what  they  do:  Arranging  motivation  seminars,  aiding  active  work  search  utilising 
individual  audiovisual  presentations,  on-site  supervision  of  employed  participants,  and 
utilisation of employment agents active in all phases of the process.  

Monitoring  and  evaluation:  Quarterly  reports,  external  expert  evaluation,  semi-annual 
assessment meetings.  

Outcome  /  result:  126  out  of  159  participants  have  obtained  jobs,  contacts  have  been  made 
with 84 firms.  

Active inclusion: Access to services 

BG: Social Services for New Employment – social support to vulnerable groups, persons and 
families (SANE). 

Target group: The elderly, people with disabilities, unemployed acting as ‘social assistants’. 

Objective: Deinstitutionalsze and decentralize the provision of social services. 

Actions / what they do: Development and testing of new funding management and provision 
models and development of new standards for the ‘social assistants’ programme. 

Monitoring  and  evaluation:  Central  project  management  unit  (PMU  SANE)  monitors 
procedures, carries out audits and evaluations. 

Outcome / result: Social services were provided to 2037 users by 700 trained social assistants 
in 12 pilot municipalities, capacity was strengthened in 264 municipalities to offer the service, 
250 social workers were trained in programme quality standards. 

Addressing social inequalities in health 

AT: ‘To your heart’s content’ – women from Favoriten live a healthy life. 

Target group: Socially disadvantaged women living in the Favoriten district of Vienna. 

Objective: Health promotion and prevention of cardio-vascular disease. 

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Actions  /  what  they  do:  An  extensive  sensitization  and  information  campaign,  creation  of  a 
women’s exercise group, invitation to join a nutrition, exercise and counselling programme, 
networking and cooperation with health authorities and local institutions. 

Monitoring  and  evaluation:  Ongoing  evaluation  documenting  satisfaction  with 
programme and achievement of goals among users. 

the 

Outcome  /  result:  Almost  1000  contacts  with  the  target  group;  250  women  from  a 
multicultural background participated in the programme. 

Housing/homelessness 

CZ: Strategy for the social inclusion of the homeless. 

Target group: The homeless. 

Objective: More systematic and effective efforts to improve the situation of the homeless.  

Actions / what they do: Creation of a definition and typology of the homeless, establishment 
of a monitoring system, research into the provision of healthcare to the homeless, evaluation 
of  increased  number  of  social  workers  working  with  the  homeless,  creation  of  a  dedicated 
website. 

Monitoring  and  evaluation:  Permanent  evaluation  (e.g.  the  typology  working  groups 
consulted  with  experts  at  intervals)  and  evaluation  of  monitoring  reports  in  context  of  ESF 
grant procedure. 

Outcome / result: All initiatives were carried out, research was disseminated and is still being 
carried  out  after  the  completion  of  the  project,  documentation  showing  the  effectiveness  of 
increased numbers of social workers was passed on to the authorities. 

PL: Social work for the benefit of social housing development. 

Target group: The homeless, the unemployed, the elderly and young people. 

Objective:  Possibilities  of  using  programmes  of  social  and  vocational  activation  of  social 
assistance recipients in order to improve their own housing situation. 

Actions  /  what  they  do:  Local  partnerships  between  social  assistance  institutions,  labour 
offices and local employers were formed during the project period 2007-2008. 

Monitoring  and  evaluation:  Monitoring  was  ensured  through  the  principles  of  ministerial 
project "Active Forms of Counteracting Social Exclusion". 

Outcome / result: Increased initiative of municipal self-governments in 2008 within the scope 
of  initiating  local  programs  of  social  work  and  public  works  in  the  area  of  social  housing 
facilities and in the field of care services. Greater interest in system solutions in the field of 
state  co-financing  of  initiatives  in  the  area  of  the  construction  of  social  housing  flats,  night 
shelters and facilities for the homeless. All in all, 84 social housing flats were constructed, a 
house for the homeless was renovated and 145 persons were engaged in social work, whereas 
40 persons threatened by social exclusion participated in the programme in one of the cities 
participating in the programme. 

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Migrants and minorities 

EL: Training for Muslim children. 

Target group: The minority student population, including those of Roma origin. 

Objective:  Harmonious  integration  of  minority  children  in  the  system,  acceptance  of  these 
children  by  the  educational  staff  and  all  citizens  of  Thrace,  provision  of  knowledge  and 
suitable  educational  material  to  teachers  including  Turkish  language  courses,  support  for 
families  to  encourage  their  children’s  good  school  performance,  awareness  of  the  education 
administration  mechanism  and  representatives  of  local  administration,  awareness  of  all 
parents and the public opinion in general. 

Actions  /  what  they  do:  Included  establishment  of  Muslim  Children  Education  Programme 
Support Centres offering language classes, creative activities for pre-school children, creative 
workshops for young persons, creation of mobile support centres to reach rural areas, creation 
of educational materials including electronic versions, training for teachers and psychologists 
including Turkish language training, counselling.  

Monitoring and evaluation: Continuing evaluation by a scientific board.  

Outcome / result: Five-fold increase in attendance by the target group. 

AT: Basic vocational guidance in the mother tongue. 

Target group: Immigrants/refugees. 

Objective: Labour market integration. 

Actions / what they do: Basic vocational guidance in the mother tongue is provided at three 
group sessions covering the labour market in Vienna, the legal framework and information on 
job-seeking. 

Monitoring and evaluation: The programme is reviewed annually in the WAFF report. 

Outcome / result: The counselling has made it possible for participants to formulate individual 
goals and plans of action leading to employment. 

Addressing financial exclusion and over-indebtedness 

IT: Microcredit to families at zero rate for unforeseen economic difficulties (Veneto region) 

Policy area: Addressing financial exclusion and over-indebtedness – Tackling child poverty 

Target group: Families or lone parents facing unexpected financial difficulties 

Objectives:  Prevention  of  over-indebtedness  with  the  aim  to  ensure  in  particular  sufficient 
resources for children 

Actions  /  what  they  do:  Provide  microcredits  free  of  charge  in  order  to  cover  extraordinary 
costs related to healthcare, education, housing, debt recovery and all unforeseen costs related 
to children 

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Monitoring and evaluation: Computerized management of  the project, regular evaluation of 
the activities and possible critical issues 

Outcome  /  result:  High  number  of  applications  received  and  full  use  of  allocated  funds. 
Payments are in line with project forecast 

NL: Measures intended to strengthen debt counselling and reduce over-indebtedness. 

Target group: The over-indebted including homeless people. 

Objective:  To  reduce  the  number  of  homes  with  over-indebtedness  and  to  improve  the 
effectiveness of debt counselling. 

Actions / what they do: Letter of intent and bilateral arrangements with housing corporations, 
power companies, debt-counselling organisations and municipalities, amendment to the Debt 
Rescheduling Act to create two new instruments: moratoriums and insolvency. 

Monitoring and evaluation: Amendments to legislation on debt rescheduling will be evaluated 
in a report to Parliament in three years time. 

Outcome  /  result:  Letter  of  intent  and  bilateral  arrangements  have  improved  cooperation 
between institutions/organisations, but still room for improvement.  

Governance 

IE: Technical Advisory Group and Data Matrix. 

Target group: Government bodies, social partners, NGOs. 

Objective: Advice on and support for the development of relevant indicators on poverty and 
social exclusion and the added scope for research into poverty and exclusion. 

Actions / what they do: Advise the Office of Social Inclusion (OSI) on indicator development, 
creation of a data matrix containing indicators for each goal, target and action contained in the 
Irish NAPincl.  

Monitoring  and  evaluation:  The  OSI  regularly  consults  stakeholders  in  order  to  ensure  the 
timeliness of the data matrix. 

Outcome  /  result:  The  data  matrix  is  being  designed  to  serve  as  a  reference  point  for  a 
streamlined reporting mechanism of social inclusion activity across the various Government 
strategies. 

Mobilising stakeholders 

LT: Webpage "Social map"  

Target group: Politicians, representatives of local communities, civil organisations, local and 
central authorities, society at large. 

Objective: Improved governance in the field of social support to combat social exclusion and 
poverty. 

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Actions  /  what  they  do:  Webpage  with  information  on  EU  and  LT  initiatives  like  e.g.  legal 
acts,  programmes,  projects,  reports,  data  and  indicators,  good  examples,  a  discussion 
forum and list of stakeholders in the field of social inclusion.  

Monitoring and evaluation: Permanent monitoring of usage. 

Outcome / result: Total number of webpage visitors from October 2007 to July 2008; 170433. 
Sharing  of  good  examples  between  actors  in  the  municipalities;  opportunity  for  dialogue 
between local and national level. 

Mainstreaming 

ES: Programme for the development of local Plans for Social Inclusion in Cataluña. 

Target group: The socially excluded in 103 municipalities. 

Objective: Stimulate and generate resources for drawing up Plans for Social Inclusion in the 
local sphere. 

Actions  /  what  they  do:  The  government  of  Cataluña  provides  financial  resources,  technical 
cooperation  and  advice,  training  and  the  transfer  of  knowledge  aimed  at  supporting  the 
drawing up of local Plans. 

Monitoring  and  evaluation:  A  working  group  consisting  of  regional  government  technical 
personnel  and  representatives  of  the  participating  municipalities  is  developing  indicators  to 
monitor  progress  while  another  group  has  been  established  to  identify  criteria  for  good 
practices; the projects of 6-8 councils will be assessed.  

Outcome  /  result:  The  number  of  local  councils  with  Plans  in  place  has  grown  from  12  in 
2006 to 22 as at 1 July 2008. 

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LIST OF EXAMPLES OF GOOD PRACTICE IN THE FIELD OF SOCIAL 
INCLUSION BY MEMBER STATE 

MEMBER 
STATE 

EXAMPLE OF GOOD PRACTICE 

Credit account for people affected by poverty / persons without cash 

KomenskýFond  (Komensky  Fund):  an  initiative  of  the  ERSTE  Foundation 
and Caritas 

"Mummy learns German" at nurseries and schools in Vienna 

Three City of Vienna projects:  

Austria 

1. “Prospects“: vocational and educational counselling for persons entitled to 
asylum and financial support for further education; 

2.  “Competence  Centre“:  counselling  to  assess  prior  learning  and  further 
education needs ofnew migrants; 

3. “Basic vocational guidance in the mother tongue” targeting newcomers 

“To your heart’s content” - -women from Favoriten live a healthy life 

“… but healthy despite everything!” 

Les experts du vécu/médiateurs de terrain  

Belgium 

Les fonctionnaires d’attention  

Inclusion de personnes sans-abri  

Validation des compétences  

Social  Services  Against  New  Employment  –  social  support  for  vulnerable 
groups, persons and families (SANE) 

Bulgaria 

Increasing  the  employability  of  the  unemployed  by  vocational  training 
(German-Bulgarian Vocational Training Centres) 

Programme  for  targeted  social  protection  for  heating  to  the  population  with 
low income 

Development of local services in social welfare services 

Cyprus 

Project  “Expansion  and  Improvement  of  Care  Services  for  Children,  the 
Elderly, Disabled persons and other Dependants” 

Czech 

Three-stage permeable housing system 

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MEMBER 
STATE 

Republic 

EXAMPLE OF GOOD PRACTICE 

Rehabilitation – Activation – Work 

Support for inclusion – Career counselling 

Introducing multidisciplinary teams into Youth Court practice 

Strategy for the social inclusion of the homeless 

Evaluation of the project Focus on the Family 

Forward - To ensure work and education for drug and alcohol misusers 

Denmark 

Integration of mothers and their children through the project Neighbourhood 
Mothers 

SPIDO (Socio-pedagogic Practice in Dementia Care) 

National Indicator Project (NIP) 

The ESF programme ‘Welfare measures to support employment 2007-2009’ 

Estonia 

Introduction of the case management principle 

Intersectoral welfare policy programme on children and youth 

Finland 

Kaiku Programme to promote occupational wellbeing 

Promoting health and functional capacity 

Instaurer la fluidité du parc hébergement/logement /Improving availability of 
housing 

Favoriser  le  retour  à  l’emploi  des  bénéficiaires  de  minima  sociaux  et 
augmenter le temps de travail des travailleurs pauvres / Return to employment 
of  minimum  benefit  recipients  and  increased  working  hours  for  low-paid 
workers 

France 

La mesure de l’atteinte de l’objectif de baisse d’un tiers de la pauvreté en 5 
ans /Monitorinig target to reduce poverty by one-third in five years 

L’insertion des jeunes par la deuxième chance / Inclusion of young people by 
giving a second chance 

Germany 

The Federal Government’s “Job – Jobs without Barriers” initiative 

Hesse’s “Experience has a Future” programme 

The Free State of Saxony’s programme “Training unemployed people without 

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MEMBER 
STATE 

EXAMPLE OF GOOD PRACTICE 

vocational qualifications to obtain recognised vocational qualifications” 

Rhineland-Palatinate “InPact” programme 

Greece 

Training addressed to Muslim children 2005-2008 

Micro-regional social closing-up programmes 

Hungary 

Subsidised housing programme for homeless people 

Senior-friendly municipality award and grant programme 

Creation of the Office of the Minister for Integration 

Ireland 

National Intercultural Health Strategy 2007 – 2012 

Technical Advisory Group and Data Matrix 

A certificate for the Italian language: the way to know and to get known 

Prestito  sull'Onore:  microcredit  at  zero  rate  for  unforeseen  economic 
difficulties 

Education  and  training  of  foster  families  of  foreign  minors  deprived  of 
parental care (undocumented children) 

Fondo Autonomia Possible: Fund allowing Autonomy 

The "Complex inclusion programme" 

Creation of ‘one-stop shop’ for employment counselling through merging of 
two state agencies 

Italy 

Latvia 

Webpage “Social map”  

State support for the social enterprises  

Lithuania 

EQUAL project “Integration of hearing impaired persons into the open labor 
market” 

Development  of  public  internet  access  points  network  (alliance  “Window  to 
the future”) 

Luxemburg 

Foyer scolaire “Parc Hosingen” by SISPOLO (Syndicat intercommunal pour 
l’éducation , l’enseignement, le sport et les loisirs) - Regional initiative of 4 
neighbour  communes  to  offer  after-school  quality  childcare  for  school 
children aged 3-13 years, in close collaboration with pre-school and primary 
school professionals 

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MEMBER 
STATE 

EXAMPLE OF GOOD PRACTICE 

RESONORD  Regional  Sozialétude  Norden  :  Projet  d’étude  sociale  de  la 
région LEADER+ Clervaux-Vianden en vue d’une démarche intercommunale 
de  développement  social  /  Project  for  social  study  of  the  region  aimed  at 
multi/commune action on social development 

Integration of Asylum Seekers into Maltese Society 

Equal Project - HEADSTART 

Malta 

National Standards of Care for Residential Childcare 

Gender Mainstreaming - The Way Forward 

Prevention Information Team (PIT) Eindhoven  

Netherlands 

Measures 
indebtedness 

intended 

to  strengthen  debt  counselling  and  reduce  over-

The  Social  Integration  Program  (the  Post-Accession  Support  Program  for 
Rural Areas – PSPRA) 

Poland 

Construction  of  multi-function  sports  fields  generally  accessible  to  children 
and young people 

Social work for the benefit of social housing development 

Transnational Project LAPs & RAPs (financed by the EU) 

Entrepreneurs for Social Inclusion (EPIS) 

Training modules for the technical secretariats of the County Commission for 
Social Inclusion 

Job  Fairs  and  Employment  Caravan  aimed  at  individuals  with  Roma 
background 

Improving  the  quality  of  social  assistance  provision  for  citizens  in  the 
Bratislava  Self-governing  Region  (BSK),  extending  and  modernising  social 
services provided and developing new types of social services relevant to the 
needs and the demand 

Building  a  system  for  prevention  and  job  placement  for  the  long-term 
unemployed, persons with low qualification and other disadvantaged groups  

Twinning project to improve resocialisation and rehabilitation of drug addicts 

‘Project  Man’  programme  for  self-help  therapy  and  social  rehabilitation  of 

Portugal 

Romania 

Slovakia 

Slovenia 

EN 

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MEMBER 
STATE 

EXAMPLE OF GOOD PRACTICE 

people with various forms of addiction 

Network  of  maternity  homes  and  shelters  for  women  and  children  who  are 
victims of violence 

‘Involvement of the elderly in providing home assistance to the elderly’ 

Programme for development of local plans for social inclusion in Cataluña 

Spain 

The minimum incomes system of the autonomous communities 

Governance process in the 2nd regional plan for social integration (2nd PRIS) 
of the Regional Board of Castilla-La Mancha  

National  guidelines  on  misuse  and  dependency  care  issued  by  the  National 
Board of Health and Welfare 

Sweden 

Action plan against male violence against women 

Family Nurse Partnership programme 

Provider-led Pathways to Work 

United 
Kingdom 

Money Matters Financial Learning Project, Inverclyde 

Social Firms 

Off the Streets and into Work & St Mungos: improving access to training and 
employment for homeless people 

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4. 

ADEQUATE AND SUSTAINABLE PENSIONS 

4.1. 

Overall strategy for Adequacy and Sustainability of Pensions 

4.1.1. 

Introduction 

Common objectives for Pensions 

Member States are committed to providing adequate and sustainable pensions by ensuring: 

(g)  adequate  retirement  incomes  for  all  and  access  to  pensions  which  allow  people  to 
maintain,  to  a  reasonable  degree,  their  living  standard  after  retirement,  in  the  spirit  of 
solidarity and fairness between and within generations; 

(h)  the  financial  sustainability  of  public  and  private  pension  schemes,  bearing  in  mind 
pressures  on  public  finances  and  the  ageing  of  populations,  and  in  the  context  of  the  three-
pronged  strategy  for  tackling  the  budgetary  implications  of  ageing,  notably  by:  supporting 
longer  working  lives  and  active  ageing;  by  balancing  contributions  and  benefits  in  an 
appropriate and socially fair manner; and by promoting the affordability and the security of 
funded and private schemes; 

(i) that pension systems are transparent, well adapted to the needs and aspirations of women 
and  men  and  the  requirements  of  modern  societies,  demographic  ageing  and  structural 
change; that people receive the information they need to plan their retirement and that reforms 
are conducted on the basis of the broadest possible consensus. 

The  2006  Synthesis  Report  on  Adequate  and  Sustainable  Pensions  outlined  the  main 
challenges  to  be  met  in  the  area  of  pension  provision.  Over  the  past  decade  reforms  have 
improved  sustainability  by  braking  and  counteracting  the  effects  of  declining  ratios  of 
working  years  to  retirement  years  and  of  workers  to  pensioners.  The  2006  report  reiterated 
that financially sustainable systems must be balanced with adequate benefits. Member States 
have increasingly employed a mix of different types of pension designs: public and private, 
pay-as-you-go  and  funded,  mandatory  and  voluntary  in  order  to  reach  these  goals.  At  the 
same  time  they  have  sought  to  underpin  changes  to  pension  systems  by  improvements  in 
labour markets, notably by raising employment rates of women and older workers.  

The  2007  and  2008  joint  reports  have  included  in-depth  analyses  of  specific  issues,  policy 
findings  and  indicators  to  measure  progress  towards  the  common  objectives.  The  SPC  has 
also  adopted  reports  on  current  and  prospective  theoretical  replacement  rates,  minimum 
income provision for older people, promoting longer working lives through pension reforms 
and  privately  managed  pension  provision.  Other  issues  such  as  pension  information  and 
financial  literacy  have  been  covered  through  peer  reviews  35.  Countries  have  contributed  to 
these studies by responding to questionnaires and participating in peer review processes. 

National Strategy Reports delivered in the early autumn of 2008 where Member States report 
on  their  responses  to  the  challenges  identified  in  the  2006  and  2007  Joint  Reports  form  the 

35 

For information from the peer review on Public information on pension systems and pension system changes please 
refer to: http://www.peer-review-social-inclusion.net/peer-reviews/2008/public-information-on-pension-systems-
and-pension-system-changes 

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foundation  for  the  policy  analysis  in  this  document,  which  is  issued  in  support  of  the  Joint 
Report 2009. 

4.1.2.  Reforming pension systems to meet the demographic challenge 

Over  the  last  decade  Member  States  have  reformed  their  pension  systems  to  better  provide 
adequate  and  sustainable  pensions  in  view  of  population  ageing,  new  societal  norms  and 
changing behavioural patterns. Consequently in their 2008 national strategy reports, countries 
focus on the implementation of reforms and further incremental progress that has been made. 
Such progress in many ways involves a delicate balancing of the dual concerns of adequacy 
and  sustainability:  how  to  secure  sufficient  pensions  for  all  without  jeopardizing  work 
incentives and the financial sustainability, and vice versa.  

Still a few Member States have legislated more substantial reforms since the last reporting. 

The Portuguese pension reform, following an agreement with the social partners, entered into 
force  in  May  2007.  The  reform  entails  increasing  the  pensionable  age  and  the  eligibility 
periods  until  2015,  as  well  as  changes  to  the  benefit  formula,  that  will  lower  replacement 
rates. The reform covers both government and private sector schemes. Changes in the latter 
include  larger  benefit  reductions  in  case  of  early  retirement  and  creation  of  incentives  to 
postpone  retirement,  the  introduction  of  a  'sustainability  factor'  that  automatically  adjusts 
benefits to changes in residual life expectancy and indexation rules for pension benefits as a 
function of real GDP growth and consumer inflation. 

The Czech Republic has started a pension reform in three phases. The first phase adopted in 
July  2008  included  new  legislation  that  increases  the  pensionable  age  to  65,  prolongs  the 
eligibility  criterion  for  contributory  years  and  introduces  new  incentives  for  prolonging 
working lives by strengthening the bonus-malus system for earlier or delayed retirement. The 
second and third phases of the reform which are to be carried out by 2010 concentrate more 
on strengthening the role of funded, privately managed pension provision.  

Greece  has  adopted  legislation  reducing  the  number  of  pension  funds,  harmonising  pension 
eligibility  ages,  limiting  access  to  early  retirement,  crediting  child  caring  years  and 
introducing a social security number for beneficiaries. While still rather complex the system 
has been simplified to improve its financial efficiency. 

Cyprus has introduced a reform that will entail gradual increases in the contribution rate and 
in  the  minimum  eligibility  requirements.  The  pensionable  age  for  civil  servants  has  been 
increased to 63 years. In Cyprus, the introductions of a Special Allowance and some ad hoc 
increases in the minimum pension have been legislated in order to address the high risk-of-
poverty in old age. Given these improvements, there is still a need to monitor the incomes of 
those claiming solely a social pension and those living in single-person households. 

The UK is continuing its programme of pension reforms affecting public and private pillars. 
Reforms  adopted  or  proposed  since  the  2007  Joint  Report  include  a  major  easing  of 
entitlement criteria for basic pension, earnings related indexation from 2012 and much wider 
coverage of supplementary pensions encouraged through means of auto-enrolment and further 
financial incentives for people to contribute to these schemes.  

A  number  of  Member  States  have  introduced  quantitative  national  targets  or  monitoring  of 
national  indicators  as  methods  of  motivating  progress  in  the  area  of  pensions.  Bulgaria  and 

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Romania  have  targets  to  decrease  contributions  in  order  to  encourage  participation  in  the 
labour  force.  Slovenia  has  set  a  target  to  achieve  a  coverage  rate  of  70%  by  2030  in  the 
voluntary funded scheme. Ten Member States have succeeded in reaching the Lisbon target of 
a  50%  employment  rate  for  older  workers  agreed  by  all  Member  States.  In  Poland  a 
programme has been introduced to increase the employment rate of older workers to 40% in 
2013  and  50%  in  2020.  Germany  has  set  national  targets  on  the  employment  rate  of  older 
workers beyond the Lisbon target. The United Kingdom is assessing progress using indicators 
on the employment rates of those ages 50-69 as compared with the overall employment rate. 

Some  countries  have  defined  targets  on  the  adequacy  of  pension  benefits  or  adopted  an 
indicator-based  approach  to  monitor  and  improve  the  welfare  of  the  elderly.  Cyprus  has 
introduced a target to reduce the at-risk-of-poverty from 52% to 40% by 2011 with the intent 
to  pursue  a  risk-of-poverty  ratio  for  the  elderly  that  is  lower  than  20%  by  2013.  Other 
countries  have  pegged  the  adequacy  of  pensions  by  quantifying  targets  in  terms  of 
replacement  rates,  although  the  definitions  of  replacement  rates  may  vary  in  the  targets  set. 
Ireland has endorsed a target of a 50% replacement rate from all sources of pension income in 
the  Programme  for  Government.  In  Belgium,  the  current  government  wants  to  increase  the 
old-age pension replacement rate for workers who are currently active. In Lithuania, targets 
correspond to a long-term  adequacy  goal of  mandatory pension levels equivalent to 50% of 
average  net  wages.  In  the  United  Kingdom,  the  percentage  of  pensioners  with  low  income 
will be monitored as part of a public service agreement to ‘tackle poverty and promote greater 
independence and wellbeing in later life’. 

4.1.3.  Prolonging working lives to address the pension challenge 

Meeting  the  pension  challenge  is  essentially  about  closing  the  gap  between  shorter 
contributory  lives  and  longer  retirement  periods  –  with  the  first  resulting  from  later  labour 
market entrance  and  decreased employment rates of older workers and the second triggered 
by premature exit and rising life expectancy. Maintaining the adequacy and sustainability of 
pension provision in an ageing society depends crucially on more people working more and 
longer.  

Pension  systems  can  support  labour  market  objectives  by  including  all  active  groups,  by 
signalling  appropriate  ages  of  retirement  and  by  establishing  economic 
incentives 
(bonus/malus) in support of desired behaviour. Activity and employment rates are influenced 
by a whole range of factors unrelated to pensions. Yet, norms for pensioning and retirement 
practices are influenced by the institutional framework created by the state. Rules of pension 
accruals,  the  pensionable  age  and  designs  of  early  retirement  benefits  represent  signals  for 
workers and employers that impact on age management.  

As  Members  States  are  seeking  to  re-establish  a  sustainable  balance  between  contributory 
working  years  and  years  spent  in  retirement  they  are  faced  with  a  combined  need  for: 
(a) lowering  the  entry  age,  (b) lowering  the  incidence  and  length  of  careers  breaks  and 
(c) increasing the effective exit age. So far most efforts have been directed at influencing the 
effective exit age. 

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Table 4.1: Average labour market exit age and life expectancy at 60 in selected EU 
Member States in 2006 

Member State 

Statutory pensionable age 

Effective exit age from the 
labour market 

Life expectancy at 60 

Belgium 
Bulgaria 
Czech Republic 
Denmark 
Germany 
Estonia 
Ireland 
Greece 
Spain 
France 
Italy 
Cyprus 
Latvia 
Lithuania 
Luxembourg 
Hungary 
Malta 
Netherlands 
Austria 
Poland 
Portugal 
Romania 
Slovenia 
Slovakia 
Finland 
Sweden 
United Kingdom 

Males 
65 
63* 
61y 6m 
65 
65 
63 
65 
65 
65 
60 
65 
65 
62 
62y 6m 
65 
62 
61 
65 
65 
65 
65 
63* 
63 
62 
65 
61-67 
65 

Females 
64 
59* 
59y 8m 
65 
65 
59y 6m 
65 
60 
65 
60 
60 
65 
61y 6m — 62 
60 
65 
60 
60 
65 
60 
60 
65 
58* 
61 
62 
65 
61-67 
60 

Males 
61.2* 
64.1 
61.8 
62.5 
62.1 
62.6+ 
63.5 
61.8 
61.8 
58.7 
60.5 
: 
: 
: 
: 
61.2** 
: 
62.1 
61.3 
61.4* 
62.9* 
65.5 
: 
59.7* 
62.3 
64.2 
63.8 

Females 
61.9* 
64.1 
59 
61.3 
61.6 
62.6+ 
64.7 
60.4 
62.3 
59.1 
60 
: 
: 
: 
: 
58.7** 
: 
62.1 
60.6 
57.5* 
62.3* 
63.2 
: 
57.8* 
62.5 
63.7 
62.6 

Males 
80.8 
76.2 
78.2 
80 
81.1 
75.9 
80.8 
81.4 
81.7 
82 
81.4*** 
81.8 
75.2 
75.5 
80.7 
76.5 
80.1 
80.8 
81.1 
77.7 
80.4 
76.7 
79.4 
76.5 
80.6 
81.8 
80.9** 

Females 
84.9 
80.3 
82.4 
83.3 
84.8 
82.2 
84.5 
83.9 
86.5 
87 
85.9*** 
84.2 
81.1 
81.5 
84.4 
81.6 
83.8 
84.5 
85.1 
82.9 
84.6 
80.5 
84.3 
81.4 
85.5 
85.2 
83.7** 

Source: Eurostat  Note: * — 2007 data, ** — 2005 data, *** — 2004 data, + — common data for both sexes 

The  2007  Joint  Report  identified  the  challenge  of  increasing  the  employment  rate  of  older 
workers (or promoting longer working lives) for 16 out of 25 Member States (CZ, DK, GR, 
ES,  FR,  IT,  CY,  LT,  LU,  MT,  NL,  AT,  PT,  SI,  FI,  and  SE).  Some  of  these  have  sought  to 
respond through new initiatives in pension and labour market policies. Yet, despite significant 
progress in recent years in many Member States (for instance LV, BG, LT, DE, SK, EE and 
NL), there is still a need to extend working lives across the Union, as illustrated by Table 4.1 
which shows that the difference between remaining life expectancy at age 60 and the average 
labour market exit age is over 20 years for women in most Member States (see 4.2). 

4.1.4.  The increasing role of privately managed pensions 

Most Member States have reported on increasing contributions to privately managed pensions 
as  a  means  of  improving  the  adequacy  and  sustainability  of  overall  national  pension 
provisions.  In  recent  reforms,  some  Member  States  promote  or  mandate  extra  contributions 
for occupational and private pension provision (e.g. BE, DK, DE, IE, UK).  

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A number of Member States that have introduced  mandatory  funded  schemes  recently  have 
done  so  by  allowing  for  a  transfer  of  contributions  from  old  pay-as-you-go  systems  to  the 
funded schemes, instead of increasing the overall contribution rates (e.g. HU, LT, LV, SK). 
Romania has introduced a voluntary funded scheme that implies moderate extra contributions 
for privately managed pension savings. In Bulgaria participation in the new funded scheme of 
supplementary  pensions  is  mandatory.  The  interest  in  these  schemes  has  often  been  higher 
than  expected  possibly  because  they  were  introduced  in  years  of  relatively  high  economic 
growth. The large number of people shifting part of their contribution has caused deficits in 
the  pay-as-you-go  systems.  Slovakia  has  responded  by  allowing  contributors  who  earlier 
chose to opt out of the pay-as-you-go system to review their choice. This has resulted in an 
increase of revenue in the pay-as-you-go systems and a delay in the full establishment of the 
mandatory  funded  scheme.  Changing  the  rules  within  such  a  short  timeframe  though 
temporarily expedient may erode the legitimacy and stability of the reforms enacted and the 
long-term sustainability of the different tiers of the pension system. 

The Joint Report of 2008 showed that the broader use of private pensions is equivalent to a 
transfer of the risk of maintaining the value of pension accruals from governments to pension 
funds and in some cases ultimately to individuals. Member State experiences indicate a need 
to monitor the effects of this trend on the adequacy of pensions, and underpin private funded 
provision by an appropriate and careful design of public regulation clarifying the definition of 
pay-out  conditions,  government  supervisory  roles,  and  the  definition  of  new  instruments. 
Current reporting shows that Bulgaria has chosen to curb risks by introducing guarantees and 
putting restrictions on the risk levels of investment portfolios. Slovakia is introducing a life-
cycle approach to fund investments on behalf of individuals (see 4.3). 

4.1.5.  Maintaining pension adequacy while ensuring sustainability: indexing and automatic 

adjustments 

The  adequacy  of  retirement  income  systems  vary  widely  between  Member  States.  In  recent 
years  some  countries  have  improved  the  share  of  income  from  earnings-related  pensions 
considerably, while in others reliance on basic pensions is just beginning to decline as a result 
of the maturing of earnings-related pensions and higher employment rates. In this context, the 
2007  Joint  Report  identified  that  Member  States  need  to  monitor  whether  the  income  of 
pensioners, including those with the weakest prior links to the labour market, maintain their 
value relative to prices and do not fall too far behind wage developments.  

Adequacy is not just about replacement levels at the time of retirement and pension take-up 
but also about how the value of benefits relative to prices and wages is maintained over time. 
Indexation allows pensions to keep a certain value over time ensuring adequacy not only at 
the time of retirement and pension take-up but also in the following years. 

Not  all  Member  States  have  systems  of  regular  indexing.  But  a  few  of  those  without 
introduced it in this reporting period (e.g. LT). A number of Member States have chosen to 
boost the adequacy of pensions by reforming of the indexation rules or by ad hoc increases in 
pensions – sometimes in combination.  

Some countries report a shift towards a higher degree of earnings-linked indexing of statutory 
old  age  pensions  (e.g.  CZ,  HU,  PL,  UK).  To  what  extent  this  shift  entails  higher  up-rating 
depends on the economic situation. In many Member States 2006-2008 has been a period with 
higher  growth  and  increasing  inflation.  Pensions  have  typically  been  indexed  to  prices  in 
order  to  ensure  a  constant  purchasing  power  over  time.  Wage  or  GDP  growth  oriented 

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indexation of pensions has been advocated as it allows the incomes of retirees to track those 
of the working population more closely. It is also positive from a financial sustainability point 
of  view  as  the  up-rating  of  pensions  become  more  closely  connected  to  economic 
development. The coming period 2008-2010 is likely to see very moderate economic growth 
and lower inflation.  

Member State experience, as reported in the National Strategy Reports, indicates that it is also 
important to weigh the adequacy effects of different types of indexation carefully against the 
sustainability impacts.  

The  use  of  automatic  annual  indexation  rather  than  ad  hoc  increases  is  an  important 
development  for  ensuring  the  transparency  and  legitimacy  of  a  pension  system.  Some 
Member States have also introduced automatic or semi-automatic adjustments to the level of 
outgoing pensions through periodic assessments of pressures on pensions. These are designed 
to  stabilise  the  financial  sustainability  of  pension  systems  through  automatic  adjustments  of 
benefit  levels  (e.g.  SE,  FI,  PL,  LV  or  DE)  or  periodically  required  reviews  and  fine-tuning 
(e.g. AT, IT or FR).  

Automatic  adjustment  and  indexing  rules  only  boost  the  transparency  and  credibility  of  a 
system if the triggers are allowed to function. Most automatic mechanisms have not yet been 
applied in practice and experience from 2006-2008 highlight that it is critical to monitor the 
functioning  of  these  mechanisms.  A  few  countries  have  already  postponed  automatic 
adjustments  by  political  means  (e.g.  the  delay  in  the  automatic  updating  of  life-expectancy 
projections for annuity calculations in IT or increases to benefit levels above those guaranteed 
by stability enhancing factors in adjustment rules in DE). This may undermine the credibility 
of such reforms.  

4.1.6.  The role and quality of minimum income provision for older people 

Amid the increasing importance of pension schemes where benefit levels are linked to work-, 
earnings- and contribution records many pensioners - including some of those currently taking 
up a retirement income - have to rely on the systems of minimum income provision for older 
people (MIPs) found in all Member States. The role, design and benefit levels of these vary 
widely across the Union. But everywhere they are meant to cater to the needs of people with 
insufficient or no rights in the employment related pension schemes and gender role legacies 
entail that women constitute the bulk of recipients. As these benefits represent a particularly 
fragile  part  of  the  overall  adequacy  of  retirement  income  the  2007  Joint  Report  called  for 
greater  attention  to  the  role,  levels  and  indexing  of  minimum  income  provisions  for  older 
people.  MIP-recipients  spend  a  relatively  high  share  of  their  income  on  basic  needs  price 
developments in certain commodities are therefore of particular concern. Phenomena such as 
the sudden hike in energy and food prices in the spring of 2008 have presented a particular 
challenge  to  adequacy.  Only  a  few  Member  States  have  reformed  their  MIPs  and  those 
countries  with  particular  challenges  with  regard  to  MIP  adequacy  have  primarily  adjusted 
their  systems  in  smaller  ways.  But  ad  hoc  up-ratings  and  improvements  to  indexing 
mechanisms have been both frequent and widespread. Indeed, in many Member States such 
measures have meant that the relative value of MIPs has been reasonably maintained despite 
rapid growth and rising inflation (see 4.4). 

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4.1.7.  Ensuring information and transparency 

Pension  reforms  have  resulted  in  a  move  towards  multi-pillar  systems  with  defined-benefit 
elements  and  made  eventual  retirement  income  considerably  more  dependent  on  individual 
behaviour and decisions in the active years. Pension systems have become more difficult to 
understand and pension benefits less easy to predict. In order to be able to respond well to the 
new  incentives  in  pension  systems  and  make  the  decisions  most  befitting  their  set  of 
circumstances and preferences workers need far more information than before. Providing this 
in an effective way has become another part of the pension challenge which Member States 
increasingly have to take up to ensure that pension reforms are well understood, gain popular 
support and achieve their intended results (see 4.5). 

4.2.  More people in work and working longer: The response of pension policy 

Getting more people to work more and for longer has been identified as one key solution to 
the  pension  challenge  that  allows  for  both  financially  robust  pension  systems  and  adequate 
benefits. While raising the likelihood that adequate pension rights are earned, the extra years 
of contributions also improve the financial situation of the system. 

4.2.1. 

Increasing  the  contributory  base  to  meet  the  challenges  of  sustainability  and 
adequacy 

In  a  number  of  Member  States  improving  the  financial  base  of  a  pension  system  through 
increases in the contribution rates has been identified as a solution to the complex problem of 
providing  adequate  pensions  without  compromising  the  financial  standing  of  the  pension 
system.  

A  few  countries  report  on  reforms  to  increase  their  contribution  revenue  through  higher 
contribution  rates  to  existing  schemes,  thus  securing  the  adequacy  and  sustainability  of 
pensions  (e.g.  CY,  DE,  HU,  IT).  Low  contribution  rates  can  lead  to  inadequate  benefits  or 
insufficient financing of benefits. From a solidarity point of view it is, however, important to 
ensure  that  mandatory  contributions  are  at  a  reasonable  level  so  as  to  not  over-burden  the 
income of the working population.  

Too  big  a  contributory  burden  on  work  income  can  create  strong  incentives  to  contribution 
avoidance  and  may  endanger  the  financial  and  political  legitimacy  of  the  pension  system. 
Romania report on reductions in contribution rates to the pension system from extraordinarily 
high levels. The idea is to improve sustainability by encouraging more workers to participate 
in the formal sector, thus widening the contributory base and the volume of contributions. In 
countries with a large informal sector, broadening the tax or contributory base also increases 
adequacy  as  more  people  are  covered  by  the  retirement  insurance.  At  the  same  time  it 
contributes to the long-term sustainability of the system because the financing base increases 
as more people become active in the formal economy. Most Member States with problems in 
their contribution base are looking at ways to include groups at the margins of labour market 
and social security systems, such as the self-employed, immigrants and the disabled.  

In many Member States young people are increasingly employed on temporary contracts. But 
membership of pension schemes is usually linked to permanent employment status, so young 
workers  are  very  often  exempted  from  mandatory  pension  contributions.  For  example  Italy 
has made improvements allowing more people with atypical contracts to be better covered by 

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social  security  and  pension  schemes.  Member  States  have  also  made  it  easier  to  transfer 
entitlements between pension funds and thereby improved labour mobility.  

If younger workers join the labour market later it can reduce the cumulative yield of accrued 
pension rights in notional defined-contribution or funded schemes, because the yield depends 
on the length of time that returns are accumulated. But even in PAYG schemes late entry will 
increase the risk of being unable to accrue enough contributory years to earn a full pension. 

4.2.2.  Protecting those with non-standard careers in reforms 

Typically pension reforms have extended the number of contributory years needed for a full 
pension  and  have  based  calculations  of  earnings-related  benefits  on  income  from  a  greater 
number  of  working  years.  Thus,  length  of  career  and  income  earned  over  the  career  have 
become much more important for the pension benefits accruing to individuals. In view of this 
development, the 2007 report advocated more in-depth analysis of the impact of these reforms 
on people u able to meet these conditions due to atypical career patterns. Future risk groups 
would include the low skilled, low waged women and men, individuals affected by long-term 
unemployment  or  illness,  people  with  caring  duties  and  people  excluded  from  pension 
coverage  due  to  short  term,  temporary  contracts  or  self-employed  status.  The  2008  national 
strategy reports show that the lowest pensions currently are received by those that have had 
the  weakest  link  to  the  labour  market  in  the  past.  De  facto  inactivity  and  longer  spells  of 
unemployment will impact on the future pension benefit of individuals. Past levels of long-
term  unemployment  in  many  new  Member  States  are  already  likely  to  result  in  lower 
retirement incomes in conjunction with recent reforms. Widespread future unemployment in 
generations  where  the  old-age  dependency  ratios  are  already  high  will  impact  on  the  long-
term  financial  sustainability  of  pension  systems,  but  also  affect  the  adequacy  of  pension 
accruals for some.  

While maintaining scheme incentives to return to work as quickly as possible many Member 
States  have  two  mechanisms  for  addressing  the  issue  of  adequacy  for  those  with  career 
breaks,  minimum  pensions  and  the  accrual  of  pension  rights  in  non-contributory  periods. 
Earnings-related  systems  usually  offer  a  minimum  pension  calculated  on  more  favourable 
terms for those with lower incomes or shorter working lives (e.g. BE, BG, CZ, ES, FR, LV, 
LT, LU HU, PL, PT, SE, SI). In their main statutory schemes all Member States offer some 
form  of  protection  of  the  accrual  of  pension  entitlements  in  typical  contingencies  of 
involuntary interruption of employment. Usually periods of unemployment, long-term illness 
and  maternity  are  credited  by  pension  contributions  being  paid  on  behalf  of  the  affected 
individuals by the relevant social insurances dealing with the contingency. Yet, contributions 
are mostly only continued at a general low level of income equivalent to the minimum wage. 
Pension accruals will therefore be much smaller in such periods. Similar protections may exist 
in many occupational schemes, but would not be present in voluntary funded schemes.  

All Member States provide some kind of recognition of caring duties in pension entitlements. 
Many Member States have recently improved the crediting of caring years (e.g. EL, ES, LT, 
MT,  PT,  UK).  The  most  common  approach  is  to  credit  caring  years  at  the  same  level  for 
everybody  irrespective  of  the  level  of  income  lost  or  foregone.  Malta  has  introduced  and 
Luxembourg plans to introduce credits for childcare years. In Spain new rules allow a person 
restricted to part-time work due to child or family care to be credited for a full day's work in 
the eligibility calculations. Other Member States provide a protection of pension entitlements 
during  childcare  which  is  linked  to  the  employment  situation  and  income  of  the  individual 

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(e.g. EE, HU, IE, PL, PT, RO, SE). Some countries, however, still deal with the issue of care 
years by lowering the pension eligibility age for women with children (e.g. CZ, SI). 

In recent years, a number of member States have also introduced care credits for other types 
of  care  than  for  children.  These  are  usually  linked  to  a  general  reference  value  rather  than 
earnings  (e.g.  BE,  DE,  AT)  or  simply  include  care  periods  as  a  part  of  eligible  qualifying 
periods (e.g. EL, IE, LT, PL, UK). 

Box 1: Illustrations of the result of absences from the labour market on pensions 

Calculations  show  that  in  most  Member  States  absences  from  the  labour  market  due  to 
unemployment  or  childcare,  though  partially  protected,  generally  lead  to  decreases  in 
theoretical replacement ratios. 

In many Member states, absences from the labour market for childcare are typically protected 
to  a  certain  extent  for  the  first  few  years  of  absence  and  usually  the  protection  is  equally 
spread  over  these  years.  In  a  few  Member  States  pension  rights  for  up  to  three  years  of 
absence  are  so  well  protected  that  calculations  show  no  drop  in  replacement  rates  (e.g.  CZ, 
ES,  LU,  MT).  Whereas  this  improves  the  adequacy  of  benefits  accruals  during  childcare 
absences,  the  work  incentives  in  the  system  can  be  questioned.  In  the  Czech  Republic,  the 
retirement age for women is decreased depending on the number of children they bear and the 
years of retirement before the age of 65 are accredited giving no change in the replacement 
rates. In Malta, where the minimum statutory retirement  age is  61 and  only 30  contributory 
years are needed for a full pension, the replacement rates do not change with a prolonged or 
shortened  retirement  age  in  this  exercise  which  is  based  on  a  36  year  contributory  period. 
However, recent legislation credits social security contributions for interrupted careers of up 
to 2 years.  

In  some  countries  childcare  credits  are  connected  to  the  birth  of  the  child  rather  than  an 
absence  from  the  labour  market  (e.g.  DE,  FR,  IT)  resulting  in  an  increase  in  pension 
entitlements when a child is born. In Romania, childcare breaks are less well protected than in 
most other Member States. In the UK the decline on the state pension side is marginal, and 
results depend more on whether private pension schemes award care credits or not.  

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Figure  11:  Difference  in  net  theoretical  replacement  rates  for  an  average  earner  entering  the 
labour  market  at  25  and  retiring  at  the  statutory  retirement  age  with  a  1,  2  and  3  year  career 
break for childcare compared with no break*  

6,0

4,0

2,0

0,0

-2,0

-4,0

-6,0

-8,0

FR CZ ES LU MT FI AT BE EL SE EE SK IE DE NL DK LT

IT UK PL CY HU PT BG LV

SI RO

I year

2 years

3 years

Source: ISG calculations on Theoretical replacement rates carried out in the OECD APEX model or in national 
models. The figures for NL are preliminary. 

*  The  calculations  assume  two  children  are  born  and  that  the  timing  of  the  childcare  years  is  such  that  full 
childcare benefits are received for each child. Retirement at the legislated statutory retirement age for women is 
calculated here 

In some Member States (e.g. CZ, DE, EE, EL, ES, FR, IT, CY, LT, LU, AT, PL, SK, FI, SE, 
UK)  the  protection  for  childcare  is  better  than  for  unemployment  over  a  three  year  period. 
Yet,  in  many  Member  States  absence  for  childcare  translates  into  lower  replacement  rates 
than unemployment absence.  

Whiles important to protect certain types of absences from the labour market it is important to 
consider the work incentives within the retirement and unemployment systems.  

On  the  other  hand,  the  drop  in  replacement  rates  are  much  higher  in  some  Member  States 
during the three years of unemployment (e.g. SK, ES), bringing the adequacy of protection of 
pension entitlements during unemployment into question. In most Member States the drop in 
theoretical replacement rates is equal throughout the three years of unemployment. In a few 
cases the drop is lower (e.g. BG, DE, FI, HU, SE, UK) or bigger (e.g. DE, ES, FR, IT, CY, 
PL, LU, SK, SI) after the first or second year of unemployment.  

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Figure  12:  Difference  in  net  theoretical  replacement  rates  for  an  average  earner  entering  the 
labour  market  at  25  and  retiring  at  the  statutory  retirement  age  with  a  1,  2  and  3  year  career 
break for unemployment compared with no break* 

2,0

0,0

-2,0

-4,0

-6,0

-8,0

-10,0

-12,0

-14,0

-16,0

-18,0

MT FR CZ HU BG EL DK IE AT NL SI UK BE LU CY PL PT LT LV IT

FI RO EE SE DE SK ES

I year

2 years

3 years

Source: ISG calculations on Theoretical replacement rates carried out in the OECD APEX model or in national 
models. The figures for NL are preliminary. 

*  The  unemployment  break  is  assumed  to  take  place  in  the  years  just  prior  to  old  age  retirement  which  is 
assumed to take place at the legislated statutory old retirement age for men. 

4.2.3. 

Improving gender equality in pension policy 

Many  Member  States  report  on  significant  wage  gaps  between  employed  men  and  women, 
ranging from under 5% (MT) to 25% (EE). Women also tend to work part-time and so their 
earnings  often  develop  more  slowly  than  men's.  Though  substantially  reduced  the  resulting 
gender gaps in retirement income are set to persist. Equalising the pension eligibility ages for 
men  and  women  is  part  of  the  solution  legislated  by  Member  States  to  ensure  that  women 
have a decent retirement income. Some Member States plan to equalise pensionable ages in 
the near future (e.g. BE, LV, HU) whiles others have longer transitional rules (e.g. EL, EE, 
LT, MT, AT, CZ). Some Member States will narrow the gap between the pensionable ages for 
men and women without making them identical (e.g. BG, RO, SI). Others have so far made 
no steps in this direction (e.g. PL).  

Constant observation and efforts are needed to achieve gender equality on the labour market 
and in the distribution of care burdens, which today are still mainly borne by women. It is also 
important  to  monitor  the  effects  of  policies  whereby  replacement  incomes  and  pension 
entitlements are given for care-related absences from the labour market in order to avoid that 
such protections become new dependency traps. As caring years have a significant negative 
effect  on  women's  long-term  participation  to  the  labour  market  in  many  Member  States,  a 
careful balance must be struck between care crediting and incentives to get women back into 
paid work. Tailoring pension scheme mechanisms to the new gender roles would promote the 

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reconciliation  of  work  and  family  life,  enabling  women  (and  men)  to  resume  their  careers 
quickly and combine parenting with work. 

4.2.4. 

Increasing the employment of older workers 

Member States have sought to encourage more employment of older workers by raising the 
pensionable age, closing early exit routes and allowing for flexible combinations of work and 
pensioning. Employment rates of older workers (aged 55-64) have improved in recent years, 
reversing a long-lasting downward trend (see section 2.1.2). 

4.2.4.1.  Increasing the pensionable age in statutory schemes 

Politically pension reforms are difficult to initiate and implement. Raising the pensionable age 
in the statutory scheme is notoriously difficult as this age is intimately connected to the social 
institution  of  retirement  and  signals  the  recognised  age  at  which  it  should  take  place.  A 
number of Member States have legislated an increase in the pensionable age for both genders 
in recent reforms.  In most of these Member States the higher eligibility ages for a statutory 
pension will be phased in over a long period and have more effect on younger cohorts (e.g. 
CZ, DK, DE, LT, MT, UK). It is therefore important to monitor the actual implementation of 
these reforms and study the political climate that allows for increases in the pensionable age 
to  be  carried  forward.  Despite  the  general  trend  towards  increases  in  the  pensionable  age, 
there are Member States where the pension eligibility age is still relatively low (e.g. BG, EE, 
FR, LV, HU, SK). 

4.2.4.2.  Increasing the contribution period 

Usually the length of contributory periods corresponds to pensionable ages. However, some 
Member  States  (e.g.  France)  have  kept  the  formal  pensionable  age  at  the  same  level  while 
increasing  the  contribution  period  needed  for  a  full  pension.  This  solution  might  be  more 
acceptable  from  a  political  point  of  view  than  increasing  the  pension  eligibility  age  in 
statutory  schemes.  If  the  right  to  receive  a  full  pension  depends  on  the  contribution  period, 
people who start working at a late age are not unduly rewarded. 

Contribution periods required for a full pension have been increased in some member States 
(e.g. CZ, FR,  AT),  so the  link between  contributions paid into the system and benefits paid 
out has been tightened. Nevertheless, conditions for drawing a full pension are very diverse 
and sometimes they are not sufficient to make people work longer, as there are Member States 
which still require only 30 years of contribution (e.g. LT, RO).  

The qualifying period for a minimum pension has recently been extended in CZ, CY, ES, and 
RO. If a minimum pension scheme guarantees the major part of pensioners' income, and the 
contribution period is too short, it can act as a disincentive to stay in the labour market.  

With  the  aim  of  ensuring  that  more  women  and  men  with  caring  duties  and  shorter  careers 
gain entitlement to a basic pension, the United Kingdom has gone against the general trend by 
reducing and equalising the number of qualifying years. This example highlights the need to 
study the effects of longer qualifying periods on those with shorter careers. 

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4.2.4.3.  Promoting flexible retirement options 

Under specific circumstances more flexible paths out of employment into retirement can help 
to  promote  longer  working  lives.  For  instance,  the  increase  in  the  employment  of  older 
workers over the past decade is partly due to a rise in part-time work, notably by men. About 
25% of employment among older workers in the EU-15 is now part-time (22.5% in the EU-25 
and 22% in the EU-27). 

Another  issue  for  the  design  of  flexibility  in  pensionable  age  is  the  conditions  for  partial 
pensions, and where individuals can take a share of their pension whilst continuing to work 
(given particular conditions). This type of provision is reported in a number of Member States 
(CZ,  ES,  FR,  IT,  NL,  FI,  and  SE).  Individuals’  motives  for  choosing  these  options  include 
reducing the number of hours worked and accruing further pension rights in order to ensure a 
higher  pension  in  the  future.  Member  States  are  fine-tuning  both  arrangements,  and 
sometimes restricting flexibility in the name of preventing abuse is required. It  has recently 
been  seen  in  the  case  of  Spain,  where  the  age  when  partial  pension  is  accessible  has  been 
raised,  and  in  Hungary  where  the  rules  on  cumulating  the  early  retirement  benefits  and 
income from work have been tightened.  

Providing flexibility in combinations of work and partial pension may enable people to work 
longer. Work time reduction can be essential for facilitating and encouraging people to remain 
in  work  after  60.  Nevertheless,  introducing  more  flexible  retirement  provision  requires  a 
careful design of the structure of incentives and a focus on a proper target group of workers 
(for instance in terms of age). 

One  solution  is  to  link  the  pensionable  age  to  the  length  of  the  contribution  period  and  a 
bonus/malus system for earlier or later take-up of the pension. This is for instance the case in 
Sweden, where the pensionable age is optional within the 61-67 age brackets.  

A  common  way  to  promote  longer  working  lives  pursued in recent reforms is  to strengthen 
the bonus-malus system in schemes with delayed and early retirement possibilities. A number 
of Member States (BE, BG, CZ, ES, GR, HU, NL, PT and UK) have recently introduced or 
increased  bonuses  (higher  accrual  factors)  as  reward  for  later  retirement,  and/or  maluses  as 
penalty  for  early  retirement.  Workers  who  decide  to  work  longer  are  usually  rewarded  for 
every additional month or year in work. One of the dilemmas concern deadweight problems 
connected to the risk of subsidising those who would in any case have postponed retirement. 
The impact of these specific measures can be rather limited. For instance the pension bonus 
introduced in France by the 2003 reform attracted only 7.6% in 2007. Furthermore, it seems 
that  incentives  to  defer  retirement  have  less  impact  than  opportunities  to  retire  early.

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Box 2: Illustration of the effects of longer and shorter working lives on pension adequacy 

Calculations of theoretical replacement rates point to a decline in future pension levels and the 
subsequent replacement rates at a given pension age (please refer to Table 2, Chapter 2). This 
reflects  the  fact  that  reforms  of  statutory  pensions  will  be  lowering  pensions  to  meet  the 
challenges  caused  by  increased  life  expectancy.  Member  States  are  planning  to  compensate 
for this decline by extending working lives and increasing supplementary pension savings. 

Most  countries  have  incorporated  incentives  to  prolong  working  life  into  their  pension 
systems. Many of these incentives take the form of reductions for early retirement or bonuses 
for later retirement. These may be carried out in an actuarial manner often based on remaining 
life  expectancy  or  through  bonuses  and  penalties  fixed  by  legislation.  Other  incentives  to 
work more and longer are generated by increasing the contributory period in pension systems 
and strengthening the link between pensions and contributions. 

Calculations  show  that  in  most  Member  States  delaying  retirement  results  in  higher 
theoretical  replacement  rates,  while  earlier  retirement  usually  results  in  lower  theoretical 
replacement rates. In all but a few Member States (e.g. DK, ES, FR, HU, IT, LU, SI, UK) the 
increments  in  pensions  for  prolonged  working  lives  are  higher  than  the  fall  in  replacement 
rates  with  earlier  retirement. In most cases the difference is  small, but there is a  clear trend 
towards rewarding late retirement more than early exit is penalised.  

In  Member  States  where  the  retirement  age  is  lower  than  65  the  calculations  show  how  the 
bonus-malus  system  would  work  if  the  retirement  age  was  set  at  65  (e.g.  BG,  CZ,  EE,  LV, 
LT, HU, MT, SI, SK). In Malta, for example, where the minimum statutory retirement age is 
61 and only 30 contributory years are needed for a full pension the replacement rates do not 
change with a prolonged or shortened retirement age in this exercise which is based on a 40 
year contributory period. In Member States where the pensionable age is planned to be higher 
than  65  in  2046  (e.g.  DE,  UK),  the  effects  of  deferring  retirement  beyond  the  legislated 
retirement age are not captured by the exercise.  

In  the  Netherlands  it  is  interesting  to  note  that  the  replacement  rates  from  statutory  scheme 
does not change with shorter or longer working lives as the pension is resident based. There 
are, however, clear changes in the occupational schemes that play an important role in Dutch 
pension income. In Italy, it is observed that the annuity coefficients used in the public notional 
defined contribution system currently do not increase above 65 years of age.  

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Figure  13:  Difference  in net theoretical  replacement rates for  an average earner working  until 
the age of 63 and 67 with 38 and 42 contributory years respectively as compared with working 
until the age of 65  

15,0

10,0

5,0

0,0

-5,0

-10,0

-15,0

MT NL CY EL IE DK UK PT PL BE RO LU LT SE FI DE LV SI BG CZ FR EE AT SK IT ES HU

retirem ent at 63

retirem ent at 67

Source: ISG calculations on Theoretical replacement rates carried out in the OECD APEX model or in national 
models. The figures for NL are preliminary. 

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4.2.4.4.  Restricting access to early retirement 

Most  transitions  from  work  into  retirement  are  not  direct.  The  average  age  of  exit  from  the 
labour market is often lower than the average age at which an old-age pension is drawn. Only 
35% of older workers  leave  their  last  job or business to take up a pension. 20% take  up  an 
early retirement benefit, 13% leave due to unemployment and 12% for reasons of long-term 
sickness or disability.  

The  proportion  of  early  or  indirect  exits  varies  considerably  from  one  Member  State  to 
another. Nevertheless, a positive trend is visible, as a number of Member States adopt reforms 
to discourage the take-up of, or even to close access to, early retirement paths from the labour 
market. Member States increase the age of entitlement to early retirement (e.g. BE, CZ, SK, 
UK), equalise the rules of access for both genders (e.g. DE, HU), plan to limit the number of 
professions  entitled  to  benefits  (e.g.  PL),  tighten  the  rules  of  access  to  recently  introduced 
schemes  that  turned  out  to  be  unexpectedly  popular  (e.g.  FR),  or  simply  phase  out  the 
schemes (e.g. IE). Other Member States strengthen the financial disincentives to retire early, 
by increasing the value of penalty factors (e.g. CZ, GR, PT, UK). Another solution adopted is 
suspension  of  early  pension  benefits  for  those  who  earn  more  than  a  minimum  wage  (e.g. 
HU).  Since  January  2006  the  Netherlands  has  tightened  fiscal  treatment  of  early  retirement 
and pre-pension schemes, and a reform of unemployment benefits is aimed at preventing the 
use of the scheme as an early retirement path. Yet some Member States have delayed planned 
reforms.  Italy,  Austria  and  Poland  decided  to  slow  down  the  process  of  tightening  the 
minimum requirements for early retirement.  

Some early retirement schemes automatically create exceptions from general rules for certain 
occupations which are thought to be ‘arduous’ or dangerous for health. The National Strategy 
Reports  do  not  report  the  details  of  such  rules,  so  the  differences  and  similarities  between 
Member States would be an issue for further study.  

Attempts  to  restrict  or  close  early  retirement  options  often  lead  to  a  run  on  schemes  in  the 
period before the changes take effect. This was the case in Poland and Slovakia, for example, 
where announcements of restrictions on early retirement from 2008 caused a massive increase 
in  applications  in  the  final  months  of  2007. The  French  National  Strategic  Report  mentions 
that a similar situation occurred in France between 2003 and 2006 with the early retirement 
option  for  those  with  long  working  records.  Latvia  experienced  a  drop  in  the  effective 
retirement age in 2007 due to early exit paths for certain categories of workers, and despite 
the fact that the pension eligibility age had been raised.  

In  general  Member  States  are  closing  access  to  early  exit  paths  from  the  labour  market. 
However, developments in the labour market will also have a strong influence on future take-
up of benefits, and expectations of a decline in the take-up might be questioned in the light of 
the global economic downturn. 

4.2.4.5.  Restricting access to disability schemes 

In  line  with  the  challenge  highlighted  in  the  2008  Joint  Report  some  Member  States  have 
sought to extend working lives by curbing exits through sickness and disability schemes (e.g. 
CZ, DK, ES, HU, MT, NL, PL, AT, SE). Measures generally involve rehabilitation efforts in 
connection with stricter eligibility rules and greater cooperation between institutions involved 
to allow for a quicker transition back into the labour market. Restricting the use of sickness 

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and disability schemes as pathways for early exit should however not preclude the use of such 
schemes for the contingencies they were meant for.  

Some  Member  States  have  recently  introduced  a  distinction  between  relative  and  absolute 
invalidity (CZ, PT, UK). These reforms aim at reducing early exits from the labour market by 
differentiating  between  those  claimants  potentially  fit  to  be  employed  on  a  full  or  part-time 
basis  and  those  more  severely  impaired.  Member  States  are  looking  for  ways  to  activate 
everyone  according  to  their  capabilities  and  the  dichotomy  of  "employable"  versus 
"unemployable" persons with disabilities is being challenged. 

4.2.4.6.  Improving employment opportunities for older workers 

To sustain pension promises it is essential to have both a well-functioning labour market and a 
high activity rate among the population of working age. Lack of progress in the employment 
rate of older workers is often caused by poor employment opportunities.  

The National Reports present two major kinds of instrument to boost activity. First, Member 
States are adapting lifelong learning, offering more training designed to make older workers’ 
skills  more  adaptive  and  to  help  them  keep  their  jobs  (e.g.  AT,  BG,  and  CZ).  Second,  by 
subsidising employment and giving employers financial incentives, they are making it more 
attractive  to  employ  elderly  people  (e.g.  AT,  DK,  ES,  LT,  HU,  and  SE).  There  are  also 
approaches that involve shifting part of the financial burden of early retirement schemes on to 
employers  and  committing  them  to  employ  a  certain  share  of  older  workers  in  their  work 
force (e.g. FR).  

As  a  number  of  National  Strategy  Reports  point  out,  the  European  Social  Fund  (ESF) 
contributes to the financial sustainability and adequacy of pension systems (€ 1 billion, 1.3% 
of  total  ESF  budget)  by  encouraging  active  ageing  and  prolonging  working  lives  (e.g.  AT, 
HU, SK), as well as by developing life long learning systems in enterprises and improving the 
adaptability of workers (€ 9.4 b illion, 12.4% of total ESF budget). 

Member  States  are  also  using  European  anti-discrimination  law  in  their  promotion  of  better 
age  management  (e.g.  DK,  NL,  UK).  European  legislation  on  age-based  discrimination 
(Council  Directive  2000/78/EC)  states  that  less  favourable  treatment  of  employees  on  the 
grounds  of  age  needs  to  be  objectively  justified.  Judgments  from  the  European  Court  of 
Justice  have  recently  confirmed  that  the  provisions  of  the  Directive  also  apply  to  the 
mandatory pensionable age. So the fact that a worker has reached pensionable age cannot be a 
sufficient  reason  to  terminate  the  employment.  Moreover,  some  Member  States  encourage 
employers,  particularly  in  small  and  medium  enterprises,  to  change  ageist  practices  and  to 
provide more opportunity and choice for their older workers (UK). 

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4.3. 

Supplementary funded pensions: impact on adequacy and sustainability 

4.3.1.  The growing importance of funded schemes 

Member  States  are  attaching  increasing  importance  to  privately  funded  supplementary 
pensions as a way of helping to maintain adequate and sustainable pensions in the face of the 
demographic  challenge36.  So  whilst  public  Pay-as-you-go  (PAYG)  pensions  are  and  will 
remain  the  most  important  element  in  European  pension  provision,  private  funded  pensions 
will have a growing role within the overall pension income of EU citizens.  

This and the impacts on the financial markets from the credit crunch and ensuing economic 
problems make it more important than ever for systems to be carefully designed. In particular 
systems  need  to  strike  the  right  overall  balance  between  public  PAYG  and  private  funded 
provision and ensure that funded schemes take an appropriate approach to investment risk.  

Member  States  employ  three  types  of  funded  pension  provision:  statutory  funded  pensions 
(pillar I); occupational pensions (pillar II); and voluntary pensions (pillar III). 

Statutory funded pensions are generally a recent phenomenon with little relevance for present 
pensioners.  Only  Denmark  has  a  mature  scheme  of  this  sort  and  its  role  in  overall  pension 
provision is very limited. However, such pensions will gradually become more important with 
Latvia,  Lithuania,  Hungary, Poland,  Romania, Slovakia and Sweden all relying on statutory 
funded provision to some degree as an element in overall future pension income. Romania is 
the  most  recent  Member  State  to  introduce  statutory  funded  provision,  with  a  system  of 
compulsory  individual  accounts  starting  in  2008.  This  pre-funded  pension  will  sit  alongside 
the traditional PAYG first pillar pension and be funded by compulsory contributions of 2% of 
salaries  rising  in  0.5%  increments  over  8  years  until  they  reach  6%.  Like  all  the  other 
statutory  funded  schemes  this  is  defined  contribution  (DC)  in  character,  where  the  risks  are 
with the individual. 

Occupational  funded  pensions  are  the  most  significant  form  of  funded  provision  for  people 
retiring today particularly in the Netherlands, Ireland the UK and Sweden. Belgium, Cyprus, 
Denmark  and  Germany  also  have  pertinent  occupational  provision  for  those  retiring  today. 
Traditionally these schemes were normally defined benefit (DB) in nature. However, there is 
a  longstanding  trend  away  from  DB  occupational  pensions  to  DC  occupational  pensions, 
particularly  in  Ireland  and  the  UK,  and  in  Denmark  major  schemes  were  DC  from  the 
beginning. For the future occupational pension schemes are expected to grow in importance in 
a number of Member States, but these schemes will increasingly be DC in nature. 

Voluntary  pension  provision  is  typically  not  a  very  significant  element  in  today's  pension 
incomes except in Germany and to a lesser extent the UK, Ireland and the Czech Republic. 
Germany is one of the few Member States anticipating significant strengthening of this type 
of provision on the back of the generous incentive structure in place for Riester pensions.  

The  role  these  different  pensions  schemes  are  expected  to  play  in  the  wider  system  varies 
considerably. Some, in particular statutory funded pensions, are meant to support or replace 

36 

such  as  the  2005  SPC  study  on  privately  managed  funded  pensions,  the  2006  Synthesis  Report  on 
Adequate  and  Sustainable  pensions,  the  2007  Joint  Report  and  the  2008  SPC  report  on  privately 
managed funded pension and their contribution to adequate and sustainable pensions 

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pension income from the main public PAYG scheme. Others, notably voluntary saving, may 
except for the self-employed simply have the role of providing a top-up to other substantial 
pension income, perhaps to allow high earners to match the replacement rates of those with 
lower  pre-retirement  income.  Occupational  pension  schemes  tend  to  sit  between  these  two, 
offering significant support to statutory PAYG pension provision. The important thing is that 
factors like the coverage and adequacy of any particular funded pension appropriately match 
its intended role in the wider pension system. 

4.3.2.  The double payment problem  

Funded  pension  provision  that  is  intended  to  replace  some  elements  of  PAYG  pensions 
effectively  brings  forward  the  costs.  This  can  help  with  smoothing  the  expected  future 
increases  in  pension  expenditure  that  demographic  change  will  bring  and  so  help  with 
sustainability. But it means that the present active generations will have to pay for both the 
PAYG schemes and the new funded schemes at the same time. Often Member States divert 
part  of  the  contribution  for  the  PAYG  scheme  into  the  funded  scheme  while  covering  the 
shortfall  from  the  state  budget  though  general  taxation  (e.g.  SK,  LV,  LT,  EE,  HU). 
Irrespective of the way it is done, bringing forward costs by increasing pre-funding can place 
strains  on  Members  States'  fiscal  positions  and  the  current  economic  situation  provides  a 
serious stress test of the viability of such arrangements. 

For instance, the 2007 report flagged up Slovakian transition costs on the one hand and long-
term sustainability on the other. Even before the financial crisis, SK had taken various actions 
to reduce the amounts of costs brought forward by earlier reforms enacted a few years earlier. 
Thus on 1st January 2008, SK re-opened the statutory funded pension scheme for a 6 month 
period giving savers a chance to join or leave. 104,000 people left and 20,000 joined. From 
the same date new entrants to the labour market will have six months to decide whether they 
want  to  take  part  in  funded  pension  savings  or  not.  All  of  this  means  more  Government 
revenue now at the expense of greater pension costs later. An unwelcome side effect of rapid 
changes of direction can be the uncertainty it creates about the long-term stability of pension 
reforms. 

4.3.3.  Privately  managed  funded  pension  and  their  contribution  to  adequate  and 

sustainable pensions  

The  2008  SPC  study  Privately  managed  funded  pension  and  their  contribution  to  adequate 
and  sustainable  pensions37  highlighted  a  number  of  issues  which  also  emerge  from  the 
National Strategy Reports. These included:- 

There is a need to improve the data on this growing segment of pension provision. 

The  role  and  development  of  private  pensions  is  very  diverse  across  the  EU,  reflecting 
cultural  and  historical  issues  as  well  as  the  wider  pensions  systems  in  place  in  the  different 
Member States. Thus private schemes must be assessed in the context of the role envisioned 
for them in the wider pension systems of particular Member States. Low coverage and breaks 
in contributions can be a cause for concern about future adequacy, in particular for women, 
the young, the less educated and the low paid. 

37 
http://ec.europa.eu/employment_social/spsi/adequacy_sustainability_en.htm 

Published 20/10/08 and available at  

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As  investment  and  longevity  risk  increasingly  are  shifted  onto  individuals  they  will  need 
better  financial  education  and  information.  Lifestyling/lifecycling  approaches  to  investment 
and flexibility around when a pension must be taken represent important ways of mitigating 
financial risk for individuals. The payout phase of funded schemes must be carefully designed 
if adequacy is to be properly ensured. Given the significant impact of administration charges 
on the pension ultimately accrued they must be kept as low as possible and this cannot be left 
to market forces alone. 

4.3.4.  Coverage 

For  statutory  funded  schemes  we  could  expect  coverage  to  be  near  universal  given  the  role 
they are intended  to  play.  However,  such coverage does not happen instantly -  schemes are 
phased in and have varying transitional arrangements. At the time of the 2008 SPC report it 
ranged  from  25%  (in  IT)  to  90%  (DK)  or  100%  (SE).  In  most  Member  States,  where  such 
schemes  have  been  introduced,  coverage  ranges  around  between  50%  and  70%:  BG  (50%), 
EE  (50%),  LT  (54%),  LV  (80%),  HU  (70%),  PL  (70%),  SK  (65%).38  Coverage  should 
approach 100% as schemes mature (since mostly only younger workers are required to join), 
but it may take a generation. 

For coverage of occupational pension schemes, we can divide Member States can into three 
broad groups:  

–  High coverage (over 75%): DK (around 75%), NL and SE (over 90%); 

–  Medium  coverage  (between  40  and  70%):  IE  (around  40%),  CY  (around  45%,  including 
both occupational schemes and provident funds), UK (around 47%), BE (around 55%) and 
DE (around 60-65%, which includes a significant share of Entgeltumwandlung);  

–  Low coverage (under 20%): IT (17%), AT (13% at the time of the SPC report, now 15%), 
FR (around 15%), ES and FI (8%), LU (5%), PT (4%), or very low (around 2.2% in PL).39  

Coverage  levels  may  change  as  schemes  evolve.  The  closure  of  existing  schemes  to  new 
members as employers seek to control costs will cause it to fall. Initiatives such as the UK's 
auto-enrolment  legislation  are  likely  to  expand  coverage  and  reverse  this  trend.  From  2012, 
employees,  who  are  not  already  in  a  good  quality  workplace  pension  scheme,  will  be 
automatically  enrolled  into  either  their  employer’s  sponsored  scheme  (if  it  meets  quality 
requirements)  or  into  a  new  savings  vehicle,  known  as  personal  accounts.  The  personal 
accounts  scheme  is  expected  to  have  between  four  and  seven  million  members,  with  up  to 
£200 billion of assets under management by 2040. The UK’s Pensions Act 2008 ensures that 
for the first time in the UK all employees will have access to an occupational pension scheme 
supported by employer contributions and tax relief. 

Another innovative approach is in Italy. The 2004 reform modified the TFR (Trattamento di 
Fine  Rapporto)  workers’  severance  pay  (a  portion  of  the  worker’s  pay  set  aside  by  the 
employer  formerly  paid  as  a  lump  sum  at  the  end  of  employment  period)  so  that  it  is 
automatically  transferred  to  defined  contribution  occupational  pension  schemes  unless  the 

38 

All figures from 2008 SPC report Privately managed funded pension and their contribution to adequate 
and sustainable pensions available at:  

http://ec.europa.eu/employment_social/spsi/adequacy_sustainability_en.htm 
39 

ibid 

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employee  actively  chooses  another  option.  With  this  so  called  ‘silent-assent’  mechanism  if 
workers do not express their desire not to be members within a six month deadline, the TFR is 
transferred  to  the  pension  schemes  set  up  by  collective  agreements  between  employers  and 
trade  unions  at  sector  or  local  level.  Employees  remain  free,  however,  to  make  an  active 
choice  to  decide  to  keep  the  TFR  with  their  employer,  a  decision  that  can  be  subsequently 
revoked. There has been a 43.4% increase in take up in 2007 compared to the previous year. 
Larger employers with good worker communication and union presence were key factors.  

For voluntary pensions, coverage is generally negligible at a few percent or less, for example 
the  French  PERP  has  coverage  of  around  2.8%.  The  Czech  Republic  introduced  the 
Supplementary Pension Insurance in 1994 which covers 49% of those aged 18 (minimum age 
to  take  part)  to  64,  though  contributions  tend  to  be  low  and  funds  are  often  taken  as  lump 
sums.  The  German  Riester  pensions  have  expanded  rapidly,  doubling  in  coverage  to  28% 
between  2005  and  the  end  of  200740  and  as  at  March  2008  there  were  11  million  Riester-
Rente contracts41. The UK at 19% and Ireland at 15% are the other exceptions with relatively 
high coverage levels42. In Portugal a Public Funded Regime (RPC) was introduced in 2008, 
based on individual accounts to which individuals can pay supplementary contributions (from 
2% to 6%) on a voluntary basis. The fund assets are invested and managed in the Portuguese 
Reserve fund, with a prudential profile and with very low administrative charges. Every year, 
individuals have the option to suspend, increase  or  decrease  contributions.  When  retirement 
conditions  are  met,  the  balance  of  the  individual  account  can  either  be  transformed  into  an 
annuity or taken as a lump sum payment.  

As  such  saving  is  voluntary  it  is  hard  to  predict  how  coverage  might  develop  as  it  can  be 
influenced  by  a  range  of  factors.  These  include  tax  and  other  incentives,  other  long-term 
saving options, information provision, perceptions of likely investment growth and the levels 
of  other  retirement  income  and  the  availability  of  the  necessary  spare  income  to  be  able  to 
contribute.  Current  economic  conditions  are  likely  to  negatively  impact  on  such  saving  at 
least in the short term. For most Member States we could perhaps expect little change or some 
continued modest growth in this area. The exception is Germany where, on the back of strong 
incentives,  the  coverage  and  significance  of  the  Riester  pensions  are  expected  to  grow 
considerably. The reason for the increasing popularity of the Riester pension is the attractive 
design of State assistance owing to the supplement system, which is particularly true for low-
income earners subject to pension insurance and for large families. At the beginning of 2008, 
the Riester pension reached its highest level of support. The basic supplement is now € 154 
and  the  child  supplement  € 185  per  year  for  each   child  for  whom  the  beneficiary  receives 
child benefit. For children born from 2008 onwards, the child supplement is as much as € 300. 
Retirement  pension contributions (taking into account the  supplement) up to € 2,100  can be 
offset as additional special expenditure against tax. 

4.3.5.  Contributions 

Contributions vary considerably between Member States and scheme type and also between 
occupational  and  voluntary  pension  schemes.  But  very  broadly,  DB  occupational  pensions 
tend  to  have  the  highest  contributions.  For  instance  in  the  UK,  contributions  to  DB  funds 

40 
41 
42 

EN 

ibid 
NSR for DE 2008 
Figures  from  2008  SPC  report  Privately  managed  funded  pension  and  their  contribution  to  adequate 
and 
at 
http://ec.europa.eu/employment_social/spsi/adequacy_sustainability_en.htm 

sustainable 

available 

pensions 

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amount to just over 20% of the gross wage whilst they are just over 16% in the Netherlands. 
DC occupational schemes tend to have lower contributions, around 9% in the UK with about 
10% in Ireland and 11% in Cyprus, though in Denmark they are at 12-17%. But contributions 
can also be quite low for occupational schemes in general for instance between 1 and 5% in 
Belgium. 

For  statutory  funded  schemes  contribution  levels  are  typically  below  the  levels  of  DC 
occupational schemes and well below DB occupational scheme levels. Some levels are very 
low  such  as  1%  on  ATP  and  1%  on  SP  in  Denmark,  or  the  severance  pay  in  Austria  with 
1.53%, or the Premium Pensions in Sweden with contributions of 2.5% of gross wages. But 
more typical, particularly for the new Member States, are contributions between 5% and 10% 
for instance Lithuania at 5.5% and Slovakia at 9% with Italy around the mid-point at 6.9%. 
Also  within  this  range  are  some  Member  States  that  have  chosen  to  gradually  increase 
contribution levels. For instance in Latvia they were 4% in 2007 and will rise to 10% in 2011, 
whilst in Romania they were 2% in 2008 and will rise to 6% by 2016.  

There  is  little  data  on  voluntary  schemes  and  clearly  by  definition  contributions  will  vary 
considerably. For the Czech Republic, which has the highest coverage of this type of scheme, 
levels are low at 2.1%. Better data are needed, particularly in DE where the Riester schemes 
are expected to grow significantly in importance, as coverage alone does not tell the full story. 
What  we  can  say  for  now  is  that  overall  it  is  likely  that  contributions  will  typically  be  the 
lowest in voluntary schemes.  

Very broadly DB occupational schemes tend to rely more on employer contributions than DC 
schemes. Other than that there are no real patterns with statutory schemes varying from 100% 
of contributions from the employer and 0% from the employee to the opposite.  

One  important  element  on  contributions  for  DC  schemes  is  administrative  charges.  Clearly 
schemes have to cover their various costs, but even quite modest charges can eat significantly 
into investment returns over the many years of pension saving. So costs need to be kept low, 
but their complexity and the typical information and skills disparity between individuals and 
providers means the market does not necessarily do this efficiently43. 

4.3.6.  Vulnerable groups 

One  aspect  of  increasing  the  proportion  of  funded  provision  is  that,  despite  variable 
investment  returns,  this  typically  brings  with  it  a  more  direct  relationship  between  actual 
contributions paid and actual pension received than is the case with PAYG schemes. This can 
help to foster personal responsibility and increase choice and transparency. On the other hand 
the  reduction  in  cross-subsidy  can  mean  that  groups  vulnerable  to  low  or  missing 
contributions  more  exposed  to  poor  retirement  outcomes  in  Member  States  where  funded 
pensions  are  expected  to  play  a  significant  overall  role  in  pension  provision.  Because  of 
current  labour  market  characteristics,  women  are  more  at  risk  than  men  of  having  poor 
outcomes  from  funded  provision.  Where  these  labour  market  inequalities  are  expected  to 
persist the pension system will also give unequal outcomes unless it is designed to mitigate 
them.  

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Some countries have introduced solidarity elements into their statutory funded schemes, while 
some  others  have  also  done  so  in  occupational  schemes,  for  example,  by  compensating  for 
certain  periods  outside  active  employment,  e.g.  with  the  state  paying  contributions  during 
periods of childcare or unemployment. In LV, HU, PL and SE, the same periods are credited 
in  both  tiers  of  statutory  schemes  (in  SE  all  non  contributory  periods  are  provided  with 
crediting,  whatever  the  tier  of  the  statutory  scheme).  In  BG,  EE,  LT,  SK  and  the  UK  only 
some risks covered under the unfunded tier are also covered by the funded tier (in BG, LT and 
UK none, in EE parental leave, in SK child care).  

Furthermore, when the same risks are covered under the two tiers, there can be differences in 
the treatments, for instance for child-raising and unemployment periods. In LV, PL, SK and 
SE, these periods are treated in the same way in both tiers, both in terms of the duration of 
payment  of  contributions  and  the  applicable  contribution  base.  On  the  other  hand,  BG,  EE, 
HU and LT treat individuals differently in  both tiers, either by not covering  them  or  with  a 
less extensive coverage. 

4.3.7.  Risk sharing 

No  pension  system  is  risk-free,  including  PAYG  systems.  But  the  move  towards  greater 
private  pension  provision  means  the  addition  of  investment  risk  and  a  different  sharing  of 
risks.  For  DB  occupational  pensions  the  risks  like  longevity,  inflation  and  investment 
performance are shared in different ways depending on the nature of the scheme. Some DB 
schemes  have  explicit  mechanisms  for  sharing  the  risks  with  pensioners  and/or  contributors 
via  indexation  and/or  contribution  adjustments  (as  in  the  Netherlands).  Others  rely  on 
employer  sponsors  (as  in  the  UK)  to  take  on  the  risks,  though  even  here  ad  hoc  employer 
negotiations with social partners may result in a sharing of the burden of cost increases, for 
instance  by  agreeing  to  reduce  the  generosity  of  the  pension  scheme  or  increase  employee 
contributions. DB schemes also smooth out the risks from shorter term investment volatility 
by spreading it between large numbers of people retiring at different times. 

DC  schemes  expose  individuals  most  directly  to  risk.  So-called  'lifestyling'  or  'lifecycling' 
investment strategies44 can help to manage risk over the saving cycle and give a reasonable 
rate  of  return  at  appropriate  levels  of  risk.  Strong  consideration  should  be  given  to  such 
investment approaches, particularly for statutory funded pension provision that is meant to be 
a  crucial  element  of  overall  pension  income.  The  right  framework,  including  good 
information  and  appropriate  use  of  default45  options,  needs  to  be  in  place  to  ensure  people 
make the right choices. In SE the premium pension system had a choice of 785 different funds 
in  2007.  When  the  system  started  in  2000  33%  of  people  made  no  active  choice  and  were 
defaulted into the Premium Savings Fund. By the end of 2007 41% had made no active choice 
and were in Premium Savings Fund. The Premium Savings Fund is described as medium-risk 
and  has  85%  of  the  capital  invested  in  equities.  Currently  many  Member  States  with  DC 
funded provision, including the vast majority of those with statutory funded pensions, do not 
have  lifestyling  as  the  mainstream  option.  This  needs  to  be  critically  re-examined  as  these 
schemes grow in importance and particularly in the light of recent market events. 

44 

45 

With  "lifestyling"  or  "lifecycling"  approaches,  investment  risk  is  concentrated  in  the  earlier  part  of  a 
person's working life with investments gradually shifted over time into lower yielding but less volatile 
assets. By the time someone is approaching retirement, where there may not be sufficient time for falls 
in investments to recover, their investments would be mostly protected from significant investment risk. 
For instance ensuring that those who don't make an active choice of investment are automatically placed 
in funds with the best chance of meeting their needs. 

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4.3.8.  Decumulation – taking a pension 

With PAYG or DB occupational pensions people acquire rights to a certain level of regular 
payments in the payout phase from retirement age until their death. With DC pensions instead 
of rights to a stream of payments, a pension fund builds up. This sum of money is then used 
for financial support in retirement.  

Where DC pension provision is only a small part of overall pension income, the exact design 
of  the  payout  phase  may  be  less  critical.  But  where  DC  pensions  are  significant,  or  will 
become so, the payout phase rules can have important implications for adequacy and risk in 
retirement. At the extreme, poorly designed payout rules can threaten the viability of pension 
policies  that  are  based  on  a  significant  element  of  DC  funded  pension  provision,  as  money 
intended for pensions is instead used for other purposes. 

As individuals don't know how long they will live, they face longevity risk. They could run 
out of money by using up their DC pension fund too quickly or they could have pension fund 
money left over on death that they could have used to have a more comforTable retirement. 
PAYG and DB schemes do not present this problem and share the risks, with those who die 
early cross-subsidising those who live longer. 

Annuities provide a regular and secure income for life and offer DC pensions with the closest 
match to the way PAYG and other DB schemes work in the payout phase. As an insurance 
product,  annuities  pool  risks  and  just  as  with  PAYG  and  DB  pensions  there  are  cross-
subsidies from those who die early to those who live longer. Where annuities are used in the 
payout phase there are also further design choices. These include how to mitigate the spot risk 
of  annuity  purchase  (for  instance  by  allowing  annuities  to  be  purchased  within  a  period  of 
time rather than at a fixed point) whether to include inflation protection (by having indexed 
annuities) and how much cross-subsidy should be maintained (for instance mandating unisex 
annuities  implies  a  cross-subsidy  from  men  to  women,  allowing  impaired  life  annuities 
implies a reduction in cross-subsidy from the short lived to the long lived).  

However, with a few exceptions (notably the UK which has the biggest annuity market in the 
world on the back of compulsory DC pension fund annuitisation) annuity markets are often 
small and underdeveloped. Often DC payouts can be via phased withdrawal leaving longevity 
risk and continued investment risk with the individual. Most risky are lump sum payments as 
these do not provide a retirement income, threatening adequacy. 

But whilst building up a DC pension fund may engender a sense of personal responsibility in 
pension savers, one difficulty this sense of ownership brings is that people do not wish to be 
restricted in how this money is ultimately used. This is in contrast to PAYG and DB pensions 
where it is accepted that contributions (or taxes) will lead to regular pension payments ending 
on  death,  with  the  inherent  cross  subsidies  these  arrangements  bring.  So  for  significant  DC 
pensions it is important to be clear that the money is to provide a pension and how this will be 
done in practical terms.  

Some Member States which have established statutory DC pensions have yet to fully set out 
the payout phase rules. For example in the 2007 Report it was noted that PL needed to put in 
place  payout  phase  arrangements.  These  arrangements  are  still  not  complete,  although  the 
issue is currently being addressed. The PL Government has introduced a bill to Parliament on 
the  pay-out  phase  of  the  mandatory  funded  scheme  proposing  two  kinds  of  payments,  life 
annuities and temporary funded pension benefits (for women aged 60 – 64). EE has stipulated 

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the basic features of the funded pension payout phase, which includes compulsory annuities 
as the main mode of payout, but the regulatory framework needs completing. In others such as 
SK where annuities are mandated, there remain questions about how viable this might be for 
small pension funds, although it will be some years before payouts begin. 

4.3.9.  Pension security and financial crisis impacts 

Pension funds are not immune to the financial crisis, though their inherent nature and the way 
overall pension systems are organised in Europe means that for those retiring today we can 
expect the impacts to be limited for most people. The impacts are dependent on the mix and 
proportions  of  various  types  of  pensions  in  Member  States'  overall  systems,  the  detailed 
design  of  these  various  elements  and  the  severity  and  length  of  the  ongoing  financial  crisis 
and wider economic impacts. 

The overall pension income of people retiring today in Europe is still made up in the main of 
statutory public pensions funded on a PAYG basis, rather than from funded pensions which 
are invested. So the overall pension income of European people is typically less vulnerable to 
impacts on investments. In the majority of Member States PAYG provides almost all of the 
pensions for those retiring today. There are only five Member States where funded provision 
is above 10% (these are DK on 16%, SE and UK both on 22%, IE on 54% and NL on 60%) 
with a further three at or slightly below the 10% level (DE, CY, BE).46  

Funded  provision  that  is  DB  helps  mutualise  the  risks  of  investment  volatility  reducing  the 
impacts  on  individuals  who  can  expect  to  get  a  pension  based  on  their  contributions  and 
service.  The  DB  pension  funds  themselves  have  long-term  liabilities  and  assets  and  so  can 
cope in the short term with falls in the value of investments. They will, though, need to take 
action to continue to preserve their long-term health and this will impact on pension scheme 
members to the extent that risks are shared via formal or informal mechanisms.  

Within  the  broad  European  framework,  different  Member  States  have  different  funding 
regimes  and  protection  systems  in  place  to  ensure  the  security  of  DB  pension  funds.  Some, 
such as the Netherlands, have long established methods for risk sharing via lower indexation 
and higher contributions and these will need to be allowed to operate for the long-term good. 
From  January  2007  a  new  supervisory  framework  for  pension  funds,  the  Financial 
Assessment Framework (FTK) was introduced. Others such as the UK, where employers have 
a  legal  obligation  to  support  the  pension  schemes  they  sponsor,  have  strengthened  their 
funding regimes. In addition the UK brought in a compulsory insurance-style protection fund 
to pay most of the benefits of pension scheme members should the worst happen. DE also has 
extensive  arrangements  to  protect  pension  benefits  including  were  necessary  insurance  type 
protection for pension scheme members benefits. However, there could be concerns that some 
other Member States regimes are not sufficiently strong to withstand serious economic stress 
and they will need to critically examine their systems to ensure they are robust for the long-
term. Indeed some, such as IE, were already looking at options for reform.  

For  DC  schemes,  temporary  falls  in  the  value  of  investments  of  those  some  way  from 
retirement should be seen as part of natural investment volatility and nothing to particularly 
worry about. Financial information and education needs to stress the nature of investment risk 

46 

According  to Table 7  "Contributions  of various  schemes  to  theoretical  replacement  rates  (base  case)" 
page 19 of the SPC report "Privately managed pension provision and their contribution to adequate and 
sustainable pensions" http://ec.europa.eu/employment_social/spsi/adequacy_sustainability_en.htm 

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in order to encourage informed decisions and to help maintain confidence in these schemes. 
For those close to retirement who are taking significant investment risk with insufficient time 
for  investments  to  recover,  falls  in  DC  pension  investments  will  mean  delayed  or  poorer 
retirements.  Lifestyling  investment  approaches  can  mitigate  this,  but  may  not  even  be  an 
option currently in some Member States with funded DC provision. Given the typically low 
importance of funded DC provision for those retiring today, this may not be critical. But in 
Member  States  where  these  funds  are,  or  will  be,  an  important  element  of  overall  pension 
provision,  the  mainstream  investment  strategy  choice  needs  to  match  this  role  providing 
reasonable returns but also not being subject to unaccepTable volatility close to retirement. In 
HU, an optional portfolio system has been introduced in the statutory funded pension as from 
2007. This creates the opportunity for long-term optimisation of investments adjusted to age 
and individual risk-taking ability and this system will become compulsory from 2009. 

4.3.10.  Pension policy responses to financial crisis 

It is too early to see how the crisis will develop and if it will affect pension schemes, but some 
Member  States  and  their  pensions  regulatory  bodies  have  taken  initial  policy  steps.  For 
instance in DK pension rules on the composition and size of assets would have forced pension 
funds to sell real estate bonds due to their fall in value. Apart from the knock-on effects to the 
market  for  such  bonds,  this  would  have  forced  pension  funds  to  realise  the  value  of  these 
assets  at  a  low  point  in  the  market.  The  Danish  FSA  therefore  changed  the  method  of 
calculating solvency requirements to allow pension funds to continue to hold these bonds. 

Similarly in FI the government put a Bill to Parliament on 17 October 2008 to strengthen the 
employment pension funds of the earnings-related pension scheme in view of the decline in 
the  equity  market.  The  proposal  aims  at  ensuring  the  solvency  requirements  of  the  pension 
funds  can  be  met  without  leading  to  forced  selling  of  equities  in  a  disadvantageous  market 
situation.  

Another  action  taken  in  several  Member  States  (notably  IE  and  NL)  has  been  to  give  DB 
pension  funds  more  time  to  report  their  funding  position  and  recovery  plan  in  the  hope 
markets  become  less  volatile  making  valuations,  planning  and  negotiations  with  social 
partners and others easier.  

A number of national regulators have also signalled that they will use their existing flexibility 
as regards recovery periods and plans for DB schemes (for instance the UK, NL, IE) to allow 
more time for pension schemes to recover their funding positions. 

PL  is  considering  introducing  lifestyling  investment  for  its  statutory  funded  pension;  the 
option had been considered previously, but the financial crisis has now given it sharper focus.  

In  SK,  a  law  approved  in  October  2008  will  make  it  possible,  between  15  November  2008 
until  30  June  2009,  for  people  to  switch  back  from  the  funded  second  pillar  as  well  as 
allowing people to move into the second pillar who are not yet in it. The Slovak Government 
decided  to  open  the  second  pillar  because  of  the  negative  impact  of  the  financial  crisis  on 
assets, especially for those who are relatively close to retirement. 

As  things  develop  further,  shorter-term  policy  responses  may  be  necessary  following  the 
essentially  pragmatic  approaches  taken  so  far.  In  addition  there  may  be  longer-term  lessons 
requiring policy action on issues like the balance of funded and unfunded provision and the 
approach to investment risk. 

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4.4.  Minimum income provision for older people (MIP)  

Building  on  the  SPC  study  on  minimum  income  provision  the  2007  Joint  Report  -  while 
noting  that  several  Member  States  have  improved  their  minimum  income  provisions 
significantly - called for greater attention to what minimum incomes are likely to deliver for 
whom and to the way improved minimum guarantees may impact on incentives for accrual of 
proper  pension  rights.  Consideration  should  be  given  to  levels  of  minimum  incomes  and 
mechanisms  of  indexing.  In  the  2006  &  2007  Joint  Report  improving  the  adequacy  of 
minimum pensions/income provision formed part of the challenges to be addressed for eight 
Member States (BG, EE, IE, CY, LV, LT, RO & UK). 

Member States are using different types of provision and delivery mechanisms: (1) Minimum 
pensions within contributory earnings-related pension schemes for people with low income or 
short contribution records (e.g. in BE, BG, CZ, ES, FR, LV, LT, LU HU, PL, PT, SE, SI ). (2) 
Basic  flat-rate  pensions  that  may  be  non-contributory  or  contributory  and  include  years  of 
residency in their qualifying criteria (e.g. in NL, DK, FI, IE). (3) Separate social assistance-
like,  means  tested  benefits  for  older  people  with  few  or  no  other  pension  rights  –  often 
referred to as ‘Social Pensions’ (e.g. in SI, PT, IT, LV, CY) or as ‘guaranteed minimum’ for 
the  elderly  (e.g.  AT,  DE,  BE,  FR,  UK).  Many  Member  States  operate  parallel  or  combined 
systems of minimum pensions and means-tested guaranteed minimum income.  

In addition all Member States to varying extents use a transversal category of old-age related 
benefits  in  cash  and  kind  that  contribute  to  the  living  standards  of  pensioners  and  are  of 
particular importance to those who rely on minimum income provision. Beyond these, there is 
considerable variation between Member States in the reference points for MIP levels and their 
coverage, means-testing, taxation and indexing. While poverty avoidance classically has been 
a  goal  of  pension  systems,  minimum  provision  for  older  people  tends  to  be  aimed  more  at 
reducing the poverty risks to accepTable levels.  

Currently minimum pensions and minimum income provisions cater primarily to the needs of 
women, who are poorly covered by the employment-related entitlement mechanisms of most 
pension systems owing to historical gender roles and subsequent gendered patterns of activity, 
employment  and  income.  Though  gender  differences  in  longevity  make  women  the  great 
majority of recipients in any provision for old age, they have typically had to rely on benefits 
at  the  margin  or  outside  of  pension  systems:  Widows/survivors  and  minimum  pensions  or 
MIPs  —  possibly  in  combination.  Thus  minimum  pensions  and  MIPs  are  very  much  about 
ensuring a minimum of adequacy for women. 

4.4.1.  Developments and progress 2006-2008 

In some Member States poverty rates grew substantially as the relative value of benefits fell 
behind rapidly growing wages (e.g. EE, LT, LV). High inflation added to problems of people 
on MIP in these Member States. In others efforts directed at improving MIP apparently lost 
most of their impact on relative poverty rates because of wage growth (e.g. ES, CY, FI, UK). 
Still, in these countries as in most Member States, the negative effects of growth not captured 
by  indexing  mechanisms  on  the  income  position  of  minimum  pensioners  and  recipients  of 
MIP, and the sudden price hikes in food and energy in the second quarter of 2008, have to a 
large degree been corrected through ad hoc up-ratings and structural improvements. 

A  couple  of  Member  States  reformed  their  MIP  in  major  ways  (e.g.  PT,  LT).  Parametric 
changes  did  also  occur.  Changes  to  up-rating  and  indexing  mechanisms  or  ad-hoc  increases 

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were particularly frequent (e.g. BE, CZ, ES, FR, IE, MT, PL). Several Member States efforts 
were more directed at implementing earlier adopted reorganisations (e.g. UK, SK, DE, AT).  

Member  States  where  adequacy  was  seen  as  a  particular  challenge  addressed  the  problems 
primarily  through  incremental  upratings  and  smaller  parametric  adjustments;  a  couple  of 
countries prepared major future advances  

A  number  of  Member  States  are  reviewing  the  results  of  reforms  to  minimum  income 
provision  and  highlighting  progress  over  a  longer  period  (e.g.  BG,  DK,  IE,  SE,  UK).  For 
some important advances until 2005 seem to have been reversed in the heat of hectic growth 
(e.g. LT, LV). 

Though  many  highlight  their  importance  very  few  Member  States  report  in  detail  on 
improvements to the MIP elements that take the form of exemptions, rebates and subsidised 
services. Attention goes first to minimum pensions and secondly to the main cash element in 
MIP. 

Recently the role of MIPs has been solidified through various improvements to benefit levels 
and  access  (e.g.  DE,  AT,  UK,  PT,  BE,  BG).  In  the  medium  to  longer  term  there  are  both 
trends that will reduce (i.e. increasing employment rates of women and OW) and trends that 
would seem to increase their role (i.e. reduction of replacement rates in statutory systems).  

Generally  the  period  2006-2008  saw  fewer  reforms  than  the  former  period  2003-2006. 
Member States tended to be more preoccupied with implementing adopted reforms than with 
introducing  new  ones.  Still  changes  to  minimum  pensions  and  minimum  income  provision 
were adopted in a few Member States. In the prior period a number of countries have made 
reforms to their minimum income systems with the purpose of: increasing levels of benefits, 
making access to benefits easier or replacing existing benefits with new systems. This reflects 
the growing attention that minimum incomes have received in recent years, alongside reforms 
that  many  Member  States  have  undertaken  to  their  general  pension  systems.  Major 
improvements of the inclusiveness and the benefit levels of basic pensions were enacted in the 
UK  and  were  being  planned  in  Ireland.  Structural  upgrading  of  minimum  pension  benefits 
came on track in some Member States (e.g. ES, PT, SL). In Spain minimum pensions where 
raised by 26% between 2004 and 2008. MIP reforms in this period resulted in the Solidarity 
Supplement  in  Portugal  (2006-08)  and  social  assistance  pensions  in  Lithuania  (2006). 
Supplements to existing benefits were introduced in Latvia (Monthly supplement) and Cyprus 
(Special allowance). Denmark, Hungary and others increased  the supplements introduced in 
the last period. Slovakia's top-up scheme for retirees with pension lower than the subsistence 
level will be significantly improved as this is raised. Parametric adjustments that made access 
to  benefits  easier  or  allowed  for  better  combination  with  other  income  happened  in  several 
Member States (e.g. BE, CZ, DE, ES, MT). Various improvements to transversal benefits in 
cash  and  kind  included  a  health  allowance  in  PT.  While  MIPs  typically  are  targeted  on  the 
older  and  poorer  elderly  they  may  only  be  delivered  after  application  wherefore  some 
Member  States  also  step  up  efforts  to  raise  the  take  up  rate  (e.g.  BE,  PT,  UK).  In  some 
Member  States,  minimum  guarantee  pensions  maintain  an  accepTable  living  standard  to  a 
reasonable degree (e.g. BE, CZ, DK, FR, LT, LU, PL, SE, SK). In many cases, however, the 
risk  of  poverty  for  those  living  solely  on  minimum  pension  is  still  very  high,  despite  the 
improvements made in the last few years (e.g. EL, ES, HU, MT, NL, PT, SI, FI, UK, BG). 

Improving  the  adequacy  of  minimum  pensions  and/or  minimum  income  provision  was 
highlighted as a key challenge for seven Member States in the 2007 Joint Report (BG, EE, IE, 

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LT,  LV,  IE,  UK).  Assuring  adequate  minimum  income  for  older  people  was  a  problem  for 
lower GDP-per-capita Member States such as BG, RO, LV, LT, and to a lesser extent EE, but 
it  also  created  problems  in  higher-income  fast-growing  Member  States  like  CY,  IE  and  the 
UK. It may be because the results of policy efforts are not captured by the common indicator 
data available, but it seems that most Member States facing serious challenges with minimum 
adequacy have made only moderate advances from 2006 to 2008. Yet in a couple of countries 
major new approaches which would significantly reduce at-risk-of-poverty-rates are planned 
or about to be presented (e.g. CY, IE). In the context of rapid wage growth and rising inflation 
and pressure of other priorities some may have limited themselves to alleviating poverty for 
the  worst-off  (e.g.  LV,  EE,  RO).  Others  have  worked  at  the  inclusiveness  of  the  pension 
system particularly in relation to women while at the same time improving their MIP systems 
(e.g.  LT,  UK,  IE).  The  UK  has  reformed  its  basic  pension  so  that  by  2010  around  75%  of 
women  (over  90%  by  2025)  will  receive  the  full  amount,  up  from  35%  at  present,  while 
lifting a large number of pensioners out of taxation and providing home visits to vulnerable 
pensioners. In a few Member States moderate progress reflects the amount of efforts invested. 
Yet, some have experienced a jump in poverty rates 65+ despite considerable efforts (e.g. UK, 
LV,  LT).  Ireland  managed  to  lower  the  at-risk-of-poverty-rate  for  people  65+  despite  rapid 
growth.  Generally  the  adequacy  of  minimum  pensions  has  received  the  bulk  of  attention 
whereas MIPs were less in focus. But Lithuania reformed widows/survivors pensions as well 
as its MIP scheme and introduced regular indexing. 

4.4.2.  Maintaining a minimum of adequacy: the issue of up-rating 

As minimum incomes are utilised to alleviate poverty the indexation of benefits in payment is 
an important aspect of the efficacy of the provision. In a context of rapid growth and sudden 
price  increases  on  food  and  energy  many  Member  States  have  introduced  extra  ad  hoc 
increases of minimum income provision and minimum pensions, (e.g. AT, CY, ES, LT, LV, 
SI, SK, IE, IT) or have opted to offer or increase an extra annual payment of pensions (e.g. 
BG,  CY,  UK).  While  the  intensity  has  varied  2005-2008  has  been  a  period  of  higher 
economic  growth  in  almost  all  Member  States.  Which  effects  have  existing  indexing 
mechanisms had in this period and to what extent have indexing been corrected or changed? 
While  common  indicator  data  only  cover  the  beginning  of  the  period  National  Strategy 
Reports recount part of the story since and allow for generalisations. In as much as many MIP 
65+  schemes  tend  to  be  price-indexed  (if  automatically  adjusted)  one  should  expect  the 
relative incomes to have fallen behind. This is also the case in the many Member States where 
minimum  pensions  and  minimum  income  provision  primarily  have  been  price  indexed  (or 
only ad hoc up-rated) and the at-risk-of-poverty-rate of 65+ therefore has increased (e.g. RO, 
LT, LV, EE, ES) and older people’s share of median equalized income for 0-64 year olds has 
declined.  Yet,  it  would  seem  that  the  relative  erosion  is  mostly  substantially  smaller  than 
could be expected. In many Member States the extra wealth and tax revenues generated have 
been used to introduce ad hoc up-rating or structural improvements to pension benefit levels 
and/or their indexing. This may have benefitted recipients of minimum income in particular or 
have been granted to benefit levels of 65+ in general. The insufficiency of ad hoc mechanisms 
in the period caused some Member States to introduce or plan regular indexing (e.g. RO, LT, 
or LV). Others changed the indexing towards wages (e.g. PL). In 2007, the UK introduced a 
statutory commitment to uprate the minimum guarantee by earnings on a regular basis. Some 
countries are planning further corrections to the erosion of relative incomes (e.g. FR). 

Various patterns emerge. In EE, LT and LV at-risk-of-poverty-rates 65+ were being reduced 
until 2005. While high growth and increasing inflation rates since made it difficult to maintain 
minimum  adequacy  ad  hoc  up-ratings  together  with  structural  improvements  have  allowed 

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recipients  of  minimum  pensions  and  MIP  to  retain  purchasing  power  and  not  to  fall  too  far 
behind. In Lithuania, for example, the at-risk-of-poverty-rate from 2005 to 2006 jumped from 
17%  to  22%  as  rapid  wage  development  caused  ad  hoc  up-rated  benefits  to  fall  behind. 
Likewise  the  median  equalized  income  of  65+  as  percentage  of  the  one  for  0-64  dropped 
about 6 pp. These measurements however fail to capture further up-ratings and improvements 
which from 2006-2007 caused the average social insurance pension to increase from 31.9% to 
32.9% of the average wage. In LV and EE minimum pensions fell radically behind wages but 
their purchasing power was maintained. In LV a referendum on minimum pensions provoked 
extra  up  ratings  even  though  it  failed.  Through  regular  and  extra  up-ratings  ES  has  largely 
been able to maintain the relative income position of the elderly despite rapid growth. On the 
other hand the latter has prevented substantial upward adjustments from registering in the at-
risk-of-poverty-rate 65+. In PT where growth has been lower the targeted implementation of 
the Solidarity Supplement and improvements to minimum pensions has helped reduce poverty 
rates.  In  the  context  of  rapid  growth  the  Special  Allowance  introduced  in  CY  has  had  no 
discernable  impact  on  poverty  rates.  Despite  considerable  growth  in  the  period  CZ,  SK  and 
PL  relying  on  mixed  price/wage  indexation  have  managed  to  keep  relative  poverty  rates  at 
almost the same level. By contrast HU with some economic difficulties has seen an increase 
from  6%  to  9%  despite  a  balanced  index  and  some  extra  up-rating.  In  Malta  the  national 
minimum  pension  has  been  pegged  to  poverty  thresholds.  Some  Member  States  have 
improved  the  indexation  of  minimum  income  provision  (e.g.  BG,  IT,  AT).  Turning  to 
Member States with flat-rate pensions (UK, IE, DK, NL, FI) recipients of basic pensions in 
the  NL  have  retained  their  absolute  and  relative  income  position.  In  Denmark  older  people 
relying  solely  on  the  people’s  pension  have  seen  moderate  improvements  in  their  situation. 
From a less comforTable income position pensioners dependent on flat-rate pension in Ireland 
have seen marked improvements. The same goes for the UK. Fast growth in FI has generated 
a sudden increase in the 65+ poverty rate. By contrast SE where the minimum pension also is 
price indexed has maintained a moderate at-risk-of-poverty-rate.  

While  inflation  rates  generally  remained  rather  low  in  most  Member  States  the  large  rapid 
increases in energy and food prices in the spring and summer of 2008 presented a particular 
challenge to mechanisms for safe-guarding the purchasing power of older people on minimum 
pensions  or  minimum  income  provision  across  the  Union.  Many  countries  have  sought  to 
counteract the effects of these and other price hikes by special up rating of minimum pensions 
and/or  MIPs  (e.g.  AT,  BG,  CY,  CZ,  DE,  LT,  LV,  MT,  SI,  SK,  IE,  IT,  UK).  In  AT,  where 
lower  pensions  are  indexed  at  a  higher  rate,  it  was  decided  to  move  pension  indexation 
scheduled for January 2009 two months forward to compensate for the price rises in energy, 
food and basic goods. In the 2008 budget MT introduced a cost of living increase (COLA) for 
pensioners comparable to that of employed persons. FR, reacting to erosion of benefits, paid 
MIP  pensioners  a  one-off  lump  sum  in  March  and  added  supplementary  indexation  in 
September 2008 and plans to do so until 2012. As supplement to the normal annual indexing 
CZ  introduced  extra  up  rating  whenever  price  inflation  exceeds  five  percent.  Reacting  to  a 
number of factors Germany has achieved a similar effect by suspending the lowering impact 
of  the  so-called  Riester  Treppe  in  the  pension  formula  to  allow  for  a  higher  increase  of 
benefits in 2008 and 2009, which will be matched by smaller increases in 2012 and 2013. 

On average older people spend a higher share of their incomes paying for basic needs (food, 
housing, energy and health) than the working age population. As indicated by Table 4.2 the 
Member States where food costs have risen the most, are also the Member States where food 
costs  dominate  the  spending  of  the  elderly  (i.e.  BG,  CZ,  EE,  LT,  LV,  HU,  MT,  RO,  SI) 
Generally  speaking,  the  actual  increase  in  pensions,  including  ad  hoc  increases,  have  been 

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higher than price inflation but lower than real wage increases. This has meant that pensioners 
have  fared  better  than  what  could  be  expected  given  the  indexing  mechanisms  in  the 
economic situation. 

Table 4.2: Structure of consumption expenditure by age in 2005, 

and inflation in October 2008 

EU-27

Bulgaria

All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy

Health

Czech Republic All items

Estonia

Greece

Latvia

Lithuania

Hungary

Romania

Slovenia

Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health
All items
Food
Housing, excl. imputed rents
of which, energy
Health

Structure of consumption expenditure by age 

Less than 
30 years

Between 
30 and 44 
years

Between 
45 and 59 
years

60 years 
and over

13,1
16,3
4,3
1,8

30,3
11,7
8,2

2,5

16,5
19,6
8,8
1,5

18,6
14,4
5,2
1,2

13,9
15,5
2,8
4,3

24
10,2
5,6
2,4

26,8
10,9
6,2
2,4

21,1
19,2
10,2
2,5

42,9
14,7
10,5
2,3

14,3
11,5
4,6
2,3

29,7
12,7
8,9

2,6

19,4
17,6
9,7
1,5

21,6
11
5,4
1,7

14,5
10
2,7
5,7

27
10
5,8
2,4

32,6
9,9
7
3

21,3
17,8
10,4
2,5

42,5
15,5
11,6
3,6

15
10,6
5,1
3

30,2
12,6
8,9

3,6

19,8
19,4
10,8
1,9

23,5
12,5
6,2
2,6

14,4
8,7
2,8
5,1

29,7
11
6,6
3,5

34,6
10,9
7,9
4,2

21,6
18,1
10,8
3,4

50
17,9
14,6
7,5

16,5
13,2
6,4
4,6

35
13,1
10,1

7

25,3
25,6
14,9
3

24,4
15,1
8,6
4,7

18,6
9,7
4
7,5

36,9
15,6
9,9
7,8

39,6
13,5
10,4
10

26,5
22,4
14,9
8,1

51,4
19,1
15,5
10,3

Average 
inflation 
Oct. 07 - 
Oct. 08
3,8
6,6
5,7
10,1
2,3
12,6
19,2
9,5
8,9

6,3

6,5
9,9
11,4
12,2
26,1
10,9
15,9
15,9
23,3
8,4
4,4
5,3
11,6
23,6
3,6
15,8
19,9
27,3
31,1
12,8
11,0
16,5
17,5
17,0
10,6
6,7
12,0
11,2
12,4
3,6
7,9
10,0
9,2
7,7
-1,5
6,1
10,9
11,3
15,4
2,6

20
16,1
13,1
9,8
8,6
6
2,2
1,3
Note:  in HU, MT and RO, imputed rents are unknown and supposed to be 0.

16,2
10,1
6,4
1,5

15,4
9,7
6
1,1

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The period 2008-2010 is likely to be marked by an economic downturn in all Member States. 
The  question  is  how  minimum  pensions  and  minimum  income  provision  will  fare  in  this 
period. Obviously much will hinge on price developments in the period and the mechanisms 
of  indexing.  Much  also  depends  on  political  intention.  A  few  Member  States  have  already 
indicated that up-rating of pensions planned for 2009 will be maintained (e.g. ES, IE). Others 
have announced major retrenchments across the board (e.g. LT and LV). 

4.4.3. 

Shifting relations between pensions proper and MIPs 

The  boundaries  between  minimum  income  provision  and  minimum  pension  may  shift  as  a 
result  of  pension  reforms  and  developments  in  labour  markets.  Some  Member  States  are 
making major efforts to include hitherto excluded groups in the pension system (e.g. UK, ES, 
FR, RO). Others are making efforts not to lose groups as pension systems diversify (e.g. DE). 
The UK has fundamentally widened the access of women to full entitlement to the Basic State 
Pension. In the Netherlands, occupational pension coverage is now extended to young people 
from the age of 21. In Germany extraordinary efforts are being made to include low-waged 
groups  in  the  voluntary  ‘Riester’  pension  schemes  that  are  meant  to  supplement  pension 
entitlements  in  the  main  statutory  scheme.  A  combination  of  direct  subsidies  and  tax 
deductions  for  these  groups  mean  that  their  premiums  are  substantially  lowered.  In  many 
Member States crediting of childcare has been improved (e.g. AT, DE, PT, EL, LT) while in 
DE  subsidies  for  private  pension  insurance  are  also  tied  to  the  number  of  children  one  is 
raising. 

The  structural  increase  in  female  labour  force  participation  is  affecting  the  relative  income 
position of the retired. The growing share of women with pension entitlements of their own 
among  present  retirees  is  already  lowering  the  number  of  women  who  have  to  rely  on 
minimum income instruments in a number of Member States (e.g. SE, DE, AT, FR, UK). The 
long standing trend towards higher activity and employment rates of women will increasingly 
tend  to  reduce  the  role  of  MIP  in  all  Member  States.  So  will  the  more  recent  growth  in 
employment rates of older workers and the maturing of supplementary pension schemes. The 
same  goes  for  reforms  that  extends  the  reach  and  inclusiveness  of  pensions  prober  through 
wider  entitlements  and  easier  access  –  for  example  for  women  with  careers  interrupted  by 
caring  duties  (e.g.  EL,  PT,  AT,  DE,  UK,)  or  for  young  people  such  as  in  occupational 
schemes in NL. Long-term reductions in replacement rates of statutory schemes will pull in 
the other direction. In the short to medium term recent improvements of MIPs including easier 
access will also tend to solidify and expand their role. Cohorts that experienced high rates of 
long-term  unemployment  during  the  transition/unification  period  in  Central  European 
Member States are rapidly approaching retirement (e.g. in CZ, PL, SK, HU [DE]). This will 
lead to lower pensions and increase the need for MIP.  

But present pension scheme designs are not just challenged to adapt better to historical gaps in 
coverage and set to benefit from or make up for labour market developments. Member States 
with scheme designs that used to relegate MIP features to a minute role are seeing evolving 
phenomena that cause the role of MIPs to grow. Thus even all-inclusive pension designs such 
as the residence-based pensions in DK, NL, (SE) and FI may increasingly find that a growing 
share  of  new  pensioners  is  unable  to  meet  entitlement  criteria.  The  bulk  of  these  are 
immigrants - including older parents brought in through family unification. But there is also a 
growing number who have worked abroad in their careers. In the Netherlands a possibility to 
buy in missing years of entitlement has been introduced. 

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The  change  in  women's  role  in  the  labour  market  is  gradually  leading  to  a  change  in  the 
dependency  on  the  traditional  breadwinner’s  income.  In  some  Member  States,  survivors 
pensions are being phased out completely and being replaced by minimum pensions (e.g. DK, 
SE). But in many Member States the quality of survivor pensions still play an important role 
in the risk of poverty for those women who survive to the death of their husbands and have 
not  earned  full  entitlements  to  a  pension  in  their  own  right.  To  what  extent  these  benefits 
provide a sufficient income in old age is an area for further study.  

A  special  dynamic  in  the  relation  between  pensions  proper  and  guaranteed  minimum 
provision for older people has to do with the disincentive effects of MIPs. Where the National 
Strategy  Reports  discuss  this,  they  tend  to  see  the  potential  negative  effects  of  MIPs  on 
propensity  to  build  up  pension  rights  and  to  save  as  rather  small  (e.g.  DE,  SE).  In  systems 
where membership of state, occupational or savings schemes are mandatory or de facto very 
difficult to avoid, eventual access to minimum income guarantees do not discourage take-up 
of  work.  In  practice  workers  cannot  deselect  pension  insurance  when  working.  Moreover, 
since  MIP  guarantees  are  rarely  if  ever  available  before  pensionable  age,  their  existence 
would  not  in  themselves  erode  incentives  to  continue  working  until  that  age  arrives.  But  in 
combination  with  early  exit  routes  they  may.  For  some  low-wage  groups  with  incomplete 
contribution  records  it  may  then  be  of  little  importance  that  no  or  only  small  pension 
entitlements can be earned from spending the last years before retirement on unemployment, 
sickness  or  disability  benefit.  Through  MIP  they  would  anyway  obtain  a  standard  of  living 
equivalent to that which could be achieved through pension contributions on a working wage. 
MIP may also make pension contributions/savings less legitimate for low-waged workers as 
these would not buy them a standard of living above what anyway is guaranteed for all. I.e. 
the  income  testing  of  MIP  appears  to  function  as  a  tax  on  the  entitlements  and  savings  of 
those  who  (continue  to)  contribute.  This  is  a  standard  problem  of  targeted  benefits  which 
crops  up  in  public  debate  in  Member  States  from  time  to  time  (e.g.  UK,  DK,  SE)  in 
connection  with  incentives  for  low-income  groups  to  save  for  pensions.  The  discussion 
centres on whether it is the low income or the MIP that constitutes the main barrier. 

4.5. 

Ensuring information and transparency  

Pension  reform  all  over  Europe  has  lead  to  a  trend  away  from  simpler  singular  systems, 
usually  of  a  defined-benefit  nature,  towards  multi-pillar  pension  provision  with  elements  of 
defined-contribution  design.  Multi-pillar  systems,  while  offering  different  risk  profiles,  also 
make pensions systems more complicated to understand and retirement income more difficult 
to predict.  

Pension reforms have, furthermore, implied a transfer of risk from pension scheme sponsors 
to  the  beneficiaries.  Increasing  links  between  contributions  and  benefits,  and  a  transition  to 
more  individually  funded  pension  provisions,  require  more  decisions  by  the  individual 
beneficiary  concerning  time  of  retirement  and  investments  in  order  to  secure  an  adequate 
income in old age. Reforms have already been implemented in most EU Member States. But 
evidence  shows,  both  from  this  round  of  reporting  and  a  peer  review  on  Information  on 
pension  systems  held  in  Warsaw,  that  in  order  for  these  to  work  and  gain  full  acceptance, 
pension  scheme  members  will  have  to  be  better  furnished  with  reliable,  intelligible 
information. 

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4.5.1. 

Public consensus building and information during pension reform 

Member States report that gaining a wide consensus for reform is vital to its success. Where 
pension  reforms  have  been  carried  out  there  has  often  been  a  political  consensus  and  a 
consensus between politicians and social partners. Most Member States have counted on the 
input  of  experts  from  social  partners,  ministries,  institutions  involved  and  scientists  for  the 
development  of  their  pension  reforms  (e.g.  DK,  IE,  FI,  DE,  AT,  PT,  GR,  CZ,  SE).  These 
countries  also  report  that  the  social  partners  fulfil  the  task  of  informing  politicians  and  the 
public about the latest trends in social systems and stimulate debate in order to foster a broad 
social consensus. One example is the Toledo Pact Commission that stretches over all the main 
political parties in Spain and debates reform proposals with the objectives recommended by 
consensus among all political parties.  

However, some Member States have reported on more direct consultations with the public in 
order to receive public consensus. To study options for pension reform, the United Kingdom 
government  set  up  an  independent  Pension  Commission.  In  more  recent  reform  efforts  in 
Ireland,  a  pensions  green  paper  was  published  followed  by  an  extensive  consultation  which 
will influence long-term pensions policy. A national awareness campaign was launched at the 
same time inviting citizens to make submissions on the Green Paper either in writing or via a 
website.  In  Malta  the  White  Paper  entitled  ‘Pensions:  Adequate  &  Sustainable’  was 
distributed for public consultation and subsequently the Pensions Working Group developed 
various models of reform scenarios to reflect public concerns. In Portugal, building social and 
political consensus in favour of reform was considered of great importance. The involvement 
of social partners and advisory councils for social security bodies was an important part of the 
Agreement on Social Security Reforms, signed after thorough consultation and broad debates 
in Parliament and other forums.  

A  few  Member  States  have  reported  on  the  information  provided  to  citizens  at  the  time  of 
reform  and  the  effects  it  had  on  the  choices  made  by  individuals.  This  is  particularly 
interesting where an active choice was required by beneficiaries, for example where there was 
an opt-in/ opt-out choice (e.g. SK, PL, BG, LT, LV, RO, EE). Judging from presentations and 
comments  at  the  peer  review  it  appears  that  in  some  cases  citizens  opted  to  join  the  newly 
developed funded pillars in their systems due to ambitious information campaigns, although 
this may not have been the best choice for them financially (e.g. BG, SK). 

In  order  for  people  to  make  economically  rational  pension  decisions  appropriate  to  their 
individual  circumstances  they  will  need  to  have  access  either  to  unbiased  information  or  to 
equally balanced information from different partisan sources. In the absence of this they may 
be  persuaded  to  make  erroneous  choices.  If  this  happens  on  a  large  scale  it  can  obviously 
undermine  popular  confidence  in  pension  reform. How  to  better  involve  social  partners  and 
other stakeholders in the provision of unbiased or equally balanced information is a field for 
future study.  

4.5.2. 

Pension projections and their effects on incentives to work longer 

In  many  pension  reforms,  work  incentives  have  been  built  into  the  structure  of  the  pension 
systems,  by  a  closer  link  between  contributions  and  benefits,  increasing  the  number  of 
contributory  years  necessary  to  be  eligible  for  a  full  pension  or  introducing  a  bonus/malus 
system with deferred or early retirement.  

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The  strengthening  of  work  incentives  in  pensions  means  that  individuals  should  keep  the 
effects  on  their  retirement  income  in  mind  as  they  make  work-related  decisions  throughout 
their  working  life.  Prolonging  working  lives  not  only  entails  decisions  for  the  individual 
regarding the age at which they retire or take up a pension but also regarding full or part-time 
work, career breaks and the age of entry into the labour market.  

Most Member States have information regulations requiring pension schemes of all types to 
provide information on the accumulation of pension rights, but the amount and character of 
information provided differs. Some may provide information on accumulated pension rights 
only if requested by individuals, while in others it is sent out automatically. This can affect 
how  the  information  is  absorbed  and  spread.  Having  to  actively  seek  pension  information 
probably limits it to certain groups, excluding the people who may need the information most.  

A  growing  number  of  Member  States  are  now  also  providing  or  developing  calculations  of 
how  these  pensions  rights  may  translate  into  a  pension  income,  based  on  projections  given 
certain economic assumptions (e.g. BE, DE, DK, IE, ES, FR, LT, FI, SE, UK). Finland and 
Portugal have recently introduced pension projections. In Finland these are available only for 
those closest to retirement, as projections for younger cohorts are considered too hypothetical. 
Yet with a move towards longer contributory periods it would seem important that individuals 
understand  the  effects  of  shorter  careers  early  on.  As  the  pros  and  cons  of  different 
approaches  are  weighed,  even  younger  cohorts  might  appreciate  forecasting  tools  which 
provide different scenarios depending on economic assumptions, contributory years and point 
of retrieving the pension.  

Projections are mostly provided for each scheme in isolation even though individuals ideally 
would need to know how their different entitlements combine into a full package of potential 
retirement  income.  But  in  a  few  of  the  Member  States  with  widespread  occupational  and 
private pension provision, steps are being taken to develop web-based pension portals where 
people can check how their pension accruals from different schemes would come together in 
an  overall  amount  of  pension  income  (e.g.  DK).  This  will  help  citizens  to  avoid  making 
retirement decisions based on incomplete or fragmented information. 

4.5.3. 

Financial education and adequate private pension provision 

Providing  information  on  accumulated  pension  entitlements  and  pension  projections  can 
involve  many  uncertainties  even  in  the  simplest  of  schemes.  There  is  a  greater  element  of 
choice, and therefore complication, in funded schemes with individual accounts than in pay-
as-you-go  schemes.  As  funded  pensions  overwhelmingly  tend  to  be  or  become  defined 
contribution  schemes  most  of  the  risks  are  furthermore  placed  with  the  insured  individuals. 
Improving information and levels of financial literacy of people covered by individual funded 
schemes  is  therefore  integral  to  the  success  of  private  pensions  especially  given  times  of 
financial  volatility.  While  this  may  have  presented  less  of  a  problem  earlier,  as  the  new 
funded schemes were generally introduced during times of economic growth, developments in 
2008 have shown that sufficient levels of information and financial literacy are a prerequisite 
for  individual  choices  on  investment  risk.  It  is  vital  for  the  continued  success  of  schemes 
already launched that individuals have a basic understanding of the risks involved.  

The  SPC  report  on  Privately  Managed  Pension  Provision  published  in  October  2008  shows 
that while the increased need for financial information has been widely recognised, the type 
and  standard  of  financial  information  varies  greatly  between  Member  States.  Information  is 
regulated in a number of Member States (e.g. AT, BE, IE, IT, HU, MT, NL, UK, BG) by the 

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supervisory authority or through self-regulation by partnership bodies. Presenting complicated 
financial  information  to  people  who  may  not  have  the  ability  or  interest  to  take  it  in  is 
difficult.  Improving  accessibility  and  absorption  of  information  through  simplification  of 
information  presented  is  a  key  concern  (e.g.  ES,  IE,  UK).  Yet  simplification  of  the 
information has to be strategic in order not to leave out any important information that might 
affect  any  savings  decision.  The  number  of  investment  choices  in  funded  schemes  varies 
vastly  from  just  three  or  four  (e.g.  HU,  BG,  PL)  to  several  hundred (e.g.  SE,  UK,  IE,  NL). 
Obviously the amount of choice will determine the depth of financial knowledge required by 
beneficiaries.  Member  States  are  trying  various  approaches.  The  ‘Altersvorsorge  macht 
Schule’ (pension provision goes to school) project in DE is a government initiative together 
with  social  partners,  consumer  organisations  and  adult  educational  institutions,  and  courses 
focus on all relevant issues of old-age provision.  

In most Member States, information is provided on current and past returns of pension funds, 
but there is limited information on fees and administration costs and the compounded effects 
of  these  on  effective  investment  returns.  Some  countries  oblige  pension  funds  to  list  their 
administration costs (e.g. DK, S) but these may not include the effect of all investment fees. 
This is a vital element when comparing funds and also when considering guaranteed returns. 
The SPC report on privately managed pension provision shows, for example, that minimum 
returns may help to support adequacy. Yet they may also entail higher direct insurance costs 
and  indirect  costs  due  to  changes  in  the  portfolio  structure.  Circumstances  are  not  always 
clearly presented and this may disfavour the least knowledgeable, often including people with 
risk-averse investment behaviour who might have benefited from less choice. 

The  peer  review  in  May  2008  concluded  that  there  is  a  need  for  independent  parties  who 
could provide information on effective yield performance in the light of administration costs. 
Companies that rate pension providers and assist consumer choice with information on market 
concentration, corporate reputation and informative advertising appear to be very successful 
in some countries. 

Whilst  risks  associated  with  pension  saving  are  often  highlighted,  particularly  given  recent 
turbulence  in  investment  markets,  less  attention  is  given  to  risks  associated  with  the  payout 
phase  of  pensions.  The  options  for  payout  phases  vary,  with  little  standardisation  and  often 
limited  restrictions.  In  some  Member  States  where  funded  schemes  are  still  maturing,  the 
payout phase is yet to be fully legislated (e.g. PL).  

Proper information on the payout phase can help mitigate some of the risks otherwise borne 
by  individuals  such  as  longevity,  investment  and  inflation  risks,  depending  on  the  payout 
options  available.  For  example  where  lump-sum  payments  are  given  at  retirement,  the 
investment,  inflation  and  longevity  risks  lie  with  the  retired  person.  Where  the  possibility 
exists  of  purchasing  an  index-linked  annuity,  an  individual  could  transfer  the  longevity, 
investment risk and inflation risk to the insurance company offering the annuity, but often at a 
cost that needs to be made clear to the individual. The advantages of annuities are not always 
well understood even in countries, such as the UK, where they are prevalent. It seems safe to 
assume that little is known in countries where the payout phase has typically not yet begun for 
the  first  cohort  affected.  This  is  an  issue  that  needs  to  be  further  addressed  to  avoid  future 
policy  problems  and  perhaps  problems  with  income  adequacy  of  older  retirees  due  to  an 
underestimation of the longevity risk in particular. 

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4.5.4.  The effectiveness of information channels 

Beneficiaries  generally  receive  pension  information  through  the  pension  providers,  and 
government  agencies  are  the  main  source  of  pension  provision  (the  main  source  of  pension 
income  is  statutory  schemes,  except  in  NL).  These  are  complimented  by  non-governmental 
pension providers and information sources such as agents, employers and advertisements. A 
growing  number  of  Member  States  have  reported  the  development  of  websites  gathering 
pension information from different schemes. There is, however, clear room for improvement 
regarding the content of the information provided and the information channels used.  

Information  and  information  channels  are  often  standardised  for  the  entire  population,  yet 
surveys have found that certain groups have disadvantages in absorbing information. There is 
a  need  for  targeted  information,  but  experiences  differ  when  it  comes  to  reaching  target 
groups.  People  are  unlikely  to  make  much  effort  to  obtain  information,  so  campaigns  and 
information should focus on the communication methods people tend to trust and use anyway. 
Local culture must be taken into account. For example, call centres may be a success in one 
country  but  remain  basically  unused  in  another.  The  internet  has  growing  importance, 
especially  with  regard  to  forecasting  and  comparing  different  providers.  However,  internet 
access  differs  greatly  in  different  countries,  and  tends  to  be  more  suited  to  younger  better-
educated groups. The young and low-educated groups are the hardest to reach. 

Most Member States reported that young people are not usually interested in pension-related 
issues. This could cause problems in the future, as reformed pension systems tend to require 
an early interest in pensions. But it may not be realistic to expect young people to show an 
interest in issues relating to their financial situation in old age.  

The information campaigns have typically been held in conjunction with reform (e.g. DE, PL, 
EE, SE). Few countries have, however, reported on how the campaigns went, which can be 
vital  when  parametric  changes  to  a  pension  system  are  made,  for  example  increasing  the 
pensionable age or extending eligibility rules. In Sweden, an information campaign has been 
carried out annually since the pension reform in 1999 in conjunction with the annual pension 
rights information sent to all insured persons. 

Few  countries  monitor  the  results  of  their  campaigns.  Even  fewer  Member  States  report  on 
efforts to evaluate annual pension information to the public and try to assess developments in 
public knowledge on pensions. In Sweden, a survey is carried out annually to gauge the level 
of knowledge of the pension system, which despite extensive information, is improving only 
slowly. Surveys and evaluations tend, to be restricted to the main source of pension provision. 
Yet  as  other  forms  of  pension  provision  grow  in  importance,  it  is  also  essential  to  measure 
public  knowledge  of  all  sources  of  pensions,  as  these  collectively  constitute  incentives  or 
disincentives to work longer or to save more for retirement. 

4.6. 

Conclusions  

The  employment  rate  of  older  people  has  increased  markedly  over  the  past  decade,  and 
improvements are particularly visible in a number of Member States. Nevertheless, much still 
needs to be done to reach the EU target of 50% employment among older workers by 2010 
which,  given  current  demographic  trends,  is  in  itself  insufficient  in  the  long  run.  So  it  is 
encouraging that some Member States ratchet up their targets as soon as they pass the 50% 
mark. Throughout Europe there is a growing willingness to act on the realisation that the age 
when people stop working has to increase. Member States are starting to increase the pension 

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eligibility  age  in  statutory  schemes.  Through  bonus/malus  rules  they  are  also  strengthening 
the  economic  incentives  in  pension  systems  to  avoid  premature  exit  and  motivate  people  to 
work  to  higher  ages.  These  are  important  signals  for  employers  to  adjust  their  age 
management practices and for employees to plan for later retirement. Member States are also 
trying  to  close  early  exit  routes  and  remove  unintended  incentives  to  early  retirement. 
Building a broad consensus for this, including the social partners, is often very difficult and in 
many  countries  there  are  still  certain  occupations  for  which  exemptions  or  special  regimes 
apply.  

Properly designed pension systems can provide important flanking support for developments 
in labour markets by signalling to workers, managers and employers which age management 
practices are acceptable and rewarded. Pension systems need to be complemented by Active 
Labour  Market  Policies,  Life  Long  Learning  and  active  ageing  measures,  as  the  lack  of 
progress  in  activity  and  employment  rates  often  can  be  explained  by  poor  employment 
opportunities for older workers, thus undermining the incentives created in pension systems.  

Unfortunately, further progress is now threatened by the worsening of the economic outlook. 
The economic downturn will be a real test for the durability of the achievements of the last 
decade.  There  is  a  risk  that  if  labour  shedding  is  again  concentrated  on  older  workers  the 
problem  may  be  off-loaded  to  retirement  systems  through  various  early  exit  paths,  thus 
reversing recent gains in activity rates and effective retirement ages. 

More people working more and longer while being covered by and contributing to pensions 
schemes has been identified as the single solution to providing both adequate and sustainable 
pensions  in  an  ageing  society.  This  entails  increasing  the  participation  not  only  of  older 
workers but also of all other groups of working age, thus widening the contributory base and 
the  coverage  of  the  pension  systems.  More  stringent  eligibility  requirements,  such  as 
increasing the length of required contributory periods for pensions and a tighter link between 
the levels of benefits paid out and contributions paid in are also becoming a commonly used 
practice  in  pension  reform  to  ensure  longer  working  lives.  While  providing  beneficial  work 
incentives,  this  makes  it  increasingly  important to  protect  justified  career  breaks  in  order  to 
avoid  a  reduction  in  pension  adequacy  for  those  who  are  not  able  to  meet  these  conditions 
during  their  working  lives,  notably  women  who  often  take  on  a  carer  role.  In  view  of  the 
current  economic  situation,  it  is  also  important  to  consider  the  position  of  the  long-term 
unemployed.  

Since pension schemes are being made more inclusive, with more and longer employment of 
women and older workers, the role of minimum income provision will decline. Yet the long-
term trend towards longer contribution periods and falling replacement rates will tend to make 
more people dependent on schemes  that top up or replace their pension incomes, especially 
groups with lower lifetime incomes and shorter contribution records. 

For  Member  States  with  special  challenges  in  minimum  income  provision  adequacy,  there 
have been only moderate advances. The best solution would be fundamental reform, but in the 
absence of that, determined strategies are needed for adequate indexing and gradual structural 
improvements  over  a  longer  period.  In  general  the  absolute  and  relative  incomes  of  older 
people  have  weathered  this  period  of  rapid  wage  growth  and  higher  inflation  better  than 
expected,  thanks  to  ad  hoc  measures  in  many  Member  States.  But  the  Member  States  that 
have fared best are those that have adopted regular indexing mechanisms that help to maintain 
both the absolute and the relative income position of MIP recipients by a combination of links 
to prices and wages. 

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In  Member  States  that  recently  introduced  substantial  funded  schemes  to  boost  overall 
pension provision, private-funded pensions have shown themselves to be less appropriate for 
groups of workers with low income and short careers. As workers are asked to opt in or out of 
alternative  arrangements,  it  is  crucial  to  tell  them  which  options  are  better  suited  to  their 
profile. 

In  order  to  optimise  reasonable  returns  whilst  reducing  the  impact  of  investment  volatility 
close to retirement, it is advisable that Member States with significant funded provision of the 
defined-contribution type adopt a ‘lifestyle/lifecycle’ approach to investment: a gradual move 
from riskier profiles in younger years to low risk, stable yield investment later in the career. 

Given  the  difficult  investment  climate,  Member  States  are  also  learning  that  unresolved 
issues, such as the pension payout phase rules in funded schemes, need to be clarified. Where 
these pensions are a significant part of overall pension provision the rules need to ensure that 
pension  savings  are  ultimately  used  to  provide  pensions  and  not  lump  sums  in  order  to 
properly  address  adequacy.  Annuities  provide  the  payout  solution  most  closely  resembling 
payout  structures  for  pay-as-you-go  and  defined-benefit  pensions.  Some  countries  are  also 
considering  supporting  continued  provision  of  defined-benefit  occupational  pensions  by 
establishing  greater  risk-sharing  elements  and  learning  from  the  negative  and  positive 
experiences  of  the  Member  States  that  pioneered  these.  Risk-sharing  is  also  raised  in  the 
context of collective defined-contribution schemes. 

In some Member States where funded provision was recently introduced, it has been difficult 
to get unbiased information. Introducing individual choice of risk profiles creates the need for 
targeted  financial  education  of  the  public  and  in  particular  of  vulnerable  groups.  But 
information and the channels for providing it are often to the same for the entire population, 
and surveys show that certain groups have difficulty absorbing this information. The need for 
information  is  a  broad  issue.  In  pay-as-you-go  schemes  too,  workers  need  to  make  well-
informed  decisions  on  employment  choices  and  the  need  for  supplementary  savings.  Partial 
information  may  mislead  individuals  into  economically  irrational  choices  and  may  even 
undermine  the  legitimacy  of  pension  policy.  One  solution  would  be  to  involve  the  social 
partners  and  other  stakeholders  in  providing  equally  balanced  information  from  different 
sources. 

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5. 

NATIONAL STRATEGIES ON HEALTHCARE AND LONG-TERM CARE 

5.1. 

Introduction 

Common objectives for healthcare and long-term care 

Member States are committed to accessible, high-quality and sustainable healthcare and long-
term  care  by  ensuring:  (j)  access  for  all  to  adequate  health  and  long-term  care  and  that  the 
need for care does not lead to poverty and financial dependency; and that inequities in access 
to care and in health outcomes are addressed; (k) quality in health and long-term care and by 
adapting care, including developing preventive care, to the changing needs and preferences of 
society and individuals, notably by developing quality standards reflecting best international 
practice  and  by  strengthening  the  responsibility  of  health  professionals  and  of  patients  and 
care  recipients;  (l)  that  adequate  and  high  quality  health  and  long-term  care  remains 
affordable  and  financially  sustainable  by  promoting  a  rational  use  of  resources,  notably 
through  appropriate  incentives  for  users  and  providers,  good  governance  and  coordination 
between care systems and public and private institutions. Long-term sustainability and quality 
require the promotion of healthy and active lifestyles and good human resources for the care 
sector. 

5.1.1.  Health as a goal and as a determinant of wealth 

Throughout  the  2008-2010  National  Strategy  Reports  (NSRs)  good  health  is  seen  as  an 
important  goal,  as  it  contributes  to  each  individual's  general  well-being.  There  is  also  wide 
recognition that good health enables people to participate in the labour market, as well as in 
social and political activities, reduces sick leave and absenteeism, increases productivity and 
postpones  retirement,  allowing  for  longer  working  lives.  Ensuring  good  population  health 
reduces  dependency  on  government  transfers  such  as  disability  benefits  and  pension 
expenditure  through  reducing  early  retirement  (due  to  ill-health).47  Health  (and  good 
healthcare  services  through  promotion,  prevention  and  curative  care)  contributes  to  the 
improvement of welfare levels of a country and its sTable economic and social development 
and social and territorial cohesion. Moreover, many suggest that the health and social sector is 
a  large  and  growing  employer  that  can  be  used  as  a  tool  to  improve  the  economy  in 
disadvantaged  regions.  It  can  also  contribute  to  achieve  the  Lisbon  objective  of  increasing 
women's  participation  in  the  labour  market  in  view  of  the  fact  that  a  vast  majority  of  this 
sector's  employees  are  women.  It  is,  therefore,  not  surprising  that  for  all  countries  the 
objective  of  health  policy  and  healthcare  services  is  more  than  just  saving  lives  but  that  of 
ensuring healthy and active lives at all ages.  

Regarding  health,  countries  identify  a  number  of  health  risks  and  ill-health  conditions  that 
remain  important  and  require  attention.  Risks  include  increasing  alcohol  and  drugs 
consumption  by  younger  people,  and  smoking,  poor  diet  and  lack  of  physical  exercise  in 
general.  The  main  ill-health  conditions  in  the  EU  are  obesity,  cancer,  cardiovascular  and 
respiratory  diseases,  mental  ill-health  and  injuries  and  accidents,  alongside  some  infectious 
diseases such as HIV and tuberculosis. Mental health diseases are seen to be gaining ground 
and  appear  to  be  related  to  working  conditions  and  exclusion.  These  risks  and  ill-health 
conditions  are  deemed  avoidable  to  a  large  extent,  especially  by  those  countries  that  report 

47 

For example the UK suggests that the UK economy loses over £100 billion a year due to ill health. 

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poor  health  status  performance  (HU,  EE,  LV,  LT).  This  pattern  of  risks  and  diseases  is 
determining the policy choices in the health sector (public health and healthcare services) to a 
large degree. 

5.1.2.  Health as the result of complex social, economic and environment factors  

Together with accessibility and quality of healthcare services and healthy lifestyles, living and 
working  conditions,  employment  and  income  can  play  a  vital  role  in  determining  health 
status.  In  this  context,  Member  States  identify  the  high  rates  of  long-term  (structural) 
unemployment,  income  inequalities  (which  have  risen  in  recent  times)  and  poverty,  and  an 
economic  development  that  has  not  necessarily  preserve  a  healthy  environment,  as  further 
determinants of health, contributing to social and regional health inequalities and creating an 
extra burden to the health sector. Evidence indicates for example that poorer households tend 
to experience a poorer quality environment and less access to environmental 'goods' such as 
parks and green areas.48 Things as varied as climate change, migration, more diverse societies 
and ageing are listed as additional challenges to policy in this field. Moreover, even economic 
growth is said not have been enjoyed by all in the same way and regional and social inequality 
(including health inequality) has increased in many countries in recent years. 

According  to  the  NSRs,  ageing  (related  to  longer  life  expectancy,  lower  birth  rates  and,  in 
some  countries,  strong  emigration  of  the  working  age  population)  not  only  means  a  larger 
share  of  old  and  very  old  people  with  multiple  and  reinforcing  degenerative  and  chronic 
conditions,  and  thus  stronger  demand  for  healthcare  and  long-term  care  services,49  but  also 
more workers needed and fewer workers available (including fewer informal/family carers), 
and  thus  high  labour  costs.  As  it  is  not  age  per  se  but  the  health  status  of  the  elderly 
population that results in greater needs for care, preventing ill-health at all ages (delaying the 
onset of disability/ dependency) is deemed crucial to ensure higher quality of life in old age, 
control healthcare and long-term care costs and ensure longer working lives.  

Patient expectations (translating into having more informed patients wanting top technology, 
more choice and faster treatment) and the changing epidemiological situation imply a need to 
adapt  the  healthcare  system  to  new  patient  needs  and  wishes,  while  ensuring  long-term 
sustainability of systems. 

5.1.3.  Main priorities for 2008-2010 

This is the second full reporting exercise under the social OMC regarding the healthcare and 
long-term care strand. As only two years have passed since the previous NSRs, virtually all of 
the  2008-2010  reports  (except  perhaps  BG,  CZ,  SK)  build  on  the  previous  strategies  and 
national health plans with similar priorities and policies and some additions or improvements 
in relation to the strategies proposed in 2006. For all Member States, universality, fairness and 
solidarity,  accessibility,  equity,  equality,  effectiveness,  and  efficiency  are  the  guiding 
principles  of  reform.  Between  2006  and  2008  a  number  of  countries  (e.g.  RO,  SE,  UK,  IE, 
NL)  have  produced  inquiries/assessments  of  population  needs  and/  or  health  sector  policies 

48 

49 

See  for  example  "The  linkages  between  environmental  and  social  sustainability  in  Europe"  at 
http://ec.europa.eu/social/BlobServlet?docId=1574&langId=en  
See for example the report Europe’s Demographic Future: Facts And Figures, European Commission, 
May 2007, which states: "An ageing population will place a strong upward pressure on public spending 
for  long-term  care  as  frailty  and disability  rise  sharply  at  older  ages,  especially  amongst  the  very  old 
(aged 80+)". 

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and, on that basis, have introduced/ plan to introduce additional policies (e.g. specific policy 
programme for health promotion in FI). Most countries have limited their reporting to a small 
number  of  policy  areas,  potentially  those  where  they  see  more  is  happening  or  they  see  as 
priorities.  Thus,  the  2008-2010  NSRs  are  not  always  as  detailed  in  relation  to  all  the 
objectives as the 2006-2008 reports were. 

In  general  the  2008-2010  NSRs  in  comparison  to  the  previous  2006-2008  NSRs  have  seen 
more  emphasis  placed  on  health  promotion  and  disease  prevention  to  improve  population 
health status at all ages and counteract the rise in expenditure expected as a result of ageing. 
There is substantial information on the implementation of national vaccination schemes and 
national screening programmes for cancer, diabetes and cardiovascular diseases. There is also 
considerable  information  regarding  national  or  group-targeted  campaigns  to  encourage 
healthy life styles and develop environments that promote healthy choices, involving a variety 
of  settings  (from  nurseries  and  schools  to  businesses).  In  2008,  more  and  growing  interest 
(although  still  restricted  to  a  number  of  countries)  is  placed  on  disease  management 
programmes  in  the  context  of  chronic  disease  (e.g.  obesity,  diabetes,  heart  disease,  renal 
failure) as well as some infectious diseases such as tuberculosis and HIV.  

Also  high  in  the  2008-2010  agenda  is  the  need  to  address  geographic  disparities  in  the 
availability and quality of care and, relatedly, the development of primary care as a means to 
address those disparities and improve access, as a vehicle for promotion and prevention, as a 
tool  to  ensure  better  care  coordination  between  types  of  medical  care  and  between  medical 
and social care, and as a means to ensure a rational use of resources in the sector and obtain 
greater value for money.  

Considerable  attention  is  paid  to  technology50  in  a  variety  of  ways:  to  improve  information 
and  access,  as  a  dimension  of  quality,  to  allow  for  a  better  use  of  resources,  notably  in  the 
context of shortage of staff and high labour costs, as a means to ensure good data collection 
and monitoring in the sector, to allow for better coordination of care, and as one of the drivers 
of expenditure, as technology allows for new treatments previously unavailable.  

Also there is considerably more consideration of staff issues and human resources policies in 
2008  than  ever  before,  including  policies  directed  at  informal/family  carers,  in  view  of  an 
ageing population and ageing staff (and thus future staff shortages) and current staff shortages 
due  to  emigration.  Policies  are  articulated  around  increasing  training  of  staff  and  carers, 
improving  work  organisation,  increasing  staff  motivation  through  remuneration  and  better 
working conditions, and developing support structures for informal/family carers. 

Significant importance is attributed to the coordination of care, between levels of government, 
between sources of funding and budget lines, between types of medical care, between health 
and  social  care,  between  public  and  private  provision,  between  the  public  and  the  third 
sector51 which is strongly involved in the care for vulnerable groups and the elderly.  

50 

51 

Technology  should  be  seen  in  a  broader  way  including  not  only  information  and  communication 
technology (ICT), devices and equipment, but also pharmaceuticals, procedures and services. 
The  third  sector  is  typically  made  up  of  all  those  organisations  that  are  not-for-profit  and  non-
government, those that are involved in community services or charity, those that relate to volunteering, 
and associations, co-operatives, foundations, church, charities, unions, clubs, societies, etc. While they 
differ  between  themselves  as  a  group  they  also  differ  from  profit  businesses  and  from  government 
departments and authorities. 

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The  contribution  of  the  Structural  Funds  to  the  improvement  of  accessibility  and  quality  of 
healthcare and long-term care is underlined in several NSRs. ESF interventions target human 
resources development and training of health personnel (e.g. CZ, EL, LT, LV, PT, PL, HU, 
SK), as well as health campaigns (e.g. HU, EL) while the ERDF will invest some € 5.2 billion 
in health infrastructure in Convergence regions (EU 12, PT, ES, EL, IT, DE). An effective use 
of  Structural  Funds  support  can  contribute  to  reducing  health  inequalities  across  and  within 
Member States. Therefore it is important to strengthen coordination between health strategies 
and investments from the Structural Funds, and improving monitoring mechanisms. 

5.1.4.  Progress in relation to 2007 Joint Report 

Overall,  Member  States  have  been  implementing  reforms  in  relation  to  the  challenges 
identified  in  the  2007  Joint  report  on  social  inclusion  and  social  protection.  Most  have 
continued  with  the  implementation  of  the  reforms  proposed  in  2006,  with  the  exception 
perhaps of: SK, that has retracted on some of the previous reforms, CZ and BG which propose 
new  reforms,  SI  who  has  approved  a  health  plan  in  2008  and  CY  where  the  reform  to 
implement  a  national  health  scheme  is  still  pending.  In  PL  some  steps  have  been  taken  but 
delays have been registered. For LU the focus should now be on implementing the proposed 
measures  rather  than  focusing  on  new  ones.  For  most  Member  States  the  2007  challenges 
remain valid. 

Based on the 2008-2010 NSRs, since 2007 the Baltic States (EE, LV, LT) plus BG and RO 
have allocated more (public) resources to the sector to improve access and quality of care and 
have placed more emphasis on health promotion and disease prevention and in accordance to 
what  had  been  suggested  in  the  2007  Joint  Report.  However,  there  are  concerns  that  the 
economic crisis will have a retracting effect in relation to this trend. A state of crisis has been 
declared in LV and a number of proposals has been put on hold, while in EE the budget rules 
suggests that a smaller amount of resources will be available to for healthcare. In LV, there 
are  concerns  that  cost-sharing  and  out-of-pockets  will  increase  as  a  result  of  the  crisis,  thus 
potentially undermine the progress so far in improving access to care. 

Since  2007  several  countries,  such  as  EE,  BE  and  DE,  have  been  successful  in  improving 
population  coverage,  although  some  gaps  still  remain.  Other  countries  send  more  mixed 
messages.  For  example,  in  AT,  gaps  in  insurance  coverage  have  not  improved  despite 
concerted efforts with the third sector and local authorities to provide access to basic care to 
non-insured  individuals.  In  CY  the  National  Health  Scheme  that  would  ensure  universal 
coverage has been postponed for some years. In addition, PL, LT, SK, and SI do not refer to 
specific  policies  that  can  lead  to  universal  coverage.  In  NL,  though  health  insurance  is 
mandatory and universal, it is not clear what happens to those individuals who do not register 
with an insurance company and how many these are. It is estimated that approximately 1.5% 
of  the  Dutch  population  is  not  insured.  Interestingly,  RO  has  conducted  a  population  needs 
assessment  exercise  which  showed  a  high  proportion  of  the  population  lacking  insurance 
coverage. This can be seen as a first step towards improving access to care, by identifying the 
extent of the problem. 

Reducing  the  financial  barriers  to  access  was  an  identified  challenged  in  2007.  While  all 
countries  appear  to  have  exemptions  or  reductions  in  relation  to  cost-sharing,  some  have 
actually  increased  the  number  of  cost-sharing  schemes  (CZ,  FR,  NL  with  a  deductible,  and 
LV in the future and in view of the financial crisis). The reduction in care utilisation in CZ, 
for example, has been significant. It remains to be seen what the impacts of these schemes on 
more vulnerable groups are. In LV, where direct financing costs of care are more than 40% of 

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expenditure, extra payments may translate into an extra financial burden on patients especially 
those more vulnerable. The financial costs of care remain high in CY and EL and no specific 
policies  have  been  mentioned  to  address  this.  In  IE,  while  the  income  threshold  for  free 
medical  care  has  increased,  the  entitlement  to  free  care  based  on  age  has  been  removed 
causing  quite  an  internal  uproar.  Interestingly,  HU  and  SK  have  withdrawn  cost-sharing 
schemes that had been recently implemented. Following the 2007 Joint Report, BE has made 
substantial  efforts  in  reducing  the  risk  of  impoverishment  due  to  healthcare  use.  Some 
countries (e.g. PT)have since 2007 been improving system coverage for dental care for certain 
groups  of  the  population  (such  as  children,  youth,  and  low  income  individuals).  Just  as  in 
2007, dental, ophthalmic  and  aural  care remain, for  the  most  part,  outside  the  public  basket 
and  more  countries  need  to  make  an  effort  to  ensure  their  coverage  for  more  vulnerable 
groups. Moreover, informal payments still persist in several countries (SK, RO, BG, EL, HU, 
PL,  LT,  LV,  IT)  and  it  is  not  clear  if  any  policies  were  put  in  place  to  address  them  and  if 
indeed they have decreased.  

Some policies appear to have been extended to many countries (FI, LT, HU, IE, AT, SI, EE, 
PT, MT, DK, SE, ES, UK, CZ) such as those regarding the more centralised management of 
waiting  lists  for  treatment  often  accompanied  by  the  establishment  of  time  frames/  limits/ 
guarantees and more public information on waiting times by health facility. These policies are 
in  some  cases  accompanied  by  the  possibility  to  use  other  regional  hospitals  or  private 
providers  when  the  wait  goes  beyond  the  specified  limit.  Note  though  that  a  number  of 
patients prefer not to exercise the right to go elsewhere for treatment. In general these policies 
appear to have reduced waiting times for certain treatments.  

In relation to the 2007 challenges, some countries (e.g. FR, FI, SE, ES) continued working on 
reducing  geographic  disparities  in  access  and quality  of  care  through  the  implementation  of 
harmonised  minimum  criteria  for  access  and  quality  or  through  incentives  to  staff  (FR,  BE, 
BG, RO, LV) or better data on regional age and health status profiles and inequalities in the 
use of healthcare (HU). Others (e.g. EL, IT) do not appear to have gone so far in addressing 
such disparities. 

The  implementation  of  screening  programmes  (e.g.  cancer)  and  disease  management 
programmes (diabetes) is becoming more common across the whole EU. Some countries, as 
compared to 2007, are encouraging more promotion and prevention at the primary care level 
through increased competences of general practitioners / family doctors (IE, LT, HU, EE, SI, 
RO, CY, SK, PT, BE, LV) and through extra remuneration based on prevention activities (LT, 
HU,  EE,  SI).  In  relation  to  cancer,  DK  and  IE  are  gradually  establishing  nationwide  cancer 
pathways to improve access to and quality of associated care, which has nevertheless required 
some rearrangement of services. The establishment of patient rights and more formal means 
of patient involvement in decision making are also taking a growing space in the EU. Most 
countries  show  progress  in  the  establishment  of  quality  standards  and  accreditation  of 
facilities and staff, as well as in the use of clinical guidelines. Some (e.g. BE, ES) have also 
shown more use of health technology assessment. Most EU countries, however, are at an early 
stage  in  terms  of  using  health  technology  assessment  in  health  policy  decision  making. 
Quality differences are still significant across the EU countries.  

As the biggest spenders in the EU, BE, FR, AT, DE and PT face the important challenge of 
ensuring  long-term  sustainability  and  obtaining  greater  value  for  money.  While  an  array  of 
policies have been proposed and some implemented, which translates in the fact that in recent 
years  expenditure  levels  have  been  more  sTable  (as  a  %  of  GDP),  more  needs  to  be  done. 
Amongst  other  measures,  AT  still  needs  to  work  towards  more  integrated  funding  as 

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announced  in  2007,  DE  still  need  to  reap  the  fruits  of  selective  contracting,  FR  is  focusing 
mainly  on  the  demand  side  (e.g.  cost-sharing,  with  a  possible  burden  on  more  vulnerable 
patients)  and  need  to  look  at  the  supply  side  incentives  (e.g.  contracting,  health  technology 
assessment),  PT  needs  to  continue  the  implementation  of  primary  care  units  and  centres  of 
excellence.  Strict  budgeting  and  cost-containment  are  measures  that  have  allowed  BE  to 
control expenditure growth in recent times. BE is still to implement a "future fund" to build 
up  reserves  for  future  use.  Greater  use  of  primary  care  and  more  cost-effective  use  of 
pharmaceuticals may be of relevance to all these countries.  

Still in relation to sustainability reforms, note that while NL expected to reap efficiency gains 
from competition in the insurance sector, 4 companies currently hold 90% of the market, fact 
that  requires further monitoring and may question  the ability for this type of competition to 
ensure efficiency gains. Furthermore, selective contracting is not fully  implemented and the 
authorities' strong focus on increasing patient choice may go against selective contracting and 
efficiency.  SK,  that  appeared  to  be  following  the  Dutch  example,  does  appear  to  have 
somewhat retracted from their focus on private insurers and providers. Since 2007 CZ and DE 
appear  to  have  improved  risk-adjustment/equalisation  across  insurance  funds.  Nonetheless, 
there are concerns that, in CZ, the possible privatisation of insurance funds may not consider 
risk-equalisation, thus questioning the solidarity and equity elements of healthcare financing 
and  the  sustainability  of  funds.  It  is  also  important  to  consider  whether  the  required 
institutional  capacity  is  available  in  CZ  to  proceed  with  such  a  reform.  In  relation  to  2007 
challenges,  HU  appears  to  have  improved  on  expenditure  control  notably  through  a  more 
strict controlled of patient care paths, the restructuring of the inpatient system, and greater use 
of generics. 

In  line  with  the  2007  challenges  all  countries  want  to  increase  the  provision  of  home  and 
community care and enhance the quality of existing facilities. Some countries are redesigning 
their  financing  and  provision  system.  NL,  for  example,  is  limiting  the  scope  of  the  benefits 
provided by their long-term care insurance scheme and making provision a responsibility of 
local  authorities,  which  may  have  access,  quality  and  sustainability  implications.  Many 
countries are, however, still at an early stage of these developments. 

5.1.5.  The financial crisis and economic slowdown  

High  growth,  low  inflation,  low  interest  rates  and  monetary  stability  witnessed  in  a  large 
number  of  Member  States  in  recent  years  have  allowed  a  positive  environment  to  address 
social challenges and improve social cohesion. In contrast, the current economic uncertainty 
and slow down, due to unfavourable global tendencies including the early 2008 high inflation 
(increase in energy and food prices), adverse exchange rate movements, and more recently the 
severe  financial  market  crisis  ("biggest  global  financial  shock  since  the  great  depression"  - 
IMF), can have a negative impact on welfare and well-being, including the health status of the 
population notably those in more vulnerable groups. The Commission Communication on the 
financial  crisis  (COM  (2008)706)  forecasts  that  shocks  hitting  the  European  economy  will 
reduce  the  potential  growth  rate  in  the  medium  term  and  cut  actual  growth  significantly  in 
2009  and  2010.  The  economic  downturn  will  affect  families,  households  and  the  most 
vulnerable  people  in  our  societies.  Those  with  low  income,  low  education,  living  in  poorer 
neighbourhoods, single parents, and children are likely to be worst affected.  

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Some of the consequences of a severe economic crisis include significant risks for health52 in 
two ways: on the supply side and on the demand side. On the demand side, depending on the 
severity of the crisis, the demand for healthcare increases as a result of poor health due to a 
combination of factors: increased job insecurity, unemployment and lower disposable income 
typically relate to increased levels of psycho-social stress and more frequent health damaging 
behaviours  such  as  increased  consumption  of  alcohol,  tobacco,  and  drugs,  together  with 
poorer nutrition. Severe past economic crisis have led to sharp rises in many causes of death 
particularly  cardiovascular  disease  but  also  to  alcohol  related  accidents  and  death  and 
increased  cancer  incidence.  Rises  in  chronic  illness  and  mental  health  problems  have  also 
been  observed.  Furthermore,  negative  health  impacts  may  persist  long  after  the  economic 
circumstances have changed. 

On the supply side, the bases for spending on health are typically taxation and employment-
based contributions. With slow economic growth and recession such revenues decrease, as a 
result of higher unemployment, and thus constrain the level of resources that can be spent on 
healthcare and long-term care services. How much is then spent on care services depends on 
the budgetary reserves Member States have made in good times and can use in worse times, 
as well as budgetary rules (e.g. Can the health insurance funds run a deficit or not?) which are 
stricter in some countries than in others. In this context, governments may be under pressure 
to cut expenditure and services or, in other words, to focus on the short-term rather than on 
long-term agendas.  

Thus, it is likely that the ambitious plans exposed in the NSRs may be delayed or made more 
gradual or even frozen. Indeed, recent country experiences related to macroeconomic stability 
(BG),  high  budget  deficits  leading  to  macroeconomic  convergence  plans  and  structural 
reforms  (HU,  EE,  PT,  DE  and  FR),  have  shown  that  additional  economic  constraints  are 
placed on social policy budgets in economically difficult times. Additionally, lack of societal 
support  for  reform  has  delayed  or  brought  reform  to  a  standstill  (e.g.  HU).  Hence,  it  is 
realistic to expect that the current crisis will place economic constraints in all Member States. 
In  general,  more  than  healthcare,  long-term  care  stands  to  lose  as  it  is  more  often  based  on 
local authorities' budget and this is often and quickly adjusted in view of the macroeconomic 
situation. As long-term care represents a smaller share of the budget, focus on only a part of 
population, and in most countries it is at an initial stage of development it may be perceived 
as an easier target for financial cuts. This is the more worrying when so many countries have 
seen a recent impetus in the provision of services.  

In this context some crucial questions come to one's mind: "how well prepared is each of the 
27  Member  States  to  face  this  economic  crisis/slow  growth  and  the  social  and  health 
challenges that come with it?" and also, "in view of the ambitions expressed in the NSRs how 
will Member States reconcile the pressure on expenditure with the need to reinforce the safety 
net in a difficult economic context?".  

These are important especially when Member States recognise that social protection including 
social  security  and  social  and  health  services  have  significantly  contributed  to  improving 
health and reducing the risk of poverty and exclusion including that associated with ill-health, 
old  age  or  accident.  Indeed,  the  values  of  universality,  solidarity  and  equity  including  the 
protection of the most vulnerable in our societies become even more pertinent and should be 

52 

For example the Finnish recession in the late 1980s and early 1990s and the economic crisis following 
economic transition in Central and Eastern European Countries had significant health consequences. 

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emphasised  as  the  basis  for  policy  responses.  The  most  relevant  policies  in  such  economic 
circumstances  are  those  which  protect  health  such  as  access  to  food  and  housing  and  those 
that  ensure  universal  access  to  good  quality  care  especially  primary  care  and  in  particularly 
for  children  and  vulnerable  groups.  Public  health  policies  aimed  at  creating  a  culture  of 
solidarity and resilience, promoting mental health and dealing with stress and at reducing risk 
taking behaviour such as smoking and harmful alcohol use are also very important. 

The  remaining  of  the  chapter  goes  as  follows.  Section  2  looks  at  access  to  healthcare  in 
greater  detail,  while  section  3  identifies  the  main  issues  in  relation  to  quality.  Section  4 
describes  the  main  challenges  and  associated  policy  measures  regarding  long-term 
sustainability  of  healthcare.  Section  5  then  addresses  the  specific  field  of  long-term  care. 
Some issues such as primary care or care coordination cut across several sections. Section 6 
concludes  and  identifies  key  issues  for  further  work  and  best  practice  exchange  under  the 
OMC. 

5.2. 

Addressing health inequalities and inequities in access to care 

Member States argue that good health and longer working lives require, amongst other things, 
effective  health-in-the-workplace  policies  (notably  those  emphasising  age  management  and 
mental health) and, importantly, that healthcare services (including health promotion, disease 
prevention, curative care and rehabilitation) are accessible for all. Inequalities in health status 
between social groups and between different parts of Member States are seen as an important 
problem  by  about  half  of  all  Member  States.  Across  the  EU  the  gap  in  life  expectancy 
between Member States has widened to 13 years for men and 8 years for women For the EU 
as  a  whole  there  is  significantly  more  (reported)  long-term  illness  and  disability  in  lower 
income groups. Strategies to tackle health inequalities range from those which focus mainly 
on tackling inequities in access to healthcare to those which aim to also tackle the underlying 
social  and  economic  determinants  and  involve policies  across  all  areas  of  government.  This 
area represents major challenges to health and social policy and is of increasing importance. 

5.2.1.  Health inequalities 

On average, general health (measured by e.g. life expectancy) has increased in the EU over 
the  past  two  decades  as  a  result  of  health  policy,  more  widely  available  medical  care  and 
improvements  in  living  and  working  conditions.  However,  improvements  have  followed 
different  patterns  across  countries.  Economic  transition,  for  example,  had  a  negative  impact 
on life expectancy in the early 1990s in Central and Eastern European Countries, followed by 
strong recovery in many but not all countries (e.g. life expectancy in LV and LT (for men) is 
still below the 1986 level). Across the EU the gap in life expectancy between Member States 
has widened to 13 years for men and 8 years for women, with individuals in the new Member 
States  of  Central  and  Eastern  Europe  typically  living  shorter  lives  than  their  Western 
counterparts.  

In  addition,  within  country  socio-economic  differences  in  health  have  remained  or  even 
increased  in  a  large  number  of  countries  for  which  there  is  data  available.  For  example,  FI, 
LT, EE, AT, IE, UK, and DK all report in the 2008 NSRs that life expectancy, healthy life 
years, long-term illness, functional capacity, self-reported working ability, and severe mental 
problems are more common in the lower socio-economic groups (measured using income or 
education) than in the higher ones. More specifically, in AT those with higher education a) are 
less  often  smokers,  b)  are  less  frequently  overweight  and  obese,  c)  have  preventive  health 
checks more often, and d) more often perceived their health to be good or very good. In EE 

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women with higher education live on average 13 years longer than men with basic education 
(against  the  average  11-year  gender  gap).  The  UK  states  that  parts  of  Wales  (notably  the 
former  mining  and  industrial  areas  of  south  Wales)  and  parts  of  Scotland  have  some  of  the 
worst health indicators of Europe and certainly Western Europe. DK indicates that the most 
disadvantaged  groups  generally  have  poorer  health  and  fewer  healthy  years  to  live  than  the 
rest  of  the  population.  In  BE  life  expectancy  at  birth  of  those  with  low  qualifications 
compared  to  those  with  higher  education  is  5.5  years  less  for  men  and  3.5  years  less  for 
women. At 45 a 5-year difference for men and women is observed. Recent EU-SILC data also 
indicates53  that  lower  income  groups  feel  their  health  to  be  worse  than  more  advantaged 
groups and that in some countries the gap has increased.  

Inequalities  in  health  status  between  social  groups  and  between  different  parts  of  Member 
States are seen as an important problem by about half of all Member States. Reducing socio-
economic  and  regional  health  inequalities  has  become  the  most  important  health  policy 
challenge for FI and UK, a major goal for LT, IE, AT, EE, SI and SK and part of BE, HU and 
ES strategy. In the UK extra funding has been allocated to implement direct action to reduce 
health  inequalities,  and  in  FI  a  national  programme  has  been  launched.  DK  reports  the 
reduction  of  socio-economic  health  inequalities  as  a  high  point  of  discussion  during  the 
national forum on social protection and social inclusion and MT recognises the need to look 
further  into  this  issue.  Interestingly,  a  number  of  countries  recognise  that  action  to  reduce 
health inequalities (i.e. improving the health of specific groups) can actually increase general 
population health at faster rate.  

Socio-economic  differences  in  health  status  suggest  that  not  all  population  groups  have 
benefited  in  the  same  way,  either  from  the  economic  progress  that  delivers  better  health 
through  better  living  and  monetary  conditions,  or,  and  importantly,  from  the  availability  of 
and improvements in medical care. Differences in care access and care utilisation explain part 
of the observed  inequalities  (e.g. EE  reports that poorer households make a different  use of 
care vis-à-vis richer households). Several countries argue that access care is not understood by 
those  to  whom  it  was  designed  and  in  greater  need.  EU-SILC  data  shows  a  clear  socio-
economic  gradient  in  self-reported  unmet  need,  which  may  proxy  differences  in  care  use 
across  socio-economic  groups.53  A  crucial  aspect  in  tackling  health  inequalities  is  therefore 
that of addressing socio-economic and regional differences in the availability and use of care 
and  creating  health-supportive  environments  (see  next  section).  As  the  UK  puts  it,  we  need 
better, local and faster access to care in some more deprived areas and for some groups.  

The  set  of  measures  put  forward  include  routine  monitoring  of  health  status  of  different 
population groups (DK, UK, IE, MT) and geographical areas (UK), which indeed can be an 
important  step  in  drafting  informed  policy.  Monitoring  should  also  done  in  relation  to  care 
utilisation by the different population groups (e.g. IE proposes looking at cancer screening by 
different socio-economic groups). In the UK, monitoring is to be accompanied by targets (for 
life expectancy and infant mortality by 2010 for the so-called most deprived areas). In DK, an 
ill-health  survey  ("SUSY  UDSAT")  provides  comprehensive  health-information  on  alcohol 
and  drug  users,  homeless,  mentally  ill  and  poor  people,  and  shows  significant  differences 
between  their  health  and  that  of  the  overall  population  (61  %  suffer  from  long-term  illness 
compared to 39% of the general population). 

53 

See http://ec.europa.eu/employment_social/spsi/docs/social_inclusion/2008/omc_monitoring_en.pdf  

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Some  countries  have  designed  health  programmes  targeting  specific  groups  in  society:  the 
national  intercultural  health  strategy  in  IE,  including  for  Travellers;  Roma  and  disability 
programmes in SI; health checks and health promotion for the Roma in LT; health mediators 
for  Roma  in  RO  and  BG;  the  health  strategy  for  disadvantaged  communities  (for  Roma, 
homeless)  in  SK;  Travellers  programme  in  the UK;  the  strategic  citizenship  and  integration 
plan  in  ES  which  looks  at  the  health  of  immigrants;  a  plan  for  health  of  migrants  in  MT; 
mobile units directed at minorities and migrants in PT; improve services delivery to homeless, 
illegal migrants and drug addicts in BE; prevention programmes for disadvantaged groups in 
DK; the phone counselling line available in Estonian and Russian in EE.  

More general policies relate to training care staff to make them aware of possible inequities of 
access  (UK)  and  of  obstacles  faced  by  those  with  disabilities  (CZ).  In  addition,  Member 
States  suggest  that  there  is  a  need  to  reinforce  the  existing  national  structures  of  health 
promotion  to  ensure  community  education  on  health  promotion.  Hence,  health  promotion 
(based  on  national  messages)  is  becoming  a  local  responsibility  as  a  means  to  reduce 
disparities. Municipal public health offices in LT, local authorities in DK and regional offices 
in AT, SI and SK are now responsible to adapt national health promotion policy to their local 
features  and  monitor  health  status  and  access  to  care.  Countries  also  propose  that  health 
promotion  is  adapted  to  those  at  higher  risk  (e.g.  IE  proposes  action  to  promote  healthy 
eating,  access  to  healthy  food  and  physical  activity  among  adults  in  disadvantaged  areas). 
Nurseries  and  schools  are  seen  as  important  vehicles  for  health  promotion  for  all,  notably 
through  appropriate  curricula  in  schools  and  as  healthy  environments.  Children  and  youth 
health is a priority in several countries (IE, SK, SI and BE, and LV).  

Given  the  various  social  determinants  of  health  above,  some  countries  (FI,  IE,  AT,  SI,  EE, 
SK, UK) have encouraged health protection and the reduction of health inequalities in other 
sectors'  policies  (e.g.  education,  employment,  housing,  social  work,  rural  development, 
environment).  This  is  in  line,  for  example,  with  a  study  looking  at  the  links  between 
environment  and  health54  that  recommends  that  the  policy  development  process  be 
strengthened  by  making  distributional  aspects  a  more  important  part  of  the  policy  impact 
assessment process, and by providing guidance on methods and approaches. This would both 
avoid/mitigate  negative  distributional  impacts  and  identify  (and  enhance)  positive  synergies 
between environmental and social objectives.  

Overall,  however,  only  half  of  the  countries  refer  to  health  inequalities  across  population 
groups  and  some  do  it  quite  lightly.  Even  those  who  put  forward  the  reduction  of  health 
inequalities as a major goal, are not too detailed in relation to what policies are pursued, let 
alone  effective,  in  reducing  unnecessary  inequalities  in  health.  This  suggests  that  more 
awareness and exchange is needed in this area. 

54 

See  for  example  "The  linkages  between  environmental  and  social  sustainability  in  Europe"  at 
http://ec.europa.eu/social/BlobServlet?docId=1574&langId=en 

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5.2.2.  Access 

All  Member  States  are  committed  to  the  objective  of  ensuring  access  for  all  to  adequate 
healthcare and long-term care55. Some of the goals expressed in the NSRs are "to develop a 
network of quality services accessible to all"; "create equal conditions for all citizens to get 
access to the care they need"; "safeguard services for all, independently of their financial or 
social  status  background,  gender,  age,  residence,  race  or  religious  background";  and  "that 
access does not cause financial dependence and poverty". Universal or almost universal rights 
to access to healthcare can be found in all EU Member States and, by design, countries want 
to  ensure  that,  while  financing  is  based  on  ability  to  pay  (taxation,  social  insurance 
contributions), access to services is not dependent on income or wealth.  

Nevertheless,  EU-SILC  data  (with  the  exception  of  DE,  BG  and  RO)  indicates  that,  on 
average, 3.1% and 5% of those living in the EU report unmet need for medical care and dental 
care respectively. Percentages vary from 0.2% in DK and SI to 15% in LV when looking at 
medical care, and from 0.5% in SI to 12.2% in EE in relation to dental care.53 In 8 Member 
States, 40% or more of the population says that access to home services and nursing homes is 
difficult.56  As  in  the  2006  NSRs,  the  2008-2010  NSRs  identify  disparities  in  access  on  a 
socio-economic and regional basis (e.g. available income, unemployment, ethnical and racial 
basis, geographical areas). Barriers to access include lack of health insurance coverage, direct 
financial  costs  of  care,  including  direct  payments  for  care  and  transport,  geographical 
disparities  in  the  availability  of  services  and  their  quality,  waiting  times  for  receiving  care, 
lack  of  information  regarding  access  to  the  healthcare  and  long-term  care  packages,  lack  of 
registration with health insurance or family doctor, complex and very lengthy administrative 
procedures  in  relation  to  eligibility  and  enrolment  for  long-term  care  services,  and 
discrimination,  language  barriers  and  socio-cultural  expectations  in  relation  to  life  and  care 
services.  As  the  current  supply  of  long-term  care  services  is  deemed  insufficient  to  meet 
current and future needs, these obstacles are often more acute in the context of long-term care. 
Differences  in  provision  and  quality  across  EU  countries  are  more  marked  here  than  in  the 
context of medical care.57  

To improve manners, more public investment is being allocated to the healthcare sector in a 
number  of  countries  (FI,  LT,  HU,  IE,  RO,  UK,  DK)  notably  to  improve  infrastructure 
(facilities and beds), staff availability and technology. Additional public funding has been/ is 
to  be  allocated  to  expand  community  and  home  care  (LV,  CZ,  HU,  LT,  MT)  and  improve 
residential care (BE, FR, LV, HU). Many Member States wish to promote rehabilitative care 
(PT, BE, CZ, EL, FI, FR, DE, LT) with a view to restoring patients' skills to regain maximum 
self-sufficiency.  Significant  emphasis  is  being  put  on  improving  coordination  between 
primary and secondary care and between healthcare and long-term care. However, the reading 
of the reports suggests that we are still at an early stage in this process. 

55 

56 

57 

Although  different  definitions  exist,  long-term  care  is  often  defined  as  a  combined  range  of  health 
(nursing)  and  social  services  provided  for  an  extended  period  to  individuals  who  are  dependent  and 
need  assistance  on  a  continuing  basis  due  to  their  physical  or  mental  disability/limitations.  Services 
relate to the basic activities of daily living (bathing, dressing, eating, getting in and out of bed or chair 
and moving around, using the toilet and incontinence) but also include help with instrumental activities 
of daily living (meals, shopping, housework). 
See 
example 
http://ec.europa.eu/public_opinion/archives/ebs/ebs_283_en.pdf  
See 
example 
http://ec.europa.eu/public_opinion/archives/ebs/ebs_283_en.pdf 

Eurobarometer 

Eurobarometer 

Special 

Special 

283 

283 

for 

for 

at 

at 

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5.2.3.  Lack of insurance coverage  

All Member States express the wish to have full universal coverage of their population. While 
this is implicit in national health systems (NHS), the state usually pays for non-contributory 
groups where the right to care is related to contributions to social insurance. While emergency 
care  is  available  for  all  (though  sometimes  involving  a  fee),  there  remain  a  number  of 
individuals  not  covered  for  other  and  more  common  care  services.  The  proportion  of  the 
population not covered is 4% in EE, 1.5% in AT, 1% in LT, 0.84% in SI, 0.4% in BE, 0.2% in 
DE  and  (as  OECD  health  data  suggests)  2.7% in  PL,  2.4%  in  SK,  and  0.1%  in  FR.  In  RO, 
5.7%  of  those  who  visited  the  doctor  during  a  national  health  assessment  were  not  insured, 
suggesting a significant proportion of uninsured in RO.  

The  reports,  though,  are  not  always  clear  about  who  the  individuals  that  lack  insurance 
coverage  are.  In  EE  the  figure  includes  those  on  long-term  unemployment,  while  in  SI  it 
relates to refugees, asylum seekers, former prisoners and foreigners with temporary residency. 
In  general,  in  addition  to  those  who  fall  out  of  social  security  (long-term  unemployed, 
homeless),  they  appear  to  include  those  who  lack  residency,  citizenship  or  official  papers 
(illegal immigrants, asylum seekers, refugees) or lack information regarding registration with 
the  system  (minorities).  Informal  unemployment  and  the  grey  economy  under  which 
individuals do not pay contributions also imply a lack of health insurance coverage.  

Moreover,  for  example  in  PT,  certain  groups  (e.g.  civil  servants)  have  double  coverage 
through  the  NHS  and  own  social  insurance  scheme,  while  CY  highlights  that  the  current 
system favours civil servants who get a wide range of free public healthcare.  

The numbers above show a reduction vis-à-vis 2006 and thus a positive outcome of the policy 
efforts  put  in  place  by  Member  States  (e.g.  in  BE  coverage  was  extended  to  all  those  self-
employed;  in  EE  coverage  was  extended  to  those  on  unemployment  benefits;  in  DE 
mandatory health insurance led to 134000 persons formerly without coverage entering public 
health insurance and 5000 persons entering private health insurance). Further steps have been 
taken since or are proposed. In DE, legislation introduced in 2007 enables people to re-enter 
social  or  private  health  insurance  and  ensures individuals  are  not  ‘kicked  out’  of  insurance. 
DE  expects  to  reach  full  coverage  by  2009.  AT  wants  to  improve  cooperation  with  private 
social  welfare  organisations  to  improve  access  to  health  and  long-term  care  of  those  more 
vulnerable  and  not  currently  covered.  EE  and  RO  are  encouraging  local  governments  to 
provide primary care to those who lack insurance and EE wants to ensure that all unemployed 
persons  participate  in  active  labour  market  measures  to  which  insurance  coverage  is 
associated.  CY  is  planning  to  introduce  universal  residence-based  coverage  under  the 
National Health Scheme (though it has been a very lengthy process). Some countries (IE, HU, 
RO, ES, CZ, PL) are  working on  clarifying the statutory provisions on eligibility for health 
and social services (i.e. defining the who, what, when and where), in relation to a minimum/ 
common basket under social health insurance or NHS. While clarity is a first step in ensuring 
coverage,  notably  by  reducing  discrimination  and  regional/  local  discretion,  and  thus 
disparities in service provision, more needs to be done to ensure access to care for all. 

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5.2.4.  Lack of coverage of certain types of care and high direct financial costs of care  

While  most  EU  countries  rely  heavily  on  public  finance,  private  healthcare  expenditure  is 
significant  (about  20-30%  on  average)  and  consists  primarily  of  out-of-pocket  payments 
(direct  payments  made  at  the  point  of  access  to  care)  for  services  excluded  from  the  public 
basket and increasing cost-sharing58 for public services. In some countries the share of private 
expenditure,  mostly  made  up  of  out-of-pocket  payments,  is  rather  high:  CY  (57%),  LV  and 
BG  (39%),  and  EL  (38%).  The  2008  NSRs  mention  (though  perhaps  less  strongly  than  in 
2006)  that  dental,  ophthalmic  and  aural  care  services  continue  to  be  some  of  the  common 
services not covered by social health insurance or the NHS. Additionally, the lack of public 
provision or funding for home, community and residential care places a large direct financial 
burden on patients and their families/relatives and large out-of-pocket payments are common 
for these services.59 Additionally, differences in the evaluation of 'dependency' and its scope 
may determine whether individuals are entitled to publicly funded services or not. Moreover, 
cost-sharing,  in  place  in  all  Member  States  (to  a  greater  or  lesser  extent),  applies  to 
pharmaceuticals, specialist and hospital care, home visits and, in some countries, to primary 
and emergency care. In some countries informal payments are an additional cost to patients 
(SK, RO, BG, EL, HU, PL, LT, LV).  

As highlighted in the 2007 Joint Report, while cost-sharing can have a role in the health sector 
in  raising  cost-awareness,  reducing  unnecessary  consumption,  and  encouraging  a  preferred 
path of care, it is a component of healthcare that must be carefully designed so that it does not 
deter or delay access to necessary care by those more vulnerable (lower income, chronically 
ill)  who  may  face  the  greatest  need.60  This  is  the  more  important  in  the  context  of  high 
expenditure and growing demand where cost-sharing may be seen as unavoidable. Hence, it is 
crucial to design it so that it minimises any negative impacts and maximises efficiency gains.  

All  countries  have  reductions  or  exemptions  of  cost-sharing  for  certain  population  groups 
based on income, age and severity of disease (e.g. children, students, elderly, chronically ill, 
benefit  recipients,  low  income,  pregnant  women,  disabled,  victims  of  violence).  In  many 
countries a minimum basket of care is available free of charge for all residents. For example, 
in  BE  and  LV  a  set  of  preventive  care  (vaccination  and  screening)  is  free  for  all.  In  NL, 
primary, obstetric and maternity care, and dental care for those up to 22 are not included in 
the compulsory excess (deductible). Some (RO) plan to extend the basic care basket covered 
by social insurance. Several countries (BE, FR, IE) want to decrease the financial burden of 
care  in  general  and  for  those  in  more  vulnerable  groups  in  particular  (low  income  and/or 
chronically ill patients). In FR free care is now available for those with chronic conditions. In 
IE  medical  and  GP  cards  entitle  those  in  lower  incomes  to  access  free  care  or  free  primary 
care. IE is increasing and indexing  the income threshold  that qualifies  for  free care (though 
decreasing  age  eligibility).  In  BE  a  medical  card  allows  full  reimbursement  for  some 

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60 

Cost-sharing  includes:  a)  co-payments  or  fixed  amounts  paid  by  patients  for  a  service  (common  for 
visits  and  hospital  stays);  b)  co-insurance  or  a  percentage  of  total  cost  of  service  (common  for 
pharmaceuticals);  and  c)  deductibles  or  a  fixed  amount  paid  (e.g.  first  €100)  by  the  insured  person 
before any reimbursement occurs. 
According to the Special Eurobarometer 283 in 9 Member States, 40% or more of the population says 
that  home  services  are  unaffordable  while  in  19  Member  States  residential  services  are  unaffordable 
(please tell me if for you personally, or for your close ones, each of the following are very affordable, 
fairly affordable, not very affordable or not at all affordable.). 
Evidence  indicates  that  charging  can  reduce  utilisation  and  has  negative  consequences  on  the  health 
status of those poor and with poor health. 

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individuals and for some conditions. Some countries operate expenditure ceilings to alleviate 
the  burden  of  those  using  services  (including  medication)  frequently  (FI,  BE,  LV).  In  AT, 
prescription charges for those with chronic illnesses are capped at 2% of individuals' income.  

Plans  are  put  forward  to  increase  the  reimbursement  of  drugs  (RO,  PT,  LV,  MT  for  cost-
effective drugs) or decrease/control the price of drugs (PT, BE, MT, BG) especially for those 
with special difficulties and the elderly (ES, UK), or chronic disease (MT) or children (UK). 
Some see a greater use of generics (PT, MT) as a way to increase the affordability of drugs 
and ensure extra reimbursement.  

FR sustains that the Couverture Maladie Universelle complémentaire funded by the State for 
those with low incomes plus financial aid to acquire complementary insurance to those around 
the  CMUc  income  threshold  have  reduced  financial  barriers  (although  there  are  reports  of 
doctors refusing CMUc patients). NL has increased the allowance to low income groups and 
those  chronically  ill  to  help  paying  for  health  insurance  premiums  and  direct  costs  of  care. 
Vouchers for dental care and home help services and home healthcare are now available in PT 
(for children, pregnant women and elderly with lower income) and in FI respectively. Extra 
financial aid/ welfare benefits are granted to the elderly dependent, disabled and chronically 
ill (FR), while State coverage of long-term care for low-income households is provided within 
social assistance (FR, NL, BE, HU, DE, SK, LV) and State subsidies are given to use private 
services (FR). 

5.2.5.  Waiting times  

Waiting  times  for  a  number  of  treatments  are  seen  as  another  obstacle  to  access,  although 
often  seen  as  a  dimension  of  care  quality.  They  appear  to  receive  greater  attention  in  this 
reporting  exercise  than  in  the  previous  one.  Waiting  times  vary  by  ill-health  condition  and 
between  regions  (FI,  SI).  For  some  countries  they  are  important  in  the  context  of  elective 
(non-urgent)  surgery,  while  for  others  improvement  is  needed  also  in  relation  to  primary, 
specialist  or  emergency  care,  chronic  disease  and  malignant  disorders.  In  several  countries, 
waiting times are also long in the context of long-term care services, particularly residential 
care, due to the current inadequate public provision/funding and limited availability of nursing 
staff.  

Several  policies  are  proposed  on  the  line  of  more  centralised  and  transparent  waiting  list 
management (FI, LT, HU, IE, AT, SI, EE, PT, MT), especially for non-urgent surgery. A first 
policy  is  that  of  implementing  a  national  monitoring  system  on  waiting  lists  and  times  for 
different healthcare facilities, whose information could be made publicly available to staff and 
patients, thus helping these choose the facilities with the shorter wait  (FI,  SI, DK,  EE, ES). 
This  is  typically,  though  not  necessary,  related  to  the  implementation  of  time  frames/  time 
limits/ time guarantees that are applied to either all or some of the following: primary care, 
urgent treatment, non-urgent surgery, chronic and malignant disorders (FI, SI, SE, DK, UK, 
ES, CZ, PT, MT). The aim is not only to ensure that no one waits too long, and thus bears 
negative repercussions on his/her health status, but also that there are harmonised principles 
for all regions in an attempt to decrease geographic disparities in waiting times. When time 
limits are reached, other public facilities in other regions or in the private sector (FI, UK, DK, 
LT, SE, IE, PT) can be used, following agreements with private institutions. For example, in 
IE, the National Treatment Purchase Fund that manages those on the waiting list (i.e. checks 
if  patients  still  require  treatment),  arranges  treatment  for  those  who  have  been  waiting  the 
longest. Interestingly, not all patients accept being treated elsewhere from originally planned 
(IE,  PT,  DK,  SE)  and  prefer  to  wait  longer  but  be  treated  closer  to  home.  Further  to  these 

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measures, in DK the patient ombudsman is to deal with waiting time complaints. In addition, 
extra  funding  has  been  put  into  increasing  the  number  of  public  beds  (IE,  UK,  MT)  or 
directed at those conditions with very long waits (SI). It is expected that an increase in long-
term  care  services  also  increases  capacity  and  reduces  the  wait  by  reducing  bed-blockers 
(MT). Moving certain healthcare services from the tertiary/secondary to the primary sector is 
also  expected  to  reduce  waiting  times  for  surgery  (MT).  The  implementation  of  electronic 
referral  systems  may  contribute  to  faster  evaluation  of  referrals  to  hospitals  (UK).  Longer 
hours  for  surgical  and  outpatient  wards  are  to  decrease  the  waiting  (MT).  In  general,  better 
coordination  between  primary  and  secondary  care  is  crucial  to  achieve  faster  referrals  and 
treatment. Policies centralising the management of waiting lists together with time frames are 
becoming  common  around  the  EU  and  appear  to  have  reduced  waiting  times  for  several 
conditions. 

5.2.6.  Geographic differences in services availability and quality  

Virtually  all  countries  report  geographic  differences  in  the  availability  and  quality  of 
healthcare and long-term care services, and recognise the need to ensure territorial cohesion in 
these  fields.  Typically,  the  2008  NSRs  report  a  concentration  of  health  and  social  care 
professionals,  facilities  and  equipment  in  cities  and  major  urban  centres  vis-à-vis  rural  and 
remote  areas.  Member  States  report  uneven  use  of  care  together  with  regional  and  social 
economic  differences  in  lifestyles  and  even  in  the  compliance  to  therapies  (LT).  In  many 
cases  the  differences  are  regional  and  coincide  with  the  socio-economic  structure  of  the 
population  (e.g.  high  income  versus  low  income  regions,  high  unemployment  versus  high 
employment  regions).  Some  countries  refer  to  deprived  areas  that  are  part  of  urban  centres. 
Disparities are more acute in the case of long-term care, which is more often a responsibility 
of local authorities or regions than healthcare. Differences in assessing dependency and thus 
eligibility are common across regions.  

In some countries differences are related to the decentralisation in the provision and financing 
of services, which provides an opportunity to adapt service to local circumstances, but makes 
services dependent on the region's income and discretion in decision making (FI, ES). Some 
argued  that  ageing  and  urbanisation  have  led  to  thinly  populated  rural  areas  and  highly 
populated cities, making it difficult to plan and distribute services. Some state that geographic 
differences  are  the  result  of  previous  "no-policy"  situation.  A  lack  of  coordination  between 
public  and  private  provision/funding  leads  to  the  concentration  of  private  provision  in  big 
centres (CY, EL). Shortages of primary care doctors, which is not always seen as an attractive 
discipline,  result  in  an  uneven  distribution  of  care  (e.g.  there  are  unoccupied  facilities  in 
disadvantaged areas in BG and PT as a result).  

Measures  proposed  relate  to  improving  infrastructure,  resource  allocation  and  staff  support 
structures  in  needed  areas.  A  large  number  of  countries  are  focusing  on  building  new 
infrastructure  and  modernising  facilities  focusing  on  primary,  common  outpatient  and 
emergency  care.  The  attraction  of health  personnel  (i.e.  primary  care  doctors)  in  isolated  or 
economically disadvantaged areas is also a priority, and some (FR,  RO, BE, BG)  provide a 
related  package  of  incentives  (also  for  emergency  staff  in  LV).  In  some  countries  the 
municipal and regional reform to broaden the population base continues (FI) and cooperation 
and  partnerships  between  local  authorities  (FI,  SI)  or  groups  of  health  centres  (PT)  is 
encouraged  to  enhance  provision.  Another  important  aspect  is  to  develop  an  adequate 
financial  framework  that  guarantees  a  uniform  supply  of  basic  health  services  of  standard 
quality  by  adjusting  regional  funding  to  population  characteristics  with  annual  updates  (IE, 
AT, HU, RO, UK) or where health indicators deviate most from the average (SI). A maximum 

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distance  to  hospital  (BE)  and  mobile  services  in  remote  areas  (RO,  BG)  are  also  foreseen, 
together  with  the  setting  up  of  pharmacies  or  outlets  in  disadvantaged  areas  (RO).  SE  is 
working  with  local  authorities  to  provide  more  psychiatric  care  while  DK  is  implementing 
cancer pathways throughout the country. FR is setting up regional health agencies comprising 
medical  and  social  care  professionals  to  improve  the  organisation  of  healthcare  services 
across  regions.  Interestingly,  in  ES  the  ministry  of  health  is  working  with  the  ministry  of 
environment and rural affairs to ensure quality primary and emergency care in rural areas.  

The  structural  funds  can  provide  extra  funding  for  regional  development  including  in 
healthcare.  Although  some  Member  States  mentioned  their  use,  (HU,  SK,  EE,  LT)  there  is, 
room for improvement in terms of more and better use of funds in this field.  

5.2.7.  Primary care 

An  important  conclusion  is  that  primary  care  is  an  important  tool  in  ensuring  greater 
accessibility for all and is at the heart of addressing disparities in care supply. All countries 
indicate that efforts must be made to have a country wide and effective primary care network 
as well as a minimum emergency care structure (FI, RO, SK, UK, LT, HU, PT, LV, BG, PL). 
Primary care should be available near to the place of residence, i.e. all individuals should have 
a  family/  personal  doctor  close  to  where  they  live  and  when  they  need.  To  this  aim  RO  is 
establishing more agreements between county health insurers and primary care practices for 
those in rural areas; IE wants to increase the number of primary care teams; BG, FI and LT 
want to establish greater cooperation between municipalities, and SK is defining primary care 
districts  where  GPs  have  to  serve  all  patients,  including  Roma  communities.  Better 
coordination  between  private  and  public  provision  of  primary  care  (CY),  allowing  all  those 
who  meet  certain  requirements  to  establish  themselves  as  primary  care  providers  (SE), 
increasing out of hours GP services (IE,  BG)  and increasing service hours of  health  centres 
(PT) are other policies designed at strengthening primary care.  

And  important  element  is  that  the  attractiveness  of  primary  care  must  be  improved.  To  this 
end, FR established a forum with health professionals and policymakers and patients, while FI 
is developing a national development  centre for primary healthcare and a network of health 
centres, together with institutes of general practice in universities and units of general practice 
in hospital districts. To increase motivation, countries (LT, HU, EE, SI) propose changes in 
payment for primary care doctors including a mixed system of age-adjusted capitation (money 
follows  the  patient)  plus  a  fee  for  preventive  services.  Motivation  is  also  provided  through 
greater competences attributed to primary care doctors and nurses (promotion and prevention 
- screening and immunisation in IE, LT, HU, EE, SI, RO, CY, SK, PT, BE, LV and disease 
management of e.g. diabetes, obesity and heart disease in IE and BE). Primary care (primary 
care  teams)  is  also  to  be  the  basis  of  multidisciplinary  networks  involving  GPs,  nurses, 
healthcare  assistants,  physiotherapists,  occupational  therapists,  obstetricians,  social  workers, 
among  other  (BE,  FR,  IE,  LT,  MT,  PT  and  UK,)  to  ensure  better  access  through  better 
coordination of care (i.e. referrals to secondary and social care).  

Indicators to monitor progress in national primary care strategy are also proposed (ES). This 
is quite pertinent given that a country wide primary care network requires sufficient numbers 
of  staff  which  may  prove  difficult  in  the  context  of  increasing  staff  shortages  and  when 
primary care physicians are fewer than specialists in many countries. Strengthening primary 
care is strongly related to the availability of human resources and only few countries currently 
acknowledge that. 

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5.2.8. 

ICT as a means to improve access to as well as quality of care 

A  vast  number  of  countries  places  high  hopes  on  ICT  to  improve  access  and  quality.  ICT, 
through  health  websites/portals,  can  allow  for  more  complete  and  always  available 
information  regarding  rights  to  access  (how  one  can  use  what  services  when)  and  health 
promotion,  disease  prevention,  treatment  or  rehabilitation.  Aside  internet  guidance,  booking 
of  services  (HU,  RO,  EE,  FI,  PT,  ES),  choosing  providers  (SE,  DK),  a  centralised  free 
medical counselling phone (SE, FI, EE, DK, PT, MT) and remote electronic diagnosis (HU, 
LV,  ES)  or  ICT  alternatives  to  staff  in  remote  areas  (EE)  can  help  improving  access  and 
diminishing  regional  differences.  Tele-monitoring,  telemedicine  and  independent  living 
systems can contribute to ensuring independent living and more user-oriented services. It can 
enable better self-management of chronic conditions and can support informal carers in their 
role. All countries are investing in the computerisation of services which allows for personal 
identification  systems  and  patient  electronic  records  (ES,  SE,  EE,  FI,  IE,  AT,  LV,  BG,  RO 
also  for  chronic  disease,  UK  for  health  and  social  care).  Electronic  referrals  (SE)  and  e-
prescriptions  (PT,  LV,  ES,  FI)  can  ensure  faster  patient  flows  in  the  system.  Finally,  ICT 
allows for data collection, monitoring and planning (EE).  

In this optimistic scenario two issues need reflexion. Indeed, if  better care coordination and 
thus  faster  and  better  quality  care  is  to  be  achieved,  it  is  fundamental  that  technology  is 
compatible across all care facilities to ensure that information flows across different medical 
facilities and from these to social care facilities. Moreover, and some countries recognise that 
ICT use is still limited, there is the problem that ICT can create a further gap between those 
richer and those poorer (as a computer and internet access is needed, for example) but perhaps 
in greater need of care. Hence, it remains to be seen how the benefits of ICT can spread across 
the whole population. 

5.3. 

Quality of healthcare 

5.3.1. 

Introduction 

Quality of care is an emerging policy issue across the EU. European healthcare and long-term 
care  systems  are  currently  facing  a  number  of  challenges,  including  population  ageing, 
migration,  mobility  of  patients  and  health  professionals,  and  rising  expectation  of  citizens. 
While  rapid  progress  of  medical  and  ICT  technologies  is  seen  as  a  source  of  demand  and 
expenditure growth because it allows for the treatment of conditions that would previously go 
untreated, they can also contribute to innovative solutions and changes in organisation of care, 
for  example,  shifting  from  hospital  care  to  preventive  and  primary  care.  In  these  changing 
systems it is crucial to ensure the provision of high quality healthcare and long-term care for 
the  European  citizens,  i.e.  care  that  is  effective,  safe  and  responds  to  the  needs  and 
preferences of patients and society.  
The  European  Observatory  on  Health  Systems  and  Policies61  uses  the  definition  of  the 
American  Institute  of  Medicine  (1990)  that  defines  quality  as  "The  degree  to  which  health 
services  for  individuals  and  populations  increase  the  likelihood  of  desired  health  outcomes 
and are consistent with current professional knowledge". The Council of Europe (1998) adds 
to this "increases (…) and diminishes the chances of undesirable results (…)". More recently 
the WHO (2000) defined quality of care as "the level of attainment of health systems' intrinsic 
goals  for  health  improvement  and  responsiveness  to  legitimate  expectations  of  the 

61 

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population". Several Member States also propose a definition of quality: for example, the UK 
Department of Health (1997) states that quality is "doing the right thing, at the right time, in 
the  right  way,  for  the  right  person".  Such  definitions  cover  the  dimensions  of  effectiveness, 
safety,  timeliness  and  patient  centeredness.  Under  the  social  OMC  we  focus  on  all  these 
aspects which relate directly to the common objectives and indicators that have been agreed. 

The previous NSRs provided a number of tools that had been developed in Member States to 
increase  high  quality  of  care.  They  were  categorised  into  three  groups:  effectiveness, 
evidence-based medicine, and integrated care. They covered issues such as quality assurance 
systems, prevention schemes, evidence-based medicine and clinical guidelines, patient safety, 
care  coordination,  and  patient  choice,  rights,  and  involvement  in  decision  making.  Current 
reports continue along these lines but give further details about preventive care and primary 
care  as  a  vehicle  for  prevention;  they  point  out  the  management  of  chronic  diseases  as  an 
issue  of  growing  concern;  they  present  work  on  quality  standards;  finally,  they  give  an 
overview of how the Member States introduce patients-centred care. 

5.3.2.  Quality assurance systems 

As in 2006, most Member States report on their progress in relation to the implementation of 
quality  standards.  The  2008  NSRs  provide  further  details  about  elaboration  and 
implementation of quality standards for hospital care (DE, DK, IE, CZ, EE, NL, UK, SI, FR, 
PL  and  AT)  but  also  for  other  healthcare  providers  (e.g.  FR,  AT).  The  standards  are 
elaborated internally but often are inspired by international organisations' work (e.g. the Joint 
Commission – CZ). Many Member States  created devoted bodies at national level (national 
quality agencies) aiming at quality improvement (ES, DE, IE, CZ, EE, NL, SI, MT and AT) 
and  in  some  cases  with  the  new  mission  of  studying  the  medico-economic  aspects  of 
healthcare  (FR).  While  in  some  countries  quality  standards  are  not  binding,  in  most  cases 
national agencies are in charge of accreditation or certification of hospitals and other health 
providers  based  on  the  specified  quality  standards  (e.g.  BE,  FR).  Some  Member  States  also 
issue  national  clinical  guidelines  (FI,  BE,  UK  and  DK),  which  are  sometimes  based  on 
evidence-based medicine or health technology assessment.  

The  work  on  standards  is  in  line  with  the  Commission's  proposal  for  a  Directive  of  the 
European Parliament and of the Council on the application of patients' rights in cross-border 
healthcare  which  refers  to  Member  States  defining  clear  quality  and  safety  standards  for 
healthcare provided on their territory and ensuring their implementation.  

The  level  to  which  the  defined  standards  have  been  met  by  healthcare  providers  is  seen  as 
necessary  source  of  information  about  the  quality  of  services  provided,  to  help  decision 
makers  in  planning  actions  aimed  at  reducing  unaccepTable  variation  and  to  help  patients 
choosing care facilities (i.e. more informed choices by patients). 

5.3.3.  Effectiveness: disease prevention and chronic disease management programmes 

According to the European Observatory on Health Systems and Policies effectiveness means 
"The extent to which a specific intervention, procedure, regimen of service … does what it is 
intended to do for a defined population" (WHO). The OECD also defines effectiveness as "the 
degree  of  achieving  desirable  outcomes  given  the  correct  provision  of  evidence-based 
healthcare services to all who could benefit"62; "the extent to which attainable improvements 
in health are, in fact, attained". 

62 

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Rendering  healthcare  systems  more  effective  is  an  issue  for  the  vast  majority  of  Member 
States and is the driver of several reforms currently undergoing or being prepared in Europe. 
In this context, improving disease prevention is reported as a way of improving health system 
effectiveness  and  efficiency  (as  disease  prevention  interventions  such  as  vaccination  and 
screening can prevent disease or provide early diagnosis that result in lower healthcare costs). 
Many  preventive  interventions  are  deemed  effective  and  cost-effective  to  reduce  disease. 
They may also offer opportunities to increase social welfare or enhance health equity63.  

In  many  Member  States,  preventive  care  has  a  history,  especially  with  regard  to  newborn, 
young mothers, and children, with a free of charge follow-up in schools for example (AT, BE, 
SI, LV, CY, LT and PL), and notably vaccination and oral health. More punctual preventive 
programmes  also  exist  and  are  gaining  more  ground  concerning  specific  diseases 
(tuberculosis,  AIDS,  cardiovascular  diseases,  diabetes).  Cancer  prevention,  notably  routine 
screening and follow-up, have however received greater attention in the 2008 NSRs and are 
well  documented  in  the  majority  of  the  reports,  although  the  statistical  data  about  the 
percentage  of  population  screened  are  not  always  provided.  Breast  cancer  screening  is 
implemented  in  the  majority  of  Member  States,  followed  by  cervical  cancer  screening. 
European Guidelines on Breast Cancer Screening are/ planned to be implemented shortly in 
almost  all  Member  States.  Other  measures  include  introducing  (LU)  or  considering  the 
introduction (IE) of vaccination programme against HPV. This is potentially related with the 
implementation of the Council Regulation on cancer screening, in relation to which the first 
report  was  launched.  This  report  identifies  differences  in  cancer  diagnosis  and  follow-up 
across  Member  States  and  that  the  EU  is  only  about  half-way  to  the  goal  of  125  million 
examinations per year.64  

Chronic  diseases  are  the  subject  of  growing  awareness  in  Europe.  Characterized  by  long 
duration and generally slow progression, they represent a considerable burden from societal 
and  economical  perspective.  Europe  today  has  a  high  prevalence  of  non-communicable 
diseases  such  as  diabetes,  obesity,  and  osteoporosis65.  They  can  lead  to  death  or  long-term 
disability.  Chronic  diseases  can  be  attributable  to  the  interaction  of  various  genetic, 
environmental  and  especially  lifestyle  factors,  including  smoking,  alcohol  abuse,  unhealthy 
diets and physical inactivity and therefore can be to certain point preventable. Good quality 
and evidence-based care of patients presenting chronic conditions may bring better quality of 
life to the patients and savings to the healthcare systems. 

Different  aspects  of  chronic  diseases  management  (often  diabetes,  kidney  failure  and  heart 
disease) are addressed at the Member States level. Clinical protocols and guidelines for use in 
primary and specialist care were introduced in Ireland. The French national plan for chronic 
diseases considers as a priority the introduction of educational programme for chronic patients 
on one side, and foresees a new system of payment (other than fee for service) for physicians 
following  patients  with  chronic  conditions.  This  new  financial  mechanism,  rewarding 
preventive  actions  and  better  care  coordination  in  ambulatory  sector,  hopes  to  contribute  to 
provision of better quality care. 

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Franco  Sassi  and  Jeremy  Hurst  The  Prevention  of  Lifestyle-Related  Chronic  Diseases:  an  Economic 
Framework, OECD Health Working Paper No. 32, 2008. 
http://ec.europa.eu/health/ph_information/dissemination/diseases/cancer_en.htm#4  
Health-EU. The Public Health Portal of the European Union. 

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Investing  in  primary  care  as  a  vehicle  for  disease  prevention  and  care  coordination  is  also 
proposed by a number of Member States. 

5.3.4.  Patient safety  

The WHO defines patient safety as "freedom for a patient from unnecessary harm or potential 
harm associated with healthcare" and the OECD defines it as "the degree to which healthcare 
processes  avoid,  prevent  and  ameliorate  adverse  outcomes  or  injuries  that  stem  from  the 
processes  of  healthcare  itself"66,  The  American  Institute  of  Medicine's  definition  of  patient 
safety  is  "avoiding  injuries  to  patients  from  the  care  that  is  intended  to  help  them".  It  is 
estimated that, in the EU, between 8% and 12% of patients admitted to hospital suffer from 
adverse  effects  while  receiving  healthcare,  although  harm  to  patients  can  occur  in  all 
healthcare settings. The 2005 Eurobarometer survey on the perception of medical errors in the 
EU67 showed that over half of Europeans believed they cannot avoid serious medical errors in 
hospitals. 

Although patient safety is narrower in its definition than healthcare quality more generally, it 
is  a  key  foundation  of  any  high  quality  health  system.  Implementing  effective  quality  and 
patient  safety  improvements  is  of  interest  to  many  international  organisations  (e.g.  WHO, 
OECD). The European Commission has also taken specific steps in many areas to address the 
issue of patient safety. However, these have focused mostly on specific sources of risk such as 
the safety of medicines, medical devices and resistance to antimicrobials. Building on those 
achievements,  the  Commission  is  currently  preparing  an  initiative  on  patient  safety  which 
aims  to  outline  an  integrated  approach,  placing  patient  safety  at  the  core  of  high  quality 
healthcare  systems  by  bringing  together  all  factors  that  have  an  impact  on  the  safety  of 
patients, including a specific focus on healthcare-associated infections.  

However,  in  the  2008  NSRs  patient  safety  is  reported  as  a  priority  by  only  a  few  Member 
States. The efforts towards improving patient safety focus on reducing healthcare associated 
infections (which are among the most frequent and potentially harmful causes of unintended 
harm) and other avoidable incidents in curative care. Member States which invested in patient 
safety  strategies  set  up  very  ambitious  objectives  (reducing  by  50%  the  health  related 
infections over 2-year period in SE or reducing the number of avoidable incidents in curative 
care by 50% within 5 years in NL). Some of the measures proposed to achieve those goals are 
as follows. The introduction of a reporting system that obliges the health providers to report 
harm  connected  to  healthcare,  albeit  within  a  blame-free  culture  of  reporting  that  makes 
healthcare  providers  feeling  confident  that  they  can  report  without  fear  of  negative 
consequences  (SE,  UK,  IE).  Collecting  and  sharing  examples  of  good  practice  between  the 
health providers is another way of addressing patient safety and it was introduced in several 
Member States (NL, FR, UK, IE) to facilitate mutual learning. The introduction of statutory 
complaints  and  redress  systems  and  information  ensures  a  possibility  for  patients  and  their 
families to get compensation for harm. Protected disclosures or "whistleblowing" on issues of 
patient safety proposed, for example, by Irish health authorities, helps to capture the extent, 
type  and  causes  of  adverse  events.  This  information  also  enables  efficient  use  of  resources, 
through developing solutions addressing the problems as evidenced by the reporting. 

Examples provided by the National Reports, although not abundant, are very constructive and 
show  the  political  awareness  of  patient  safety  issues,  and  the  willingness  to  place  patient 
safety as a public health priority. 

66 
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http://ec.europa.eu/health/ph_publication/eurobarometers_en.htm  

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5.3.5.  Patient centeredness 

Although  there  is  an  overall  awareness  of  the  need  to  make  the  patient  the  central  point  of 
healthcare  and  especially  long-term  care  systems,  the  level  of  effort  and  the  measures 
undertaken by Member States to assure the patient's central role vary across Europe. This is 
partly due to different departing points and partly due to different systems of delivering care. 

The  most  common  way  to  address  patient  centeredness  is  defining  the  patient  rights.  A 
Charter  of  Patient  Rights,  either  already  in  existence  or  under  preparation,  is  reported  as  a 
measure being used by most EU countries. For example, CY issued, in 2008, the Charter of 
Citizens'  Rights  regarding  healthcare  in  public  medical  institutions  and  in  the  NL  there  is 
ongoing work on establishing seven rights for patients, giving them a central role in the Dutch 
healthcare system.  

In some systems patient centeredness is addressed by providing more choice of physician or 
hospital (e.g. DK, EE, UK).  

The  National  Reports  stress  also  the  importance  of  providing  information  for  patients  (SE, 
DK, EE, BE, CZ) about quality in care settings, level of patient safety, waiting lists, etc. in a 
form  easily  accessible  for  everyone  (e.g.  webpages)  and  that  may  help  patients  choose 
between care facilities. An interesting example of information to a specific target group of the 
population is reported by BE where the right to information for foreigners is assured by the 
presence of a mediator and translator.  

Active  participation  of  patients  in  the  decision-making  process  is  becoming  a  reality  across 
Europe.  Recently  reported  efforts  in  this  area  come  from  EE  (where  patients'  associations 
actively participate in policy-making) and DK (which encourages participation of patients in 
advisory boards of the legal health insurance).  

Patient's satisfaction with healthcare services is rarely mentioned in the NSRs. Indeed, only a 
few  Member  States  report  about  the  satisfaction  of  patients  with  healthcare  services.  Data 
exist in BE and a study is planned for the last quarter of 2008 for hospitalised patients in LU.  

Strengthening  self-responsibility  and  self-determination  of  patients  is  a  priority  for  certain 
Member States (AT, FI). 

Only a few Member States (IE, FR) underline the role of patients' relatives and carers as being 
part of the policy-making process. 

5.4. 

Sustainability  

5.4.1. 

Introduction 

The sustainability of the healthcare system is a complex issue depending on many factors, but 
especially  two:  financial  sustainability  and  a  continuous  and  sustainable  flow  of  workers. 
Regarding  the  first  aspect,  as  demand  for  healthcare  increases,  it  is  difficult  to  impose 
restrictions  on  financing  without  jeopardising  quality  and  access  at  the  same  time.  As 
healthcare  systems  can  be  financed  publicly  or  privately,  it  is  essential  to  find  the  best 
combination of financial sources in order to solve existing trade-offs in the design of incentive 
mechanisms i.e. maximise efficiency gains and minimise the negative impact on the access of 
those  more  vulnerable  (e.g.  lower  income  and  severely  or  chronically  ill).  Regarding  staff, 
societal changes, mainly the ageing of the population and staff migration trends, will have an 
enormous  impact  on  the  inflow  of  workers  to  the  healthcare  sector,  putting  at  risk  access, 
quality,  and  long-term  sustainability  at  the  same  time.  Additionally,  the  health  status  of  the 

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population, which determines the need for care, can have a significant impact on expenditure 
and long-term sustainability as shown in the EC/EPC forecasts.  

Most EU Member States prioritise highly the health of their population, as the high level of 
expenditure in healthcare shows. Nevertheless, there are big differences in the amounts spent, 
as it can be seen in Figure 10 above (section 2.1). 

Data from the OECD and the WHO show that health expenditure varies from 11.1% of GDP 
in FR to 5.0% of GDP in EE. DE, BE, PT and AT also spend more than 10% of GDP in the 
health  sector,  while  PL,  CY,  LT  and  RO  spend  only  around  or  less  than  6%  of  GDP.  A 
previous  European  Commission  document68  states  that  in  order  to  ensure  more  equiTable 
access  to  care,  improve  the  health  status  of  the  general  population  and  reduce  health 
inequalities in these last countries, it may be necessary to increased funding – notably public 
funding  to  the  sector,  given  the  structure  of  expenditure  in  most  of  these  countries  (high 
private expenditure). As regards the composition of expenditure, public health expenditure as 
a percentage of total health expenditure ranges from 90.9% in LU to 42.8% in EL. It is more 
than 80% of total expenditure in the CZ, the UK, DK and SE and less than 70% in PL, RO, 
NL, BG, LV and CY. 

Nevertheless,  both  public  and  private  expenditure  have  increased  during  the  last  decades 
throughout the EU, especially in those countries that had a very low departure level and are 
now catching up in improving the general availability of healthcare services to their citizens 
such  as  CY,  LT,  LV  or  RO.  In  addition  to  this  catching-up  trend,  the  main  drivers  of 
expenditure have been the demographic composition of the population, where the weight of 
the  elderly  drives  costs  up,  changes  in  the  health  status  of  the  population  and  morbidity 
patterns,  the  income  level  of  the  population,  which  increases  demand  for  more  and  better 
services, the rising expectations of people to receive quality care at an affordable price and the 
surge  of  new  medical  and  pharmaceutical  technologies  that  most  people  are  willing  to  take 
advantage of. 

The projections of public expenditure on healthcare as % of GDP show a rise from 6.4% of 
GDP in 2004 to 7.9% of GDP in 2050 in the EU-25 (EU-15: from 6.4% of GDP to 8.1% of 
GDP and EU-10: from 4.9% of GDP to 6.2% of GDP). The Commission services have carried 
out an analysis to assess the impact of medical technology on healthcare expenditure69. In the 
model, aggregate healthcare spending is determined both by demographic factors, such as the 
size  and  the  structure  of  a  population,  and  by  non-demographic  factors,  such  as  aggregate 
income  (GDP),  technological  factors  growth  and  relative-price  movements  in  the  supply  of 
health services. As it is not possible to make reliable forecasts of the future developments in 
the  medical  technology  the  document  concentrates  on  an  econometric  analysis  of  the  past 
trends, which suggests that between 2% and 3% of yearly growth in the health care spending 
can be associated with non-demographic and non-income factors. However, given high level 
of uncertainty and strong assumptions underlying the calculations, the results of this exercise 
should be interpreted with caution in the future policy debate. 

68 

69 

Monitoring progress towards the objectives of the European Strategy for Social Protection and Social 
Inclusion. Commission Staff Working Document - October 2008. 
European Commission, DG ECFIN (2008), Alternative scenarios for assessing the impact of technology 
on health care expenditure projections. Note for the attention of the Ageing Working Group attached to 
the EPC, REP. 56451.  

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5.4.2.  Progress on reforming healthcare financing and provision 

Due  to  the  above  mentioned  expenditure  trends,  the  2008-2010  NSRs  show  that  most 
countries  are  adjusting  the  structure  of  health  financing  and  delivery  in  order  to  rationalise 
resources,  make  their  systems  more  efficient  and  cost-effective,  avoid  duplication  and 
improve the link between the provision of health services and their financing. 

However,  Member  States  face  a  big  dilemma  between  access,  quality,  and  financial 
sustainability. In some Member States, financial sustainability seems assured but either at the 
cost  of  lower  quality  of  the  services  or  by  not  guaranteeing  access  to  everybody.  Once  the 
intended measures to improve both quality and access are implemented, sustainability is not 
longer certain. In other Member States, measures intended to improve financial sustainability, 
as for instance, making the system more dependent on social contributions or improving the 
incentive  mechanisms  in  order  to  contain  costs,  could  jeopardise  the  access  to  healthcare 
services of the poorest people. Finally, in another group of countries, financial sustainability 
does not appear to be the binding constraint but the scarcity of human resources. This is a real 
problem, especially in those countries that are currently loosing qualified healthcare personnel 
to countries that may offer better working and salary conditions. The measures presented in 
the  reports  can  be  articulated  around  the  following  core  lines:  reinforcing  funding, 
rationalising care provision, containing costs, improving incentive mechanisms, rationalising 
administration and strengthening health promotion policies. 

Reinforcing and improving financing 

In the EU, sustainability problems regarding funding have mainly two different origins; one is 
insufficient  financing,  the  other  is  the  design  of  the  funding  structure.  In  the  first  case,  the 
problem  relates  to  a)  non-mature/still  developing  health  insurance  systems  which  witness 
constant  reforms,  and/or  b)  to  the  existence  of  relatively  high  unemployment  and  extensive 
informal labour markets, which imply that contributions are not always paid and revenues are 
limited.  In  the  second  case,  the  coexistence  of  compulsory  social  health  insurance  and 
voluntary private health insurance combined with a lack of risk adjustment mechanisms may 
have  the  undesirable  outcome  of  a  segmented  market  due  to  adverse  selection  effects.  This 
can in turn imply an underfinanced social health fund for the poor together with rich private 
health funds for the well-off part of the population. 

The required solutions are therefore different. Measures to increase funding are taking effect 
in  many  countries  that  are  improving  the  collection  mechanisms  of  health  insurance 
contributions  (BG),  imposing  more  control  against  the  avoidance  of  contributions  (HU), 
increasing the health insurance tax base (EE) or earmarking the revenues from some so-called 
“sin”  taxes  as  tobacco  and/or  alcohol  excise  duties  (RO,  AT).  Regarding  the  lack  of  risk-
adjustment, DE has carried out an extensive reform that will centralise contributions in a new 
National Health Fund. On the basis of a unified contribution rate, the National Health Fund 
will allocate resources to each of the other funds based on a risk-adjusted capitation formula, 
which will be adjusted to take account of morbidity in addition to gender and age. The Social 
Health Insurance and the Private Health Insurance systems will be modified so that the first 
will become more competitive, while more social elements are introduced in the second. The 
German authorities will evaluate the effects of the new risk adjustment system in due time. In 
AT,  there  are  some  measures  intended  to  improve  financing,  such  as  increasing  health 
insurance  contributions  and  increasing  patient'  co-payments.  In  HU,  health  insurance 
coverage  was  linked  to  employment  and  this  resulted  in  an  increase  in  the  number  of 

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contribution  payers  and  in  the  revenue  of  the  health  insurance  fund  and  in  a  surplus  of  the 
Health Insurance Fund in 2007. 

Making healthcare provision more rational 

A group of countries are restructuring the provision of healthcare services in order to make a 
more rational use of public resources by avoiding waste, duplication or expensive treatments 
in  expensive  facilities  when  it  is  possible  to  offer  effective,  high  quality  care  using  less 
money.  The  main  idea  is  to  develop  and  reinforce  primary  healthcare  and  the  role  of  the 
general practitioner (GP)/ family doctor as a gatekeeper, channelling resources from inpatient 
to  outpatient  care,  concentrating  some  hospital  care  in  a  smaller  number  of  hospitals  and 
modulating rehabilitation and nursing care in case of chronic illness. 

Therefore, EE, IE, GR, FR, LV, HU, AT, PT, RO, SE, UK are reinforcing primary care by 
developing  the  GP  or  family  physician  system,  by  reorganising  existing  professional 
resources and by introducing financial incentives to increase and strengthen the use of a GP as 
a  gatekeeper  and  avoid  the  excessive  use  of  specialists.  As  a  novelty,  in  IE  there  is  active 
community involvement in the planning and the delivery of primary care services. 

Cost-effectiveness is thus achieved by reinforcing the patient routing (i.e. ensuring preferred 
and cost-effective paths of care) and restructuring outpatient and inpatient healthcare services 
in order to increase the share of outpatient care and channelling services from inpatient care to 
ambulatory, outpatient and home care. This makes possible a concentration of the specialised 
care  and  the  optimisation  of  the  work  of  inpatient  care  institutions,  strengthening  the 
efficiency of inpatient treatment and containing costs. 

Finally, the management of chronic diseases will be improved through a reorientation of care 
towards primary and prevention care and self-care and coordinating these efforts with those of 
the specialists. 

Containing costs 

In some countries health expenditure has risen in GDP terms more than the average in the EU, 
so they are taking measures in order to contain costs. Several Member States argue (EL, ES, 
LV, LU, AT, FI) that one of the reasons behind the growth in expenditure is the extended use 
of  pharmaceuticals  or  their  increasing  price.  To  contain  pharmaceutical  expenditure  growth 
they are implementing a wide array of solutions to curb overuse and control prices including 
more rational methods of prescription, better purchasing policies in hospitals (such as better 
negotiations  i.e.  licensing  deals  with  the  pharmaceutical  companies),  a  better  administration 
and more efficient use of medicines in hospitals and extending the use of generics (see Box on 
pharmaceutical expenditure in the EU). 

Some  measures  improve  the  mechanisms  of  payments  as  in  BG,  EE  or  LT.  In  EE,  for 
instance,  the  control  and  optimisation  of  health  insurance  costs  will  be  done  via  cost-based 
prices  and  diagnostics-related  group  prices  Other  measures  are:  more  rational  criteria  for 
purchasing  management  (ES,  LU,  LV  and  MT),  making  costs  more  transparent  (NL)  or 
stronger  incentives  (e.g.  performance  based  contracts)  for  providers  to  deliver  high  quality 
care  whilst  controlling  costs  (MT  and  UK).  Cost  control  at  macro  level  by  the  use  of 
expenditure  ceilings  has  been  implemented  in  some  countries,  more  or  less  successfully.  In 

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BE financial resources not used in the corresponding budget will be allocated to a "Fund for 
the future of healthcare", whose purpose is to constitute reserves that can be used when the 
ageing  of  the  population  will  require  greater  growth  of  the  budget  of  mandatory  healthcare 
insurance. 

Pharmaceutical expenditures in the EU 

Spending  on  pharmaceuticals  has  risen  rapidly  across  most  OECD  countries,  consuming  an 
increasing share of overall health expenditure. Since 1995, growth in pharmaceutical spending 
has  averaged  around  4.6%  per  year,  compared  with  the  4.0%  annual  rise  in  total  health 
spending, to account for around 17% of health spending or 1.5% of GDP by 2006. 70  

In 2007, the total size of the pharmaceutical market in the EU was € 214 billion at retail price 
level.71  On  ex-factory  price  level  this  corresponded  to  €  138  b illion,  of  which  88%  was  for 
medicines  that  required  a  prescription  from  a  medical  doctor.  The  remaining  part  of  the 
market was non-prescription medicines, which usually can be bought freely over the counter 
by  the  consumers.  For  the  medicines  sold  via  pharmacies  in  the  EU,  public  funding  (tax-
financed or by compulsory health insurance) cover on average 82% of the prices, and patients 
have to pay some 18% themselves.72 This ratio varies between 60% / 40% and 99% / 1% in 
the EU Member States. On the demand side, the pharmaceutical sector is unusual in that for 
prescription  medicines  the  ultimate  consumer  (the  patient)  is  not  the  decision  maker,  but 
generally it is the prescribing doctor and in certain Member States the pharmacist. Nor does 
the  ultimate  consumer  usually  directly  bear  the  costs,  as  these  are  generally  paid  for  by  a 
public  health  scheme.  Because  of  this  unique  structure,  there  is  usually  limited  price 
sensitivity on the part of decision makers and patients.73  

Given  the  limited  public  financial  resources  available  for  healthcare  and  the  constantly 
increasing expenditures, it is highly important for the Member States to continuously optimise 
the use of different pharmaceuticals and achieve the best value possible for the money spent. 
In doing so Member States can apply a range of various strategies, for instance: regulation of 
prices,  reimbursement  conditions  for  prescription  medicines,  optimise  the  use  of  generic 
products  that  replace  more  expensive  original  medicines.  These  issues  were  addressed  by 
Member  States,  EFTA,  members  of  the  European  Parliament,  various  stakeholders  and  the 
European Commission in the Pharmaceutical Forum74. 

The actual market conditions for, and effects of, the entry of generic medicine products into 
EU markets are currently being studied by the European Commission with a sector inquiry. In 
markets where generic medicines become available, average savings to the health system (as 
measured by the development of a weighted price index of originator and generic products) 
are  almost  20%  one  year  after  the  first  generic  entry,  and  about  25%  after  two  years  (EU 
average).  Generic  companies  began  selling  generic  medicines,  on  average,  25%  lower  than 
the price of the originator medicines. Two years after entry, generic medicine prices were on 

70 

71 

72 

73 
74 

the  European  Commission 

Introductory  Presentation:  Some  key  features  of  growth  and  cross-country  differences  in  health-care 
spending,  at  the  conference  Improving  Health-system  efficiency  -  achieving  better  value  for  money, 
jointly  organised  by 
the  OECD  17  Sept.  2008 
http://ec.europa.eu/social/main.jsp?catId=88&langId=en&eventsId=106&furtherEvents=yes  
Pharmaceutical  Sector  Inquiry,  Preliminary  report  (28  Nov.  2008),  European  Commission,  DG 
Competition http://ec.europa.eu/competition/sectors/pharmaceuticals/inquiry/index.html  
The  pharmaceutical  industry  in  figures  2008,  European  Federation  of  Pharmaceutical  Industries  and 
Associations http://www.efpia.org/content/default.asp?PageID=322  
Pharmaceutical Sector Inquiry, Preliminary report, European Commission, DG Competition. 
The Pharmaceutical Forum: http://ec.europa.eu/pharmaforum/  

and 

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average  40%  below  the  former  originator  price.  The  inquiry  points  to  considerable 
differences, however, in the entry of generics in various EU Member States and in the effects. 

However, a generic alternative product can usually only enter the market 20-25 years after the 
first introduction of a new, patenTable original medicine. Thus, Member States apply a range 
of  policy  measures  to  optimise  the  use  of  and  expenditures  for  prescription  medicines. 
Pharmaceutical  policies  are  expected  to  attain  multiple  goals  that  reflect  different 
perspectives.  So,  market  interventions,  such  as  regulating  prices  and  reimbursement 
conditions  for  pharmaceuticals,  aim  to  limit  dynamic  expenditure  increases  while  ensuring 
affordable access to medicines, and maintaining the incentive for pharmaceutical companies 
to continue with research and development on new, useful medicines. 

In the National Strategy Reports 2008-2010 several member States report on actions that have 
been  carried  out  to  either  increase  citizens  access  to  pharmaceuticals  (e.g.  BG),  make 
prescription medicines more affordable to the patients (BE, DE) and/or limit the increases in 
public  expenditures  for  pharmaceuticals  (AT).  Some  Member  States  also  report  on  planned 
actions (e.g. FI). The improved affordability for patients is often achieved by ensuring that the 
co-payment  amounts  do  not  grow  too  fast.  For  instance,  BE  states  that  various  policies 
enacted  to  reduce  the  cost  of  medicines  have  reduced  the  average  cost  (all  medicines 
prescribed for ambulatory care) for the patient by 8% from 2003 to 2007. To achieve this BE 
apply  a  whole  range  of  measures  with  both  detailed  expenditure  budgeting,  use  of  generic 
alternatives  and  regular  decreases  in  the  price  of  medicines  older  than  12  years.  However, 
there are also Member States that introduce (or increase) the patients' co-payment share trying 
to reduce the consumption of pharmaceuticals (e.g. CZ). Such measures typically also include 
maximum  co-payment  limits  to  ensure  that  more  vulnerable  groups  can  still  access  the 
medicines needed (e.g. SI). 

A peer review to exchange practical experiences and ideas about pricing and reimbursement 
of  pharmaceuticals  was  held  in  Berlin  mid  2008.75  The  peer  review  concluded  that  it  is 
essential to promote the transparency of the pharmaceutical markets in the EU, especially on 
the efficacy and safety of the products, the prices actually paid by consumers and insurers, as 
the  price-setting,  reimbursing  and  other  regulatory  mechanisms  for 
well  an  on 
pharmaceuticals.  Future  work  within  the  OMC  could  aim  to  contribute  significantly  to  the 
needed transparency. 

Improving incentive mechanisms for patients 

Some  countries  can  contain  costs  by  reducing  the  overuse  of  resources  caused  by  a  wrong 
mechanism  design.  This  is  done  by  implementing  policies  to  motivate  people  to  use 
healthcare  services  in  a  more  responsibly  manner  as  in  CZ,  where  the  introduction  of 
regulatory fees is giving good financial results – after the introduction of the fees, the number 
of  specialist  outpatients  visits,  the  length  of  hospitalisation  and  the  use  of  pharmaceuticals 
were  reduced  –  or  in  FR  where  the  financial  participation  of  patients  in  the  form  of  co-
payments was augmented in order to moderate demand. More innovative is the coordination 
of care, in order to avoid duplication, and the introduction of a financial incentive to increase 
the use of a GP as a gatekeeper. In case the patient does not use the GP and goes directly to 
the specialist, the patient will face reductions in the amount paid by the social insurance and 
the  specialist  would  be  allowed  to  surpass  the  established  tariffs.  ES  will  establish 
mechanisms to promote responsible demand. 

75 

See 
pharmaceutical-sector-innovative-approaches-to-contracting-while-ensuring-fair-access-to-drugs  

http://www.peer-review-social-inclusion.eu/peer-reviews/2008/cost-containment-in-the-

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Rationalising bureaucracy 

To render the system more cost-effective, another type of measures aims at rationalising and 
simplifying bureaucracy. Thus in BE, DK, SE and FI there are administrative simplification 
policies,  which  intend  to  identify  and  eliminate  needless  bureaucracy  in  order  to  get  more 
time  to  core  activities.  Many  countries  like  BE,  EL,  ES,  FR,  LV,  LT,  MT  and  AT,  are 
developing e-Health systems to integrate information files about patients, organize medicine 
prescriptions, ensure a quicker examination of patients and assessment of the results, optimise 
therapeutic processes and increase quality, and avoid duplication. 

Health promotion policies 

Many countries have recognised in their policies that better promotion will help to trim costs 
down  in  the  future  by  reducing  the  need  for  healthcare  services.  Health  promotion  in  early 
ages can result in a better health status later in life, requiring thus fewer resources from the 
healthcare system. Therefore, CZ, DK, DE, ES, LV, LU, MT, NL, AT, SE, and the UK will 
intensify  the  promotion  of  healthy  lifestyles  regarding  better  eating  and  exercise  habits  to 
improve the general health of the population. With the same objective, DE, EE, LV, LU, HU 
and the UK will pay particular attention to health promotion of children and young people and 
to the promotion of better food at schools and childcare institutions.  

Furthermore, EE, NL, AT, RO, SE, and the UK will implement policies aimed at reducing the 
consumption  of  addictive  substances,  tobacco  and  alcohol,  accompanied  in  some  cases  (AT 
and RO) by financial disincentives in the form of excise duties that will be assigned to health 
expenditure or (NL) by encouraging health insurance funds to promote healthy behaviour and 
reward  it.  Even  if  it  may  sometimes  seem  an  exaggerated  intervention  of  public  policies  in 
individual  decisions,  in  general  it  is  considered  that  prevention  policies  regarding  smoking, 
alcohol  and  obesity  are  needed,  as  these  lifestyle  risks  are  increasing  the  number  of  the 
chronically  ill.  In  the  last  years,  many  countries,  as  BE,  DK,  ES  and  the  UK,  have  banned 
smoking  from  public  spaces.  Moreover,  policies intended  to raise awareness  concerning the 
prevention  of  some  specific  diseases  such  as  diabetes,  obesity,  cardiovascular  diseases  and 
several types of cancer are being implemented in CZ, DK, EE, IE, HU, NL and SE. DK has 
decidedly set up a Prevention Commission, which will study the possibilities of reducing the 
need for healthcare services in the future. There are also some country-specific policies: LU’s 
Action Plan will promote health in the area of sexual education, EE will improve the physical 
and psychosocial environment and the UK will implement a health improvement policy aimed 
to support people to make healthier lifestyle choices, particularly children and young people, 
adults of working age and those who are socially excluded or are "hard to reach". 

Long-term sustainability of human resources 

Over  the  next  20  years,  the  EU  will  face  a  serious  challenge  in  the  availability  of  human 
resources in the healthcare sector. This also casts doubts on its long-term sustainability. One 
reason for this development is to be found in the ageing of the population. This implies not 
only an increase in the needs for care in general, but also an increase in the age profile of the 
health  workforce.  A  second  reason  is  the  underinvestment  in  education  and  training  of 
professionals, which was seen in the late 80s and early 90s in some countries. The insufficient 
training  of  professionals  was  due  to  restrictions  in  the  access  to  training  in  healthcare 
professions (numerus clausus). This trend is now reversed, but will not have any immediate 
effect. It shows both the difficulty of long-term planning the availability of human resources 

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and  the  existence  of  trade-offs  between  financing  more  training  and  lacking  doctors  and 
healthcare workers. In other countries, even if training and education has been sufficient, the 
emigration of trained personnel has led to a serious drain of human resources. The healthcare 
sector in some countries also faces the dilemma that it needs people with high qualifications, 
but neither wages nor working conditions are especially attractive compared to other sectors. 
Keeping  the  wages  of  health  workers  low  is  also  used  to  contain  expenditure  growth,  so  in 
some countries working conditions in the health professions do not motivate health workers to 
stay in the sector, but rather provoke an exodus to other sectors. 

Figure 14: Medical and nursing graduates, practising physicians and nurses, 2006 

Practising physicians and nurses, density per 1000 persons, 
2006

Medical and nursing graduates per 1 000 practising physicians 
and nurses, 2006

Austria

Belgium

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Ireland

Italy

Luxembourg

Netherlands

Poland

Portugal

Slovak Republic

Spain

Sw eden

United Kingdom

Austria

Belgium

Czech Republic

Denmark

Finland

France

Germany

Greece

Hungary

Ireland

Italy

Luxembourg

Netherlands

Poland

Portugal

Slovak Republic

Spain

Sw eden

United Kingdom

0

2

4

6

8

10

12

14

16

18

0

20

40

60

80

100

Practising physicians

Practising nurses

Medical graduates

Nursing graduates

Source: OECD, Health data 2008. 

Hence, policies regarding human resources are articulated around a) granting more financial 
resources to the training of qualified doctors and nurses, b) organising work more efficiently, 
c) restructuring care between primary, outpatient, inpatient and long-term care, d) improving 
the structure of incentive mechanisms in order to motivate the health work force to stay in or 
to return to the profession and e) smoothing regional differences in the allocation of human 
resources. 

CZ, IE, HU, MT, NL, FI, and the UK are granting more financial resources to the training of 
qualified doctors and nurses, improving the systems of training and re-training (including on-
the-job training) and increasing the influx of new personnel focusing on young people, non-
natives  and  people  with  low  qualifications.  The  European  Social  Fund  interventions  in  this 
field are targeted at developing human resources for the health sector (CZ, EL, LT, LV, PT, 
PL, HU, SK). 

In  DK,  NL,  SE  and  FI  the  main  long-term  challenge  is  to  attract  sufficient  and  qualified 
labour, so efforts aim at ensuring efficient work organisation and avoid needless bureaucracy 
to  devote  staff  time  mostly  to  core  activities.  They  are  making  efforts  to  raise  productivity 
introducing modern techniques, using IT more effectively and developing new care concepts, 

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dropping inefficient and outdated administrative routines and thus reducing waiting times and 
costs. Also in order to attain a more effective utilisation of healthcare personnel, EE and SE 
are  restructuring  their  systems  by  reinforcing  primary  care,  making  hospital  care  more 
efficient,  e.g.  by  concentrating  highly  specialised  care  at  national  level,  and  modulating 
rehabilitation and nursing care in case of chronic illness.  

Regarding incentive mechanisms, IE, ES, LT, HU, MT, NL and FI are all trying to improve 
the working and professional development conditions of health workers through a broad range 
of measures in order to restore the prestige of the professions and to get them to remain in or 
return  to  the  profession.  These  measures  involve  the  development  of  new  systems  for 
attaining and recognising qualifications in medical care (CZ and MT), better career prospects 
and on-the-job training that offer opportunities for learning and personal improvement, more 
competitive  payroll  systems  and  new  salary  conditions  for  young  doctors,  more  decision 
capacity in developing the content of work, management systems and the assignment of duties 
and last but not least offering the personnel more flexibility in general and, in particular, more 
flexible working hours. 

Finally, some countries (BE, BG, FR, RO) show strong regional differences in the allocation 
of human resources and are trying to implement plans that will motivate young professionals 
to  go  to  less  attractive  regions.  Others,  like  LV  and  LT,  face  the  challenge  of  emigration 
through a better planning of human resources. 

5.5. 

Long-term care services 

5.5.1. 

Introduction 

Long-term  care  is  often  defined  as  a  variety  of  health  and  social  services  provided  for  an 
ongoing or extended period to individuals who need assistance on a continuing basis due to 
physical  or  mental  disability76.  The  definition  of  long-term  care,  the  services  and  benefits 
provided and the population coverage vary between Member States.  

Member  States  have  continued  in  their  quest  for  modernising  social  protection  systems, 
particularly  in  light  of  ageing  and  the  concerns  over  expanding  expenditure.  The  growing 
demand  for  long-term  care  continues  representing  a  major  policy  challenge  for  many 
countries as current supply is considered to be insufficient and inadequate to meet current and 
future  long-term  care  needs.  Recognition  that  there  is  no  comprehensive  system  for  the 
provision of long-term services in the EU is coupled with a firm commitment on the part of 
EU countries to ensure universal access to high quality and affordable long-term care.  

2008  saw  an  impetus  in  the  attempts  to  address  the  expanding  long-term  care  needs  of  the 
population. The majority of Member States acknowledged that policy actions were necessary 
in order to secure adequate and sustainable funding structures for current and future long-term 
care (LTC) provision, particularly in light of demographic ageing and its consequences. The 
work carried out in cooperation with the Social Protection Committee within the framework 
of the social OMC resulted in the publication of a European Report on LTC in April 200877. 
Following  the  submission  of  the  2006  national  reports,  the  2007  and  2008  Joint  Reports  on 
Social Protection and Social Inclusion identified several challenges that were assessed in the 

76 
77 

OECD Observer 2007, Long-term care: a complex challenge. 
See http://ec.europa.eu/employment_social/spsi/docs/social_protection/ltc_final_2504_en.pdf  

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European  Report.  The  2008-2010  national  reports  are  examined  in  relation  to  those 
challenges, focusing on four specific themes and stressing the progress since the last reporting 
round: the search for financial sustainability, care coordination practices, high level of quality 
in LTC services and the LTC workforce. 

5.5.2.  The search for financial sustainability  

Long-term care funding and expenditure varies across the EU as shown in Figure 15, with an 
upward resource-allocation trend over time. 

Figure 15: Long-term care expenditure as percentage of GDP, 2003-
2005

Long-term care expenditure as %  of GDP

2

1,75

1,5

1,25

1

0,75

0,5

0,25

0

2003

2004

2005

cz Czech Republic
bg Bulgaria
be Belgium
dk Denmark

de Germany 
ee Estonia

es Spain

fr France

cy Cyprus

lu Luxembourg
nl Netherlands
lt Lithuania

pl Poland
pt Portugal

ro Romania

si Slovenia

Source: Eurostat Health expenditure data 

Several Member States are concerned by the need to create a solid financing basis for long-
term  care  and  ensure  the  availability  of  devoted  resources.  Some  established  or  are  in  the 
process of establishing dedicated universal social insurance schemes (DE, LU, NL, SI). Due 
to the important increase in expenditure spent through the LTC insurance and concerned by 
the future funding of the system, the NL are planning a reform that would reduce/ redefine the 
entitlements of the LTC insurance scheme and thus address the observed increase in spending 
and  duplication  with  other  policy  fields  such  as  social  support  and  domestic  care.  Though 
improving financial sustainability, there are reports that local authorities may initially struggle 
with  the  role  of  buyers  of  services.  Others  address  LTC  via  general  taxation  (AT,  SE)  or 
within  a  more  restrictive  social  assistance  framework,  defining  access  and  allocating 
resources through means or dependency testing (UK, CY, HU). Other countries intend to or 
have  implemented  a  combination  of  healthcare  insurance  elements  with  tax  funded  social 
assistance mechanisms such as social care (FR). 

Most  Member  States  are  concerned  by  the  expected  increases  in  demand  for  LTC  services. 
Some intend to foster, via an increase in provision, the services provided (AT, FR, LT, BE, 
HU,  DE)  reinforcing  the  capacity  of  their  systems  to  address  the  resulting  multiplicity  of 
health  and  social  care  needs.  Others,  wish  to  expand  the  range  of  provision  through  the 

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establishment of new and amelioration/adaptation of existing services, responding to patients 
needs  and  reflecting  their  preferences  in  terms  of  locus  of  care  (SK,  LV,  BG,  MT,  PT,  LT, 
DE).  

Independent  of  a  country's  public  financial  arrangements,  private  direct  payments  play  an 
important  role,  with  a  differentiated  impact  on  the  devised  systems'  accessibility.  Some 
countries envisage including the assets of dependent and elderly people in the calculation and 
aggregation  of  financial  benefits  with  a  targeting  for  vulnerable  groups  (FR,  LT,  SK).  The 
2008  National  Reports  point  to  a  potential  mix  of  public,  private  and  third-sector  provision 
(CY, EL). Private sources of finance refer to private health insurance coverage of LTC (often 
supplementary  or  for  high  income  groups)  and  to  private  household  payments  (either  co-
payments for publicly provided care,  and/or out-of-pocket  payments for  which very little or 
no reimbursement is offered). 

High private costs impose a major financial burden on users and their relatives and act as a 
barrier  to  access,  particularly  for  low-income  groups,  with  private  payments  having  a 
significantly  regressive  effect.  Some  countries  have  recourse  to  private  health  insurance  in 
order  to  address  the  regressive  incidence,  with  the  introduction  of  supplementary  insurance 
(FR).  Policies  to  reduce  the  individual  direct  costs  of  care  include  amongst  others:  co-
payment  exemptions,  means-tested  co-payments  capping  (FR);  extra  financial  aid/welfare 
benefits granted to the elderly dependent, disabled and chronically ill (FR); state coverage of 
LTC for low-income groups in a social assistance framework (FR, NL, CY, BE, HU, DE, SK, 
LV,  RO);  nationwide  standardisation  of  copayments;  state  subsidies  to  use  private  services 
and  coordination  between  the  different  benefits  provided  through  the  social  welfare  budget 
and the healthcare budget (FR, FI, DE). 

Since  demographic  developments  point  to  increasing  longevity  of  the  population,  a  serious 
challenge, or opportunity, in terms of public health is the prevention of ill-health in old age, 
i.e.  delaying  the  onset  of  disability  or  dependence.  Successful  health  promotion  and  disease 
prevention  programmes  can  delay  the  onset  of  dependency/disability  and  could  result  in 
financial savings, which is a major concern for countries that aim to limit or curb long-term 
care  expenditures  (DK).  Equally  important  is  the  degree  of  care  coordination  between 
different  contingency-based  social  benefits,  which  can  help  in  avoiding  the  duplication  of 
support and care services provision, leading to a more rational use and allocation of resources. 

5.5.3.  Care Coordination and integrated long-term care provision  

Several  Member  States  emphasise  their  strategies  to  address  often  new  and  (re)emerging 
health threats such as chronic conditions (LT) and mental illnesses, with national action plans 
aimed at holistically addressing the needs of mentally affected patients (AT, BE, LV, LT, HU, 
BG, PT, MT). Equally related to the ageing of the population is the emerging health threat and 
necessity  to  address  a  growing  number  of  patients  affected  by  Alzheimer's  disease,  with 
countries proposing national plans (FR, AT, SK). Some countries focused on the provision of 
integrated  geriatric  and  palliative  care  (LT,  LU).  Many  Member  States  wish  to  promote 
rehabilitative care (PT, BE, CZ, EL, FI, FR, DE, LT) with a view to restoring patients' skills 
so  that  they  regain  maximum  self-sufficiency  in  order  to  function  in  a  normal  or  as  near  a 
normal manner as possible, also aimed at allowing, where possible, the patients' reintegration 
within the labour market (BE, DE). 

Several  countries  have  made  significant  steps  towards  increasing  the  public  spending 
dedicated  to  home  and/or  community  care  (LV,  CZ,  HU,  MT,  DE)  and  develop  homecare 

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provision  for  particular  target  groups  such  as  the  elderly  (LT,  BG),  patients  affected  by 
Alzheimer's  disease  (DE)  and/or  disabled  persons  (BG).  Countries  are  firmly  focused  on 
enhancing  tailored  home  and  community  care  services  (LT,  HU)  and  moving  away  from 
institutional care, whilst allowing and/or securing institutional care access if alternatives are 
unsuiTable or unavailable (BE, FR, LV, HU, BG, DE, RO). Information and communication 
technology can enable better self-management of chronic conditions and can support carers in 
their  role  (DK).  The  provision  of  home  care  services  in  conjunction  with  enhanced 
information  and  communication  technology  depends  on  resource  availability  (SK,  LV)  and 
the degree to which long-term care is provided in an integrated framework.  

The uniform and tailored provision of long-term care services depends on the organisational 
features  of  each  system  and  on  the  degree  of  coordination  between  the  different  services 
operating within these systems. Care coordination is mainly aimed at enabling a high level of 
quality and efficient use of resources in the provision  of LTC services in an institutional or 
community  setting  (FR,  DE);  ensuring  an  adequate  continuum  of  care  irrespective  of  the 
different  levels  of  long-term  care  provision  and  organisation  (BE);  and  promoting  a 
sustainable  funding  base  streamlining  the  various  related  social  benefits  such  as  health 
insurance  and  social  assistance  benefits  (FR,  FI).  Care  coordination  policies,  particularly 
between different associated budgets, can help addressing differentiated provision modes and 
result  in  a  more  integrated  financing  structure  clarifying  entitlement  rules  for  dependent 
persons  and  addressing  the  sustainability  and  adequacy  of  the  provided  social  benefits. 
Equally  important  is  the  demarcated  address  of  different  contingencies  that  can  become 
mutually reinforcing (disability, dependency and old-age).  

Coordination  problems  in  the  interface  between  medical  care,  social  services  and  informal 
care  can  result  in  negative  outcomes  for  users  and  inefficient  use  of  resources,  with 
duplication of care provision or of financial and in-kind benefit provision. In some instances, 
care professionals, or dedicated teams are responsible for ensuring that patients can follow a 
coherent path of care with the appropriate treatment provided in the appropriate setting, with 
an integration  of the  various  social benefits or insurance coverage  (BE,  DE,  FR,  FI).  Long-
term  care  is  often  associated  with  the  notion  of  a  'care  continuum'  and  an  integrated  care 
provision  including  elements  of  other  public  health  policies  such  as  preventive  measures, 
active  ageing,  autonomy  promotion  and  empowerment,  social  assistance,  healthcare  and 
palliative care. The care continuum approach is aimed towards the coordinated provision of a 
range  of  services  (particularly  homecare)  on  one  hand  and  the  bettered  management  of  the 
transitions between services and settings. Several Member States encourage care coordination 
practices and integrated long-term care provision (FR, DE, MT, NL, and FI). 

The  uniform  allocation  of  resources  across  administrative  levels  and  loci  of  care  can  be 
sought  on  dependency  profiles  for  example  (BE,  HU,  NL).  Since  long-term  care  is  usually 
provided  in  a  devolved  context  and  run  by  sub-national  levels  of  government,  national 
standards can ensure uniform provision and financing for all the regions of the country (ES, 
SE,  UK,  BG).  Another  mechanism 
framework  contracts  and  binding 
recommendations  between  long-term  care  insurers  and  providers  (DE).  The  alignment  of 
long-term  care  funding  between  health  and  social  care  components  (HU,  FR,  BE)  are  also 
aimed  at  a  care  continuum  provision.  When  resources  are  lacking,  in  addition  to  the 
integration  between  health  and  social  care  budgets,  several  countries  are  engaging  with  the 
private and voluntary sectors of the economy (HU, LV, LT, EL, CY). The integration of long-
term  care  delivery  involves  creating  single  entry  points  or  local  assessment  teams  (NL,  PT, 
UK, DK, DE) on one hand and the devolution of long-term care services at sub-national level 
(ES,  PT,  SE,  UK),  for  a  bettered  management,  on  the  other.  Several  countries  are 

relies  on 

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encountering  financial  complications  as  the  sought  decentralisation  in  the  provision  of 
services  is  not  backed  by  a  solid  funding  basis  for  the  local,  devolved  or  decentralised 
responsible level (LT, SK, BG, RO). 

5.5.4.  High level of quality in long-term care services 

The quality of long-term care services for dependent persons varies widely both between and 
within  countries.  Many  Member  States  have  introduced  or  improved  regulation  and 
legislation  for  assessing  and  enhancing  the  quality  of  long-term  care  services.  The 
increasingly pervasive and all-encompassing nature of long-term care services renders quality 
definition and measurement a complex task. Indicators of the quality of care are used in some 
countries to assess and evaluate the quality of the services provided in both institutional and 
community  settings  (BE).  Quality  regulations  for  long-term  care  are  evolving  from  basic  or 
minimum  requirements  for  the  structure  and  process  of  care  into  more  comprehensive  and 
complex  quality  assurance  mechanisms  combining  procedural,  structural  and  outcome 
oriented  indicators  such  as  continuous  staff  training  requirements  (BE,  LT)  coupled  with 
patient  rights  mechanisms  allowing  greater  patient  participation  and  consultation  (DK,  HU, 
and  MT).  Inevitably,  they  refer  to  formal  long-term  care  services  rather  than  informal 
provision, which is much more difficult to measure and evaluate.  

For  some  countries  with  devolved  responsibility  for  LTC  provision  at  municipal  or  local 
level,  quality  in  LTC  services  is  mainly  assessed  through  formal  regulatory  and  licensing 
mechanisms, determining the scope and accreditation processes of the services provided (SK, 
LT, DE, RO). Others focus on the establishment of national quality standards (CZ, ES, HU, 
LT, MT, RO) throughout the concerned territories. The use of outcome indicators for quality 
monitoring still remains in its infancy and different modes of quality assurance coexist such 
as  internal  (DE)  or  external  quality  assurance  mechanisms  and  national  inspectorates  (FR, 
UK)  with  varying  sanctioning  capacities.  Accessibility  of  internal  and  external  auditing 
results to service users and the general public also has been taken up as an important measure 
of  quality  control  (DE).  Quality  of  care  and  its  evaluation  are  increasingly  viewed  as 
encompassing  other  important  factors  such  as  the  support  given  to  family  caregivers  (DE), 
increasing consumer choice through the promotion of consumer-directed care (BE), ensuring 
the capacity of the long-term care workforce and assistive technologies. Examples of poor or 
inadequate  care  quality  in  both  institutional  and  community  settings  include:  inadequate 
housing  (nursing  homes),  lack  of  privacy,  poor  social  relationships  and  use  of  restraints, 
amongst others. One basic requirement for quality assurance, of particular relevance to long-
term  care,  is  also  the  active  deterrence  of  patient  maltreatment  or  abuse  (SK,  LT,  RO), 
particularly in the institutional setting.  

5.5.5.  Workforce shortages 

Most  countries  have  expressed  concerns  with  regard  to  expected  staff  shortages  in  the  LTC 
sector  (LT,  SK,  LV,  NL,  DK).  The  availability  of  carers  and  their  competence  and  skill 
specialisation are inseparable concerns (SI). LTC needs have traditionally been met within the 
private sphere or the extended network of families. In a home or community care setting, the 
problem of insufficient and inadequately trained caregivers is more difficult to tackle than in 
institutional settings, even if formal home or community care tends to be cheaper than acute 
institutional  care.  The  support  of  relatives  (as  care  providers)  and  volunteers  is  and  will 
remain  an  indispensable  part  of  LTC  provision.  It  is  important  to  ensure  that  family  or 
informal  caregivers  receive  adequate  training,  guidance  and  support  (DE,  LV,  RO).  Supply 

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shortages in the homecare sector cannot be viewed in isolation, but are related to the labour 
situation in other care settings.  

Recognition that the bulk of long-term care is provided within informal settings has prompted 
national concerns regarding the availability and role of informal carers. While informal home 
care is not included in cost calculations, the lack of support of informal carers does not entail 
that  it  is  a  budget-neutral  option  for  society.  Informal  carers  are  often  relied  upon  heavily 
without  necessarily  receiving  compensation,  whilst  foregoing  employment.  The  expected 
increase in the demand for LTC services translates into an expected increase in demand for 
formal LTC services since the number of working age women able to provide informal care 
will  decrease  at  a  time  when  the  number  of  elderly  dependent  people  is  increasing;  the 
increased labour market participation of women means less time at their disposal to devote to 
providing care and the changing family structures such as smaller families and an increase in 
the prevalence of single-parent families, mean that family members are further apart and less 
able to care for dependent family members in an informal, unsupported setting.  

In both the institutional and home care settings, the main concern is recruiting and retaining 
an  adequately  qualified  and  skilled  workforce.  In  an  institutional  setting,  developments  in 
medical  and  assistive  technologies  necessitate  an  upgrading  of  workforce  skills  and 
qualifications as well as measures to ensure their retention in the LTC sector, with reports of 
difficult working conditions and low pay levels (EL, DK). The earmarking of specific funds 
to upgrade working conditions and training (DK) is all the more difficult in light of existing 
budgetary constraints and several countries intend complementing the devoted resources with 
Structural  Fund  support  (BG).  The  increased  recourse  to  cost-sharing  mechanisms  coupled 
with  limited  financial  resources  dedicated  to  LTC  and  coordination  problems  between 
competing  budgets,  inevitably  limit  the  possibilities  for  upgrading  working  conditions  and 
raising pay for the staff formally employed in the sector.  

Several measures are proposed in order to support informal carers. These measures depend in 
turn, on the organisational, administrative and funding mechanisms prevalent in each country. 
A  overview  of  measures  can  be  found  in  the  following list: in-kind benefits (DE); financial 
benefits such as care allowances dedicated to paying the informal carers (HU, BG, AT, DE, 
RO)  and  to  provide  some  additional  financial  support  to  the  person  in  need  (FR),  amongst 
others; respite care services to allow time-off and maintenance of employment activities for 
informal carers (UK, MT, AT, DE); counselling and training services (MT, DE) and informal 
carers'  needs-assessment  and  social  security  inclusion  and  formalisation  measures  for  the 
informal carers (BG, DE). 

5.6. 

Conclusions 

As  mentioned,  the  2008-2010  NSRs  build  on  the  previous  2006  NSRs  and  national  health, 
inclusion and/or social protection plans. They tend to focus on some more specific topics that 
are  seen  as  priorities  or  on  the  most  recent  policies.  The  fact  that  reforms  often  require  the 
approval  and  implementation  of  legislation,  which  are  often  lengthy  processes,  may  partly 
explain the similarities between the 2006 and the 2008 NSRs. As in the 2007 Joint Report, the 
2008  NSRs  show  the  strong  interlinks  between  improving  access,  enhancing  quality  and 
ensuring  sustainability  in  a  number  of  policies.  Moreover,  all  Member  States  recognise  that 
social protection including healthcare can have a significant impact in improving health and 
reducing poverty.  

In assessing the 2008-2010 NSRs a number of issues can be raised. 

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While important efforts have been made to ensure universal care coverage, some gaps can still 
be  identified  in  a  number  of  Member  States.  In  some  countries  private  expenditure  (direct 
payments for care) is large and in all countries some types of care (dental, aural, ophthalmic, 
residential  care)  are  not  covered  by  the  public  basket  of  health  or  social  care.  In  addition, 
large differences in the availability and quality of healthcare and long-term care services can 
be observed. This suggests that barriers to access still remain that need addressing. 

As  said,  for  all  countries  primary  care  is  seen  as  the  way  forward  to  address  geographic 
disparities  and  improve  access,  as  a  vehicle  for  promotion  and  prevention,  as  the  basis  for 
better care coordination, and as a means to ensure a rational use of resources in the sector and 
obtain  greater  value  for  money.  However,  in  many  countries  the  shortages  in  GPs/  primary 
care doctors are structural i.e. they have been going on for a long time and appear to continue. 
Ageing may render them even more acute. Therefore, it is difficult to see how the ambition 
expressed  in  the  reports  of  having  primary  care  close  to  residence  of  all  individuals  and 
reducing  regional  disparities  may  be  met  without  a  proper  primary  care  policy  that 
encompasses more training and motivation of GPs (competences and remuneration related to 
additional competences on health promotion, disease prevention and care coordination and if 
are  to  go  to  deprived  areas).  Additionally,  there  is  a  widespread  consensus  of  the  need  to 
address the expected workforce shortages in the long-term care sector (formal care) as well as 
devising  ways  to  support  family  or  informal  carers.  Adequately  recruiting,  (re)training,  and 
retaining  long-term  care  workers  remains  a  challenge.  Again,  measures  proposed  relate  to 
training and motivation (higher wages and better working conditions), and the formalisation, 
where  possible,  of  informal  carers  into  social  security  schemes.  The  looming/  current  staff 
shortages may remain a challenge for years to come as even training (which is proposed by 
some  countries  in  their  attempt  to  address  the  ageing  consequences  on  healthcare  staff) 
requires time to bear fruit. Finally, several countries are currently advertising for doctors and 
nursing  staff  in  nearby  countries  while  some  are  experiencing  massive  brain-drain  of  care 
staff. This suggests that more responsibility is needed in recruiting staff and that there may be 
place  for  improved  exchange  of  information  and  coordination  between  Member  States 
regarding staff policies.  

Another issue is technology and more specifically e-health. Virtually all countries propose a 
package of e-health measures to improve access, quality and sustainability. While this may be 
the  case,  they  require  important  sums  of  investment  (informatisation  of  the  system,  e-
prescription,  e-booking)  and,  importantly,  they  require  that  technology  is  compatible  across 
all facilities in the sector, if technology is to bring about better care coordination. Moreover, 
despite  claims  that  technology  may  improve  access,  some  of  the  measures  (internet-based 
measures) may actually create a gap, as those more vulnerable are also likely to be those more 
computer illiterate or have fewer means to access computers and internet. 

The 2008-2010 NSRs show a growing awareness of the need to ensure healthcare and long-
term care quality and present different initiatives aimed at providing their citizens with good 
quality  and  safe  preventive  and  curative  healthcare  as  well  as  long-term  care  services. 
However,  quality  is  being  addressed  to  varying  degrees  from  one  country  to  another.  The 
2008 NSRs reflect the lack of consensus across Europe about the definition and perimeter of 
quality of care. While investing in health promotion, disease prevention and primary care does 
not appeared to be controversial and Member States continue developing related strategies – 
though  some  more  successfully  than  others  given  their  available  resources,  existing  care 
delivery  structures  and  primary  care  attractiveness  in  each  country  –,  huge  disparities  are 
observed regarding patient centeredness and patient safety.  

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While  patient  centeredness  is  often  declared  as  an  important  issue,  only  a  few  concrete 
examples of action are provided. Some Member States are advanced in their efforts to ensure 
that the patient act as an actor in their healthcare systems, in others awareness of the issue is 
growing,  and others  are still at the beginning of their reflection process in this area. Patient 
safety  is  addressed  in  a  very  advanced  way  in  several  reports,  but  not  even  mentioned  in 
others.  Some  of  these  disparities  may  be  explained  by  the  limited  resources  allocated  to 
healthcare in some Member States and the need to address other more urgent issues. Patient 
safety  strategies,  for  example,  require  a  considerable  initial  investment,  with  long-term 
expected  results.  Member  States  may  therefore  choose  allocating  their  limited  resources  to 
other  areas  of  healthcare  which  are  supposed  to  bring  immediate  improvement  of  health 
indicators  of  the  population  (for  example  the  emergency  care  system).  Hence,  enhancing 
quality of care and notably patient safety remains a significant challenge for healthcare, while 
quality of facilities, care coordination and the need for qualified carers are important issues in 
the context of long-term care. Growing interest is placed on prevention and management of 
chronic  diseases,  which  are  addressed  through  targeted  health  promotion  actions,  clinical 
guidelines and financial encouragement of doctors to provide better quality care for patients 
presenting chronic conditions. Finally, a number of indicators exist and are used with regard 
to quality of care, but available data do not, however, enable solid international comparisons 
about  care  quality  in  European  countries.  Further  effort  is  needed  to  develop  common 
terminology and gather comparable data on different aspects of quality at European level.  

The  NSRs  also  show  that  several  Member  States  have  been  going  down  the  avenue  of 
privatisation  and  decentralisation  as  a  way  to  improve  access,  quality  and  especially 
efficiency of the health system. However, it is important to note that these should be treated as 
means to an end and not a goal in itself or a decision taken on the basis of political whims. It 
is important to assess whether it is possible to achieve efficiency gains by privatisation and 
decentralisation in each national context. In general, it is necessary to consider if there is the 
institutional capacity to monitor and regulate private practice, to ensure risk equalisation and 
quality standards, to identify what the private and what the public can do better, or to induce 
the geographic location of private entities in order to tackle geographic disparities. Whether 
private  entities  promote  quality  and  efficiency  depends  on  the  number  of  entities  and  the 
incentives they face notably the nature of contracts established in the market. The experience 
with decentralisation in some Member States is a mixed one, resulting in variations in supply 
and  quality  of  care  which  have  lead  these  countries  to  rethink  their  resource  allocation 
mechanisms and establish nationwide norms and guidelines. Some countries that have a large 
private  provision  report  duplication  of  care  and  waste  of  resources  and  thus  the  need  to 
coordinate private and public provision. Hence, a number of issues must be taken into account 
when going down the avenue of more private insurance, private provision and decentralisation 
of provision. 

All  countries  have  cost-sharing  schemes  in  place,  complemented  with  exemptions.  In  some 
countries these have increased and have led to a reduction in care utilisation while in others 
they do not appear to have much effect on patient behaviour as they are covered by insurance. 
It is also not always clear whether there is a coherent logic behind their design i.e. are they 
inducing  preferred  pathways  of  care?  Are  they  based  on  what  is  cost-effective?  More 
monitoring is needed to ensure they achieve maximum efficiency gains while minimising the 
impact on necessary care utilisation by vulnerable groups. 

Another  interesting  trade-off  relates  to  increased  patient  choice.  While  a  large  number  of 
countries  see  increased  patient  choice  as  a  dimension  of  patient  centeredness,  it  is  not 
acknowledged  how  greater  choice  impacts  on  the  goal  of  increasing  system  efficiency. 

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Several  countries  claim  they  will  increase  patient  choice  but  at  the  same  time  refer  to  the 
establishment of selective contracting between insurers and providers as a means to encourage 
efficiency. This would mean that what countries refer to as choice is additional choice within 
a preferred care framework. From the point of view of efficiency this is logical as evidence 
suggests that free choice is related to increased costs of care.  

Member States are looking at various mechanisms to address the expected increase in demand 
for long-term care services in light of the demographic ageing and the prevalence of disability 
and  dependency,  particularly  in  old  age.  In  their  quest  for  a  sound  financial  footing  for  the 
long-term  care  sector,  Member  States  are  fostering  and  upgrading  existing  services  and 
establishing new ones, on one hand, whilst developing sound financial mechanisms to cover 
the  multiple  contingencies,  on  the  other.  Secure  long-term  care  financing  is  still  to  be 
achieved in many countries and changes to financing mechanisms are required, with several 
countries engaging in reforms. Care coordination is seen as crucial in enabling a high level of 
quality  and  efficient  use  of  resources  in  the  provision  of  long-term  care  services  and  thus 
ensuring an  adequate continuum  of care. It also encompasses  the  search for  coordination of 
budgets and thus sustainability of long-term care systems. 

Ageing  is  seen  as  an  important  challenge  as  it  leads  to  multi-morbidity  and  increased 
disability and dependence if increased life expectancy is not accompanied by healthier lives. 
Hence, the intensification of health promotion  and disease prevention in all Member  States, 
seen  as  crucial  means  to  improve  health  at  all  ages,  thus  increasing  quality  of  life  while 
reducing  the  demand  and  costs  of  healthcare  and  long-term  care.  Several  countries  expect 
successful  health  promotion  and  disease  prevention  programmes  to  delay  the  onset  of 
dependency/disability and eventually result in financial savings. In this context, there may be 
room for more effective and targeted health promotion actions. Interestingly, though, while all 
countries  put  a  stronger  emphasis  on  promotion  and  prevention,  curative  care,  notably 
hospital care, engulfs the largest part of the expenditure and a large number of countries are 
still directing extra funds towards the hospital sector. Hence, the expenditure share allocated 
to promotion and prevention may be too small in relation to the goals they are to achieve.  

Ageing  is  also  seen  as  a  window  of  opportunity  to  use  in  relation  to  older  employees, 
immigrants, people with disabilities and socially disadvantaged and the young and contribute 
to attaining the Lisbon objectives, if these groups are provided with relevant training. On the 
other  hand,  it  may  mean  that  countries  need  to  be  more  innovative  and  improve  the  use  of 
technology and methods of work as well as working with third sector to try and reach those in 
more  remote  and  disadvantaged  areas  or  at  risk  groups  when  in  the  presence  of  staff 
shortages. 

A  final  number  of  issues  are  worth  mentioning.  Firstly,  as  mentioned  in  the  introduction, 
health  is  seen  as  goal  in  itself  but  also  as  a  means  to  ensure  employment  and  economic 
development, while the result of a set of social and economic factors. This holistic approach is 
translated  in  some  countries  by  a  broader  consultation  with  various  sectors,  with  NGOs  on 
social  welfare  and  health,  and  with  local  and  regional  authorities.  It  is,  however,  not 
necessarily clear how the consultation was taken into consideration in the report. Some of the 
reports  were  prepared  in  joint  collaboration  by  more  than  one  ministry.  More  multi-sector 
cooperation  is  necessary  to  ensure  greater  coherence  between  economic,  education, 
employment, environment and social policy including health and housing policies if we are to 
ensure a high level of health protection in all policies.  

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Secondly, only a handful of countries report using the European Structural Funds in the field 
of health, even if health is a priority for the 2007-2010 funding programme. This may reflect 
general  lack  of  awareness  of  the  possibility  to  use  structural  funds  for  developing  health 
promotion,  address  geographical  gaps  in  infrastructure,  or  increased  staff  training.  At  the 
same  time,  some  argue  that  more  technical  support  and  monitoring  of  the  investment  is 
needed.  

Finally, some countries show a departure from previous reforms. While this may be expected 
in  the  field  of  healthcare  due  to  a  continuous  change  of  treatment  practices  and  staff 
qualifications, in some cases new reform choices are political in nature and their design is not 
necessarily  thought  through.  Ensuring  a  rationale  for  reforms  and  avoid  leaving  health 
responsibility  of  policy  makers.
systems 

is  also  an 

important 

limbo 

in  a 

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6. 

ANNEX: INDICATORS 

6.1. 

Definition of the 14 overarching indicators 

1a. At-risk-of-poverty rate: Share of persons aged 0+ with an equivalised disposable income 
below 60% of the national equivalised median income78. Source: SILC. 

+  Illustrative  threshold  value:  Value  of  the  at-risk-of-poverty  threshold  (60%  median 
national  equivalised  income)  in  PPS  for  an  illustrative  household  type  (e.g.  single  person 
household). Source: SILC. 

1b. Relative median poverty risk gap: Difference between the median equivalised income 
of persons aged 0+ below the at-risk-of poverty threshold and the threshold itself, expressed 
as a percentage of the at-risk-of-poverty threshold. Source: SILC. 

2. S80/S20: Ratio of total income received by the 20% of the country’s population with the 
highest income (top quintile) to that received by the 20% of the country’s population with the 
lowest  income  (lowest  quintile).  Income  must  be  understood  as  equivalised  disposable 
income. Source: SILC. 

3.  Healthy  life  expectancy  Number  of  years  that  a  person  at  birth,  at  45,  and  at  65  is  still 
expected to live a healthy life (also called disability-free life expectancy). To be interpreted 
jointly with life expectancy. Source: EUROSTAT. 

4.  Early  school-leavers:  Share  of  persons  aged  18  to  24  who  have  only  lower  secondary 
education  (their  highest  level  of  education  or  training  is  0,  1  or  2  according  to  the  1997 
International  Standard  Classification  of  Education  —  ISCED  97)  and  have  not  received 
education or training in the four weeks preceding the survey. Source: LFS. 

5.  People  living  in  jobless  households:  Proportion  of  people  living  in  jobless  households, 
expressed as a share of all people in the same age group79. This indicator should be analysed 
in the light of context indicator No 8: jobless households by main household types. Source: 
LFS. 

6.  Projected  total  public  social  expenditure: Age-related  projections of  total  public  social 
expenditure  (e.g.  pensions,  healthcare,  long-term  care,  education  and  unemployment 
transfers),  current  level  (%  of  GDP)  and  projected  change  in  share  of  GDP  (in  percentage 
points) (2010-20-30-40-50).   
Specific assumptions agreed in the AWG/EPC. See ‘The 2005 EPC projections of age-related 
expenditures (2004-2050) for EU-25: underlying assumptions and projection methodologies’ 
Source: EPC/AWG. 

7a. Median relative income of elderly people: Median equivalised income of people aged 
65+ as a ratio of income of people aged 0-64. Source: EU-SILC. 

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79 

Equivalised  median  income  is  defined  as  the  household’s  total  disposable  income  divided  by  its 
‘equivalent size’, to take account of the size and composition of the household, and is attributed to each 
household member (including children). Equivalisation is on the basis of the OECD modified scale. 

Students aged 18-24 who live in households composed solely of students are not counted in either the 
numerator or denominator. 

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7b. Aggregate replacement ratio: Median individual pensions of 65-74 year-olds relative to 
median individual earnings of 50-59 year-olds, excluding other social benefits. Source: EU-
SILC. 

8. Self-reported unmet need for medical care: Total self-reported unmet need for medical 
care for the following three reasons: financial barriers + waiting times + too far to travel. 

+  Care  utilisation:  To  be  analysed  together  with  care  utilisation  defined  as  the  number  of 
visits to a doctor (GP or specialist) during the last 12 months. Source: EU-SILC. 

9.  At-risk-of-poverty  rate  anchored  at  a  fixed  moment  in  time  (2005):  Share  of  persons 
aged  0+  with  an  equivalised  disposable  income  below  the  at-risk-of-poverty  threshold 
calculated  in  the  year  2005  (1st  EU-SILC  income  reference  year  for  all  25  EU  countries), 
adjusted for inflation over the years. Source: SILC. 

10. Employment rate of older workers: Persons in employment in the 55–59 and 60–64 age 
groups as a proportion of the total population in the same age group. Source: LFS. 

11.  In-work  poverty  risk:  Individuals  who  are  classified  as  employed80  (distinguishing 
between  ‘wage  and  salary  employment  plus  self-employment’  and  ‘wage  and  salary 
employment’ only) and who are at risk of poverty. 

This indicator needs to be analysed according to personal, job and household characteristics. 
It should also be analysed in comparison with the poverty risk faced by the unemployed and 
the inactive. Source: SILC. 

12.  Activity  rate:  Share  of  employed  and  unemployed  people  in  the  total  population  of 
working age, 15-64. Source: LFS. 

13.  Regional  disparities  —  coefficient  of  variation  of  employment  rates:  Standard 
deviation81 of regional employment rates divided by the weighted national average (15-64 age 
group). (NUTS II). Source: LFS. 

14. Total health expenditure per capita: Total health expenditure per capita in PPP. Source: 
EUROSTAT based on system of health accounts (SHA) data. 

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81 

Individuals classified as employed according to most frequent activity status. The most frequent activity 
status is defined as the status that individuals declare having for more than half the number of months in 
the calendar year. 
Standard deviation measures how, on average, the situation in regions differs from the national average. 
As a complement to the indicator, a graph showing max/min/average per country is presented. 
Possible alternative measures:  
Regional disparities — underperforming regions. Source LFS 
1. Share of underperforming regions in terms of employment and unemployment (in relation to all 
regions and to the working age population/labour force) (NUTS II).  
2. Differential between average employment/unemployment in underperforming regions and the 
national average for employment/unemployment (NUTS II). Thresholds to be applied: 90% and 150% 
of the national average rates for employment and unemployment, respectively. (An extra column with 
the national employment and unemployment rates would be included). 

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6.2. 

Data sources 

Indicators of income and living conditions: EU-SILC 

For  the  first  time  this  year,  EU-SILC  data  are  available  for  25  EU  countries.  The  newly 
implemented reference source of statistics on income and social exclusion is the Framework 
Regulation (No 1177/2003) for the European Survey on Income and Living Conditions (EU-
SILC). The technical aspects of this instrument are developed by Commission implementing 
regulations, which are published in the Official Journal. The data for Bulgaria and Romania 
are still based on the national household budget surveys under the transitional arrangements 
agreed for the European Statistical System82. 

The  EU-SILC  definitions  of  total  household  gross  and  disposable  income  and  the  different 
income components keep as close as possible to the international recommendations of the UN 
‘Canberra Manual’. A key objective of EU-SILC is to deliver timely, robust and comparable 
data  on  total  disposable  household  income,  total  disposable  household  income  before 
transfers, total gross income and gross income at component level (in the ECHP, the income 
components were recorded net). This objective will be reached in two steps, in that Member 
States  have  been  allowed  to  postpone  the  delivery  of  gross  income  at  component  level  and 
total household gross income data until after the first year of operation.  

Although  certain  countries  (e.g.  Denmark)  are  already  able  to  supply  income  including 
imputed  rent  —  i.e.  the  money  that  one  saves  on  full  (market)  rent  by  living  in  one’s  own 
accommodation  or  in  accommodation  rented  at  a  price  lower  than  the  market  rent  —  for 
reasons  of  comparability,  the  income  definition  underlying  the  calculation  of  indicators 
currently excludes imputed rent. This could have a distorting effect in comparisons between 
countries, or between population sub-groups, when accommodation tenure status varies. This 
effect  may  be  particularly  apparent  for  the  elderly  who  may  have  been  able  to  accumulate 
wealth in the form of housing assets. In the statistical annex, data for Denmark are therefore 
shown  both  with  and  without  imputed  rent,  as  an  illustration  of  the  impact  of  this  income 
component on the results. Once imputed rent is taken into account, the at-risk-of-poverty rate 
falls  for  people  aged  65  and  over,  the  inactive  other  than  pensioners  and  those  living  in 
owner-occupied accommodation.  

It should also be noted that the definition currently used for income excludes non-monetary 
income components, which include the value of goods produced for own consumption83 and 
non-cash employee income. This component will be available for all countries from the SILC 
(2007) exercise onwards, and will therefore be included in the indicators to be published in 
January 2009. 

The  reference  year  for  the  data  is  the  year  to  which  the  income  information  refers  (i.e.  the 
‘income  year’),  which  in  most  cases  differs  from  the  survey  year  in  which  the  data  were 
collected. Accordingly, 2006 data refer to the income situation of the population in 2005, even 

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National  data  sources  are  adjusted  ex-post  and  as  far  as  possible  using  the  EU-SILC  methodology. 
While the greatest effort is made to maximise the consistency of definitions and concepts, the resulting 
indicators cannot be considered to be fully comparable with the EU-SILC-based indicators. 
Before the introduction of EU-SILC in the new Member States, the value of goods produced for own 
consumption  was  included  in  the  calculation  of  the  EU  indicators  estimated  on  the  basis  of  national 
sources. This transitional arrangement was intended to take account of the potentially significant impact 
of this component on income distribution in these countries. 

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if the information was collected in 2006. EU aggregates are computed as population-weighted 
averages of available national values.  

Note on trends 

During  the  transition  to  EU-SILC,  income-based  indicators  were  calculated  on  the  basis  of 
available national sources (household budget survey, micro-censuses, etc) that were not fully 
compatible  with  the  SILC  methodology  based  on  detailed  income.  Following  the 
implementation of EU-SILC in a given country, the values of all income-based indicators (at-
risk-of-poverty  rates,  S80/S20,  aggregate  replacement  ratio,  etc)  cannot  be  compared  to  the 
estimates presented in previous years. This is why no trends for income-based indicators are 
presented in this year’s report. 

Limitations 

The limited sample size for certain data sources used for the collection of income data and the 
specific  difficulties  of  collecting  accurate  information  on  disposable  income  directly  from 
households  or  through  administrative  records  raise  certain  concerns  as  regards  data  quality. 
This  is  particularly  the  case  for  information  on  income  at  the  two  ends  of  the  income 
distribution. 

Furthermore,  household  surveys  do  not  cover  persons  living  in  collective  households, 
homeless persons or other difficult-to-reach groups.  

It  must  also  be  acknowledged  that  self-employment  income  is  difficult  to  collect,  whatever 
the data source. It must also be kept in mind that the difficulty in recording income from the 
informal economy can introduce a bias in income distribution as measured by surveys. 

Finally,  while  it  is  considered  to  be  the  best  basis  for  such  analyses,  current  income  is 
acknowledged to be an imperfect measure of consumption capabilities and welfare, as, among 
other  things,  it  does  not  reflect  access  to  credit,  access  to  accumulated  savings  or  ability  to 
liquidate  accumulated  assets,  informal  community  support  arrangements,  aspects  of  non-
monetary  deprivation,  differential  pricing,  etc.  These  factors  may  be  of  particular  relevance 
for  persons  at  the  lower  end  of  the  income  distribution.  The  bottom  10%  of  the  income 
distribution should not, therefore, necessarily be interpreted as being the bottom 10% in terms 
of living standards. This is why reference is made to the ‘at-risk-of-poverty’ rate rather than 
simply the poverty rate.  

Confidence intervals 

Indicators are estimated values based on a sample drawn from the target population and thus 
are  affected  by  sampling  error.  Statistical  theory  provides  us  with  tools  for  calculating 
confidence  intervals  in  which  the  population  value  lies  with  a  high  probability.  The 
confidence  intervals  are  centred  around  the  estimated  values  reported  and  their  length  is  a 
measure of the precision of these estimates. The precision depends on the design of the survey 
and can thus vary between countries. However, the EU-SILC Regulation provides for national 
samples to be designed so as to achieve a confidence interval of +/-1% around the estimated 
value of the total at-risk-of-poverty rate. Eurostat is computing these intervals for a number of 
indicators  and  exact  values  will  be  reported  in  EU  quality  reports.  First  computations  show 
that  the  confidence  intervals  around  the  total  at-risk-of-poverty  rate  are  of  the  order  of  +/-
0.8%. For the S80/S20 income quintile share ratio, the confidence intervals are of the order of 

EN 

156 

   EN 

 
+/-0.2. For the relative median at-risk-of-poverty gap, they are of the order of +/-1.7. For the 
Gini coefficient, they are of the order of +/-0.9. These indications of precision must be taken 
into account when interpreting the data. 

LFS: the European Union Labour Force Survey 

The  European  Union  Labour  Force  Survey  (LFS)  is  the  EU's  harmonised  survey  on  labour 
market developments. The survey has been carried out since 1983 in the EU Members States, 
with some states providing quarterly results from a continuous labour force survey, and others 
conducting  a  single  annual  survey  in  the  spring.  From  2005,  all  EU  Member  States  have 
conducted a quarterly survey. If not mentioned otherwise, the results based on the LFS refer 
to  surveys  conducted  in  the  spring  ('second  quarter'  in  all  countries  except  for  France  and 
Austria, which is 'first quarter') of each year. It also provides data for Bulgaria, Croatia and 
Romania. 

The Annual Averages of Labour Force Data series is a harmonised, consistent series of annual 
averages of quarterly results on employment statistics based on the LFS, completed through 
estimates when quarterly data are not available. It covers all the EU-15 (for the period from 
1991  to  present)  and  all  new  Member  States  and  Candidate  Countries  (since  1996  or  later, 
depending  on  data  availability)  except  the  Former  Yugoslav  Republic  of  Macedonia.  The 
Annual Averages of Labour Force Data consist of two series: 1) population, employment and 
unemployment,  and  2)  employment  by  economic  activity  and  employment  status.  The  first 
series is based mainly on the EU LFS. Data covers the population living in private households 
only  (collective  households  are  excluded)  and  refers  to  the  place  of  residence  (household 
residence concept). They are broken down by gender and aggregate age group (15–24, 25–54, 
55–64 and 15–64). Unemployment data is also broken down by job search duration (less than 
6  months,  6–11,  12–23,  24  months  or  more).  The  second  series  is  based  on  the  ESA  1995 
national  accounts  employment  data.  Data  covers  all  people  employed  in  resident  producer 
units  (domestic  concept),  including  people  living  in  collective  households.  They  are  broken 
down 
status 
(permanent/temporary) using LFS distributions. All key employment indicators presented in 
this document are based on the Annual Averages of Labour Force Data series. They represent 
yearly  averages  unless  stated  otherwise.  Where  the  Annual  Averages  of  Labour  Force  Data 
series does not provide the relevant breakdowns, the original LFS data has been used for this 
report. 

sex,  working-time 

(full-time/part-time) 

contract 

status 

and 

by 

Age-related expenditure projections 

Long-term budgetary projections were prepared in 2006 by the Economic Policy Committee 
and  the  European  Commission  (DG  ECFIN)  —  see  European  Policy  Committee  and 
European Commission (2006), ‘The impact of ageing on public expenditure: projections for 
long-term  care,  education  and 
the  EU25  Member  States  on  pensions,  healthcare, 
unemployment transfers (2004-2050)’, European Economy, Special Report No 1/2006.  

The  projections  are  made  on  the  basis  of  a  common  population  projection  and  agreed 
common  underlying  economic  assumptions  that  have  been  endorsed  by  the  EPC.  The 
projections are made on the basis of ‘no policy change’, i.e. only reflecting enacted legislation 
but  not  possible  future  policy  changes  (although  account  is  taken  of  provisions  in  enacted 
legislation that enter into force over time). The pension projections are made on the basis of 
legislation enacted by mid-2005. They are also made on the basis of the current behaviour of 
economic agents, without assuming any future changes in behaviour over time: for example, 

EN 

157 

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this  is  reflected  in  the  assumptions  for  participation  rates,  which  are  based  on  the  most 
recently  observed  trends  by  age  and  gender.  While  the  underlying  assumptions  have  been 
made  by  applying  a  common  methodology  uniformly  to  all  Member  States,  for  several 
countries adjustments have been made to avoid an overly mechanical approach that leads to 
economically  unsound  outcomes  and  to  take  due  account  of  significant  country-specific 
circumstances.  The  pension  projections  were  made  using  the  models  of national authorities, 
and thus reflect the current institutional features of national pension systems. In contrast, the 
projections for healthcare, long-term care, education and unemployment transfers were made 
using common models developed by the European Commission in close cooperation with the 
EPC  and  its  Working  Group  on  Ageing  Populations.  The  projection  results  show  the 
combined  impact  of  expected  changes  in  the  size  and  demographic  structure  of  the 
population,  projected  macroeconomic  developments  and  assumed  neutral  evolution  in  the 
health status of the population in each Member State of the European Union. 

Pension expenditure 

The  ‘pension  expenditure’  aggregate  according  to  the  ESSPROS  definition,  goes  beyond 
public  expenditure  and  also  includes  expenditure  by  private  social  protection  schemes. 
‘Pension  expenditure’  is  the  sum  of  seven  different  categories  of  benefits,  as  defined  in  the 
1996 ESSPROS Manual: disability pension, early retirement benefit due to reduced capacity 
to work, old-age pension, anticipated old-age pension, partial pension, survivors’ pension and 
early  retirement  benefit  for  labour  market  reasons.  Some  of  these  benefits  (for  example, 
disability pensions) may be paid to people who have not reached the standard retirement age. 

Replacement rates 

The  figures  for  current  and  prospective  pension  replacement  rates  are  based  on  the 
methodology developed by the Indicators Sub-Group of the Social Protection Committee. The 
results  are  based  on  the  baseline  assumption  of  a  hypothetical  person  (male  where  gender 
matters) retiring at the age of 65 after a 40-year full-time working career with a flat earnings 
profile at average earnings with contributions to the most general public pension scheme as 
well as to occupational and private pension schemes for some Member States.  

The  replacement  rate  represents  the  individual  pension  income  during  the  first  year  of 
retirement  relative  to  the  individual  income  received  during  the  year  preceding  retirement. 
Calculations are by the Member States. 

Healthcare expenditure — WHO Health for All database (www.who.int\nha) 

This  information  is  based  on  national  health  accounts  (NHAs)  collected  within  an 
internationally  recognised  framework.  NHAs  depict  the  financing  and  spending  flows 
recorded in the operation of a health system. In future, the System of Health Accounts (SHA) 
will contain uniform data for Eurostat, the OECD and the WHO. In the meantime, the WHO 
database is the only one to cover all Member States.  

About 100 countries have either produced full national health accounts or report expenditure 
on  health  to  the  OECD.  Standard  accounting  estimation  and  extrapolation  techniques  have 
been used to provide time series (1998-2004). Ministries of Health have responded to the draft 
updates  sent  for  their  inputs  and  comments.  The  principal  international  references  used  are: 
the  International  Monetary  Fund  (IMF),  Government  Finance  Statistics  and  International 
Financial Statistics; OECD health data; and the United Nations National Accounts Statistics. 

EN 

158 

   EN 

 
National  sources  include:  national  health  accounts  reports,  public  expenditure  reports, 
statistical  yearbooks  and  other  periodicals,  budgetary  documents,  national  accounts  reports, 
central  bank  reports,  non-governmental  organisation  reports,  academic  studies,  reports  and 
data  provided  by  central  statistical  offices  and  ministries,  and  statistical  data  on  official 
websites.

EN 

159 

   EN 

 
6.3. 

Statistical tables 

1a. At-risk-of-poverty rate by age and gender, 2007

Total population

Total
Men
Women

Children aged 0-17 Total
People aged 18-64 Total
Men
Women
Total
Men
Women

People aged 65+ 

EU27
16ps
15ps
17ps
19ps
15ps
14ps
15ps
19ps
16ps
22ps

EU25
16p
15p
17p
19p
15p
14p
15p
19p
17p
21p

BE
15
14
16
17
13
12
13
23
21
25

BG(1)
14i
12i
16i
16i
12i
12i
12i
18i
9i
24i

CZ 
10
9
10
16
8
8
9
5
2
8

DK
12
11
12
10
11
11
11
18
16
19

DK(2)
13p
13p
13p
12p
13p
13p
13p
14p
12p
16p

DE
15p
14p
16p
14p
15p
14p
16p
17p
14p
20p

EE
19
17
22
18
16
15
17
33
21
39

IE
18
16
19
19
15
14
16
29
24
33

EL
20
20
21
23
19
18
19
23
21
25

ES
20
19
21
24
16
15
17
28
26
30

FR
13
12
14
16
12
11
13
13
12
14

IT
20
18
21
25
18
16
19
22
18
25

CY
16
14
17
12
10
8
12
51
47
54

LV
21
19
23
21
18
18
19
33
21
39

LT
19
17
21
22
16
15
16
30
15
37

LU
14
13
14
20
13
12
13
7
7
8

HU
12
12
12
19
12
11
12
6
3
8

MT
14
14
15
19
12
10
14
21
24
18

NL
10
10
11
14
9
8
10
10
9
11

AT
12
11
13
15
11
9
12
14
10
18

PL
17
18
17
24
17
18
17
8
6
9

PT
18
17
19
21
15
14
16
26
24
27

1a. At-risk-of-poverty threshold (illustrative values), EUR and PPS, 2007
CZ 
3251
6828
5348
11231

EUR '- One-person household
       '- Two adults with two dep. ch
PPS '- One-person household
       '- Two adults with two dep. ch

EU25
8368s
17573s
:
:

BE
10538
22129
10035
21075

EU27
:
:
:
:

BG(1)
:i
:i
:i
:i

DK
14004
29409
10175
21367

DK(2)
15002,73
31505,91
10819p
22720p

DE
10624p
22310p
10403p
21846p

EE
2668
5603
4059
8524

IE
13291
27911
10706
22483

EL
6120
12852
6946
14588

ES
7203
15127
7807
16394

FR
9938
20870
9363
19661

IT
9003
18907
8748
18371

CY
9590
20140
6298
13226

LV
2010
4222
3356
7049

LT
1966
4128
3512
7376

LU
17929
37650
17575
36908

HU
2361
4959
3979
8355

MT
5475b
11498b
7543b
15841b

NL
10924
22941
10631
22325

AT
10945
22985
10933
22960

PL
2101
4413
3422
7187

PT
4544
9542
5360
11255

RO(1)
19p
18p
19p
25p
17p
17p
16p
19p
13p
22p

RO(1)
90p
140p
189p
295p

SI
12
10
13
11
10
10
10
19
11
25

SK
11
10
11
17
9
9
10
8
3
11

FI
13
12
14
11
11
12
11
22
18
24

SE
11
11
11
12
10
11
10
11
7
14

UK
19
18
20
23
15
14
16
30
27
32

SI
5944b
12482b
7979b
16756b

SK
2382
5003
4133
8678

FI
11222
23565
9321
19573

SE
11132
23378
9581
20120

UK
12572
26402
11366
23868

Source: SILC 2007, Income data 2006; except for UK, income year 2007 and for IE moving income reference period (2006-2007);  (1) BG HBS 2006, income data 2006and RO National HBS 2007, income data 2007; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

Total population

1b. Relative median at-risk-of-poverty gap by age and gender, 2007
EU27
22ps
23ps
21ps

Total
Men
Women

EU25
22
23
21

BG(1)
17i
18i
17i

BE
18
19
17

Total

Children aged 0-17
People aged 18-64 Total
Men
Women
Total
Men
Women

People aged 65+ 

22ps
24ps
25ps
23ps
19ps
18ps
19ps

22
24
25
23
19
18
19

18
21
22
20
15
17
14

22i
18i
19i
18i
14i
8i
16i

CZ 
18
19
17

19
19
21
19
7
14
7

DK
17
19
16

21
24
24
22
9
7
9

DK(2)
18p
20p
17p

16p
24p
25p
23p
7p
8p
7p

DE
24p
25p
23p

21p
26p
28p
24p
19p
19p
19p

EE
20p
24p
19p

26p
26p
29p
23p
14p
14p
14p

IE
18p
18p
17p

19p
20p
20p
20p
10p
10p
10p

EL
26p
26p
26p

29p
26p
25p
26p
24p
24p
24p

ES
24
24
24

25
27
27
27
21
21
20

FR
17p
17p
16p

15p
17p
18p
17p
19p
19p
19p

IT
22
24
22

25
25
25
25
19
17
20

CY
20
18
21

16
18
17
19
23
21
24

LV
25
27
24

28
30
32
28
19
12
19

LT
26
28
23

30
29
30
28
15
12
16

LU
19
19
19

20
20
20
19
9
8
12

HU
20
21
19

19
21
21
21
13
10
15

MT
17
17
18

16
19
17
20
17
17
16

NL
17p
18p
17p

18p
18p
22p
18p
10p
9p
11p

AT
17
19
16

19
21
23
20
12
12
12

PL
24
25
23

26
25
25
24
14
15
14

PT
24
24
24

26
27
27
27
19
14
22

RO(1)
23p
23p
24p

26p
23p
23p
23p
19p
17p
20p

SI
19
19
20

21
19
20
19
20
15
20

SK
19
22
17

21
20
22
19
12
19
11

FI
14
15
14

12
17
18
16
10
10
10

SE
20
22
18

17
24
26
22
11
11
12

UK
23
23
23

22
25
26
24
20
18
21

Source: SILC 2007,  Income data 2006; except for UK, income year 2007 and for IE moving income reference period (2006-2007);  (1) BG HBS 2007, income data 2007 and RO National HBS 2006, income data 2006; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

2. Inequality of income distribution: S80/S20 income quintile share ratio
CZ 
3.5

BG(1)
3.5i

EU27
4.8ps

EU25
4.8p

S80/S20

BE
3.9

Total

DK
3.7

DK(2)

3.6p

DE
5p

EE
5.5p

IE
4.8p

EL
6p

ES
5.3

FR
3.8p

IT
5.5

CY
4.5

LV
6.3

LT
5.9

LU
4

HU
3.7

MT
3.8

NL
4p

AT
3.8

PL
5.3

PT
6.5p

RO(1)
5.3p

SI
3.3

SK
3.5

FI
3.7

SE
3.4

UK
5.5

Source: SILC 2007,  Income data 2006; except for UK, income year 2006 and for IE moving income reference period (2005-2006);  (1) BG and RO National HBS 2006, income data 2006; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

EN 

160 

EN 

 
  
1999
:
:
:

:
:
:

73,8
:
:

80,4
:
:

2000
:
:
:

:
:
:

74,4
31,8
15,7

80,8
37,2
19,4

2001
:
:
:

:
:
:

74,7
32,1
15,9

81,1
37,4
19,6

2002
74,5
31,9
15,9

80,9
37,2
19,5

75
32,3
16,1

81,3
37,6
19,7

2003
74,6
31,9
15,9

80,8
37,2
19,4

75,1
32,3
16,1

81,2
37,5
19,6

74,9
:
:

75,4
32,6
16,1

76
75,7
33,1
32,9
16,4
16,3
63.2 e  63.5 e  63.6 e  64.3 e  64.5 e

75,9
33
16,4

81,1
:
:

81,4
37,7
19,7

81,7
37,9
20
63.9 e  64.4 e  65.0 e  65.8 e  66.0 e

81,7
38
20

81,7
38
20

3. Healthy life years : Disability free life expectancy (+ life expectancy at 0, 45, 65) 1995-2005

life expectancy at birth - males
life expectancy at 45 - males
life expectancy at 65 - males

life expectancy at birth - females
life expectancy at 45 - females
life expectancy at 65 - females

life expectancy at birth - males
life expectancy at 45 - males
life expectancy at 65 - males

life expectancy at birth - females
life expectancy at 45 - females
life expectancy at 65 - females

life expectancy at birth - males
life expectancy at 45 - males
life expectancy at 65 - males
Disability free life expectancy at birth - males

life expectancy at birth - females
life expectancy at 45 - females
life expectancy at 65 - females
Disability free life expectancy at birth - females
Source: Eurostat - Demography; e: estimate

eu27
eu27
eu27

eu27
eu27
eu27

eu25
eu25
eu25

eu25
eu25
eu25

eu15
eu15
eu15
eu15

eu15
eu15
eu15
eu15

1995
:
:
:

:
:
:

72,8
:
:

79,7
:
:

73,9
31,5
15,3
:

80,4
36,9
19,1
:

1996
:
:
:

:
:
:

73,2
:
:

79,9
:
:

74,2
31,7
15,4
:

80,6
37,1
19,2
:

1997
:
:
:

:
:
:

73,5
:
:

80,2
:
:

74,6
32
15,6
:

80,9
37,3
19,4
:

1998
:
:
:

:
:
:

73,5
:
:

80,2
:
:

74,6
:
:
:

80,9
:
:
:

EN 

2004
75,2
32,5
16,4

81,5
37,7
19,9

75,7
32,8
16,6

81,9
38,1
20,2

76,8
33,7
17,1
:

82,8
38,9
20,8
:

2005
:
:
:

:
:
:

75,8
:
:

81,9
:
:

:
:
:
:

:
:
:
:

161 

EN 

 
  
Disability free Life expectancy (+ Life expectancy at 0, 45, 65) 1995-2006
Source: Eurostat - Demography

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995

73,5
31,1
14,8
63,3

80,4
37
19,3
66,4

1995

67,4
26,6
12,7
:

74,9

32,4
15,3
:

1995

69,7

27,6

12,7

:

76,8
33,4

16,2

:

1996

73,9
31,4
15
64,1

80,7
37,2
19,4
68.5 (e) 

1996

67,4
26,6
12,5
:

74,5

32,2
15
:

1996

70,4

27,9

13,1

:

77,5
33,9

16,6

:

1997

74,2
31,6
15,2
66,5

80,7
37,2
19,5
68,3

1997

67
26,3
12,3
:

73,8

31,7
14,7
:

1997

70,5

28,1

13,2

:

77,6
34,1

16,7

:

BE
BE
BE
BE

BE
BE
BE
BE

BG
BG
BG
BG

BG
BG
BG
BG

CZ
CZ
CZ
CZ

CZ
CZ
CZ
CZ

1998

74,4
31,7
15,3
63,3

80,7
37,2
19,6
65.4 (e) 

1998

67,4
26,4
12,5
:

74,6

32,2
15
:

1998

71,2

28,6

13,5

:

78,2
34,5

17

:

162 

1999

74,4
31,8
15,5
66

81
37,4
19,6
68,4

1999

68,2
27,2
12,9
:

75

32,5
15,4
:

1999

71,5

28,8

13,7

:

78,3
34,5

17

:

2000

74,6
32
15,6
65,7

81
37,5
19,7
69,1

2000

68,4
27
12,7
:

75

32,4
15,3
:

2000

71,7

29

13,8

:

78,5
34,8

17,3

:

2001

75
32,3
15,9
66,6

81,2
37,7
19,9
68,8

2001

68,6
27,2
13
:

75,4

32,8
15,6
:

2001

72,1

29,3

14

:

78,6
34,8

17,3

:

2002

75,1
32,3
15,8
66.9 (e)

81,2
37,5
19,7
69.0 (e) 

2003

75,3
32,5
15,9
67.4 (e)

81,1
37,3
19,6
69.2 (e) 

2004

76
33
16,4
58.4 (b)

81,8
38
20,2
58.1 (b)

2002

68,8
27,3
13
:

75,5

32,9
15,7
:

2002

72,1

29,3

13,9

62.8 (p)

78,7
34,9

17,3

63.3  (p)

2003

68,9
27,3
13
:

75,9

33,1
15,8
:

2003

72

29,2

13,8

:

78,6
34,7

17,2

:

2004

68,9
27,3
13
:

75,8

33
15,8
:

2004

72,6

29,7

14,2

:

79,2
35,3

17,6

:

2005

76,2
33,1
16,6
61,7

81,9
38
20,2
61,9

2005

69
27,2
13,1
:

76,2

33,3
16,1
:

2005

72,9

29,9

14,4

57.9 (b)

79,2
35,3

17,7

59.9 (b)

2006

76,6
33,6
17
62,8

82,3
38,5
20,6
62,8

2006

69,2
27,3
13,2
:

76,3

33,5
16,3
:

2006

73,5

30,4

14,8

57,8

79,9
36

18,3

59,8

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

1995

72,7

30,2

14,1

61,6

77,9
34,4

17,6

60,7

1995

73,3

30,7

14,8

60

79,9
36,4

18,7

64,3

1995

61,5

23,4

12

:

74,3

32,4

16,1

:

DK
DK
DK
DK

DK
DK
DK
DK

DE
DE
DE
DE

DE
DE
DE
DE

EE
EE
EE
EE

EE
EE
EE
EE

1996

73,1

30,5

14,4

61,7

78,3
34,9

17,9

61,1

1996

73,6

31

14,9

60,8

80,1
36,5

18,8

64,5

1996

64,3

24,5

12,2

:

75,6

33

16,4

:

EN 

1997

73,6

30,9

14,6

61,6

78,6
35

18

1998

74

31,1

14,9

62,4

79
35,4

18,3

60.7 (e) 

61.3 (e) 

1997

74,1

31,4

15,2

1998

74,5

31,7

15,4

1999

74,2

31,3

15

62,5

79
35,2

18,1

60,8

1999

74,8

32

15,6

2000

74,5

31,6

15,2

62,9

79,2
35,5

18,3

61,9

2000

75,1

32,2

15,8

2001

74,7

31,7

15,2

62,2

79,3
35,6

18,3

60,4

2001

75,6

32,5

16,1

2002

74,8

31,8

15,4

62.8 (e) 

79,4
35,6

18,2

2003

75

32

15,6

63 (e)

79,8
35,9

18,5

2004

75,4

32,4

15,9

68.3 (b)

80,2
36,4

19

61.0 (e) 

60.9 (e) 

68.8 (b)

2002

75,7

32,6

16,2

2003

75,8

32,7

16,2

61.9 (e)

62.1 (e)

62.3 (e)

63.2 (e)

64.1 (e)

64.4 (e)

65 (e)

80,5
36,9

19,1

80,8
37,1

19,3

81
37,3

19,4

81,2
37,5

19,6

81,4
37,6

19,8

81,3
37,5

19,6

81,3
37,5

19,5

64.3 (e) 

64.3 (e) 

64.3 (e) 

64.6 (e) 

64.5 (e) 

64.5 (e) 

64.7 (e) 

1999

64,9

25,2

12,6

:

76

33,5

17

:

2000

65,5

25,3

12,8

:

76,2

33,6

17

:

2001

64,9

24,9

12,7

:

76,4

33,7

17,3

:

2002

65,3

25,3

12,8

:

77

34

17,3

:

2003

66,1

25,6

12,7

:

77,1

34,1

17,4

:

1997

64,3

24,9

12,5

:

75,9

33,3

16,8

:

1998

64,1

24,3

12,2

:

75,4

32,9

16,5

:

163 

2005

76

32,8

16,1

68,4

80,5
36,6

19,1

68,2

2005

76,7

33,4

16,9

55 (b)

82
38,1

20,1

55.1 (b)

2005

67,3

26,2

13,1

48

78,2

35

18

2004

76,5

33,3

16,7

:

81,9
38

20,1

:

2004

66,4

25,8

13

49.8 (b)

77,8

34,6

17,8

53.3 (b) 

52,2

2006

76,1

32,8

16,2

67,7

80,7
36,8

19,2

67,1

2006

77,2

33,8

17,2

58,5

82,4
38,5

20,5

58

2006

67,4

26,3

13,2

49,4

78,6

35,1

18,3

53,7

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995

72,8

30,1

13,5

63,2

78,3

34,8

17,2

:

1995

75

32,6

15,9

65,8

80,1

36,5

18,2

69.2 (e)

1995

74,4

32,5

16,2

64,2

81,8

38,4

20,2

67,7

IE
IE
IE
IE

IE
IE
IE
IE

EL
EL
EL
EL

EL
EL
EL
EL

ES
ES
ES
ES

ES
ES
ES
ES

1996

73,1

30,5

13,9

64

78,7

35,1

17,4

:

1996

75,1

32,6

16

66,9

80,2

36,6

18,3

69,6

1996

74,5

32,6

16,2

65,1

82

38,5

20,3

68,4

1997

73,4

30,7

14

63,2

78,7

35,2

17,6

:

1997

75,4

32,9

16,2

66,4

80,4

36,8

18,4

68,7

1997

75,2

32,8

16,3

65,5

82,3

38,8

20,5

68,2

1998

73,4

30,9

14,2

64

79,1

35,5

17,8

:

1998

75,4

32,8

16,1

66,5

80,3

36,7

18,3

68,3

1998

75,3

32,8

16,2

65,2

82,4

38,7

20,4

68,2

164 

1999

73,4

30,8

14,1

63,9

78,9

35,3

17,6

67,6

1999

75,5

32,9

16,2

66,7

80,5

36,8

18,4

69,4

1999

75,3

32,7

16,2

65,6

82,4

38,7

20,3

69,5

2000

74

31,5

14,6

63,3

79,2

35,7

18

66,9

2000

75,5

32,8

16,1

66,3

80,6

36,8

18,4

68,2

2000

75,8

33,2

16,7

66,5

82,9

39,2

20,8

69,3

2001

74,5

31,9

15

63,3

79,9

36,4

18,5

66,5

2001

75,9

33,2

16,5

66,7

81

37,2

18,7

68,8

2001

76,2

33,4

16,9

66

83,2

39,4

21

2002

75,2

32,4

15,4

2003

75,9

33

15,9

2004

76,4

33,4

16,2

63.5 (e) 

63.4 (e) 

62.5 (b)

80,5

36,9

18,9

80,8

37

19,2

81,4

37,6

19,7

65.9 (e) 

65.4 (e) 

64.3 (b)

2002

76,2

33,4

16,6

2003

76,5

33,5

16,7

2004

76,6

33,7

16,9

66.7 (e)

66.7 (e)

63.7 (b)

81,1

37,2

18,7

81,2

37,2

18,7

81,3

37,5

18,9

68.5 (e)

68.4 (e)

65.2 (b)

2002

76,3

33,5

16,9

2003

76,3

33,5

16,8

2004

76,9

34

17,3

66.6 (e) 

66.8 (e) 

62.5 (b)

83,2

39,4

21

83

39,2

20,8

83,7

39,9

21,5

69.2 (e) 

69.9 (e) 

70.2 (e) 

62.5 (b)

2005

77,3

34,1

16,8

62,9

81,7

37,9

20

64,1

2005

76,8

33,9

17,1

65.7 

81,6

37,8

19,2

67,2

2005

77

33,9

17,3

63,2

83,7

39,7

21,3

63,1

2006

77,3

34,1

16,8

63,3

82,1

38,2

20,2

65

2006

77,2

34,3

17,5

66,3

81,9

37,9

19,4

67,9

2006

77,7

34,6

17,9

63,7

84,4

40,4

22

63,3

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

FR
FR
FR
FR

FR
FR
FR
FR

IT
IT
IT
IT

IT
IT
IT
IT

CY
CY
CY
CY

CY
CY
CY
CY

EN 

1995

1996

1997

:

:

:

60

:

:

:

:

:

:

:

:

:

59,6

60,2

:

:

:

:

:

:

62,4

62,5

63,1

1995

75,1

32,6

15,8

66,7

81,6

38

19,9

70

1996

75,5

32,9

16

67,4

81,8

38,3

20,1

70.5 (e) 

1997

75,9

33,1

16,1

68

82,1

38,4

20,2

71,3

1998

74,8

32,4

16,5

59,2

82,6

39,1

21,2

62,8

1998

76,1

33,1

16,1

67,9

82,2

38,5

20,3

71,3

1999

75

32,6

16,6

60,1

82,7

39,2

21,2

63,3

1999

76,6

33,5

16,4

68,7

82,7

38,8

20,5

72,1

2000

75,3

32,9

16,8

60,1

83

39,4

21,4

63.2 (e) 

2000

77

33,8

16,7

69,7

82,9

39

20,7

72,9

2005

76,7

33,9

17,7

62

83,7

40

22

:

:

:

2001

75,5

33

17

2002

75,7

33,1

17

2003

75,8

33,1

17

2004

76,7

33,9

17,7

60,5

60.4 (e) 

60.6 (e) 

61.2 (b)

83

39,4

21,5

63,3

2001

77,2

34,1

16,9

69,8

83,2

39,3

21

83

39,3

21,3

82,7

39

21

83,8

40,1

22,1

63.7 (e) 

63.9 (e) 

64.1 (b)

64,3

2002

77,4

34,2

17

2003

77,1

34

16,8

2004

77,9

34,7

17,5

70.4 (e) 

70.9 (e) 

67.9 (b)

65,8

83,2

39,3

21

82,8

38,8

20,6

83,8

39,8

21,5

:

:

:

73.0 (e) 

73.9 (e) 

74.4 (e) 

70.2 (b)

67

2006

77,3

34,4

18,2

62,7

84,4

40,6

22,6

64,1

2005

2006

1995

1996

1997

1998

1999

2000

2001

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

:

:
:

:

:

:

:

:

165 

2002

76,4

33,7
16,3

:

81

37,4

19

:

2003

77,4

34,2
16,8

68,4

81,6

37,7

19,3

69,6

2004

76,8

33,9
16,7

:

82,1

38

19,5

:

2005

76,8

34,2
16,8

59.5 (b)

81,1

37,6

19,1

57.9 (b)

:

:

:

:

:

:

:

:

2006

78,8

35,4
17,7

64,3

82,4

38,3

19,7

63,2

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995

1996

1997

1998

1999

2000

2001

:

:
:

:

:

:

:

:

1999

66,3

26,4
13,4

:

77

34,5

17,6

:

1999

74,4

31,8
15,3

:

81,4

37,5

19,8

:

:

:
:

:

:

:

:

:

2000

66,8

26,7
13,7

:

77,5

34,8

17,9

:

2000

74,6

32
15,5

:

81,3

37,7

20,1

:

:

:
:

:

:

:

:

:

2001

65,9

26,2
13,5

:

77,6

34,7

17,9

:

2001

75,1

32,5
16

:

80,7

37,4

19,7

:

LV
LV
LV
LV

LV
LV
LV
LV

LT
LT
LT
LT

LT
LT
LT
LT

LU
LU
LU
LU

LU
LU
LU
LU

:

:
:

:

:

:

:

:

1995

63,3

24,5
12,9

:

75,1

33

16,9

:

1995

73

30,5
14,7

:

80,6

37,3

19,7

:

:

:
:

:

:

:

:

:

1996

64,6

25,2
13

:

75,9

33,6

17,2

:

1996

73,3

30,7
14,8

:

80,2

37,1

19,5

:

:

:
:

:

:

:

:

:

1997

65,5

26
13,2

:

76,6

34,1

17,3

:

1997

74

31,2
14,8

:

80

36,7

19,2

:

:

:
:

:

:

:

:

:

1998

66

26,2
13,3

:

76,6

34,1

17,4

:

1998

73,7

31,2
15,2

:

80,8

37,3

19,5

:

166 

2002

64,7

24,9
12,5

:

76

33,5

17

:

2002

66,2

26,1
13,3

:

77,5

34,6

17,8

:

2002

74,6

32,3
15,9

:

81,5

37,7

20

:

2003

65,6

25,3
12,6

:

75,9

33,2

16,8

:

2003

66,4

26,1
13,3

:

77,8

34,8

18,1

:

2003

74,8

31,9
15,3

:

80,8

37

18,9

:

2004

65,9

25,4
12,6

:

76,2

33,7

17,1

:

2004

66,3

26,1
13,4

:

77,7

34,7

17,9

:

2004

75,9

33,1
16,5

59.1 (b)

82,3

38,5

20,5

60.2 (b)

2005

65,4

25
12,5

50.6 (b)

76,5

33,8

17,2

53.1 (b)

2005

65,3

25,3
13

51.2 (b)

77,3

34,3

17,6

54.3 (b)

2005

76,7

33,3
16,7

62,2

82,3

38,4

20,4

62,1

2006

65,4

24,9
12,7

50,5

76,3

33,5

17,3

52,1

2006

65,3

25,1
13

52,4

77

34,2

17,6

56,1

2006

76,8

33,5
17

61

81,9

38

20,3

61,8

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995
65,4

24,7

12,2

:

74,8

32,2

16

:

1995
74,8

32,5

15,5

:

79,6

35,7

17,6

:

1995
74,6

31,6

14,7

61,1

80,5

36,9

19,2

62.1 (e) 

HU
HU
HU
HU

HU
HU
HU
HU

MT
MT
MT
MT

MT
MT
MT
MT

NL
NL
NL
NL

NL
NL
NL
NL

1996
66,3

25,1

12,3

:

75

32,4

15,9

:

1996
74,8

32,3

14,8

:

79,6

36,5

18,3

:

1996
74,7

31,6

14,8

62,1

80,5

36,9

19,2

61,5

1997
66,7

25,4

12,5

:

75,5

32,7

16,3

:

1997
75,2

32,1

14,6

:

80,1

36,6

18,4

:

1997
75,2

32

15,1

62,5

80,7

37

19,3

61,4

1998
66,5

25,3

12,5

:

75,6

32,8

16,4

:

1998
74,9

32

14,6

:

80

36,3

18,1

:

1998
75,2

32

15,1

61,9

80,8

37,1

19,4

61.1 (e) 

167 

1999
66,7

25,3

12,5

:

75,6

32,6

16,2

:

1999
75,3

32,1

15

:

79,4

35,9

17,8

:

1999
75,3

32,1

15,2

61,6

80,5

36,9

19,2

61,4

2000
67,6

26

13

:

76,2

33,2

16,7

:

2000
76,2

32,7

15,1

:

80,3

36,5

18,5

:

2000
:

:

:

61,4

:

:

:

60,2

2001
68,2

26,4

13,2

:

76,7

33,5

17

:

2001
76,6

33,4

15,7

:

81,2

36,9

18,7

:

2001
75,8

32,6

15,6

61,9

80,8

37,1

19,4

59,4

2002
68,3

26,4

13,2

:

76,7

33,6

17

:

2002
76,3

33

15,3

65.1  (p)

81,3

37,3

19,1

65.7  (p)

2002
76

32,7

15,6

2003
68,4

26,3

13

53.5  (p)

76,7

33,5

16,9

57.8  (p)

2003
76,4

33,2

15,6

:

80,8

36,9

18,6

:

2003
76,3

32,9

15,8

61.7 (e) 

61.7 (e) 

80,7

37

19,3

81

37,2

19,5

59.3 (e) 

58.8 (e) 

2004
68,7

26,6

13,4

:

77,2

33,8

17,3

:

2004
77,4

34,1

16,3

:

81,2

37,4

19,1

:

2004
76,9

33,5

16,3

:

81,5

37,7

19,9

:

2005
68,7

26,4

13,3

52 (b)

77,2

33,8

17,2

53.9 (b)

2005
77,3

33,8

16,2

68.5 (b)

81,4

37,5

19,4

70.1 (b)

2005
77,2

33,8

16,4

65 (b)

81,7

37,9

20,1

63.1 (b)

2006
69,2

26,8

13,6

54,2

77,8

34,3

17,7

57

2006
77

33,6

16,1

68,1

81,9

37,7

19,5

69,2

2006
77,7

34,2

16,8

65

82

38,1

20,3

63,2

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

AT
AT
AT
AT

AT
AT
AT
AT

PL
PL
PL
PL

PL
PL
PL
PL

PT
PT
PT
PT

PT
PT
PT
PT

1995
73,4

31

15

60

80,1

36,5

18,8

:

1995

67,7

26,7

12,9

:

76,4

33,6

16,5

:

1995

71,7

30,7

14,7

59,6

79

35,9

18,1

63,1

1996
73,7

31,2

15,1

62,3

80,2

36,6

18,9

:

1996

68,1

26,9

12,9

59,9

76,6

33,7

16,5

66,8

1996

71,6

30,6

14,6

58,2

79

35,9

18,1

60,5

1997
74,1

31,4

15,2

62,2

80,7

37

19,1

:

1997

68,5

27,1

13,1

:

77

33,9

16,8

:

1997

72,2

31

14,9

59,3

79,3

36,3

18,4

60,4

1998
74,5

31,7

15,4

63,4

81

37,3

19,4

:

1998

68,9

27,4

13,4

:

77,4

34,2

17,1

:

1998

72,4

31,1

14,9

59,1

79,5

36,4

18,5

61,1

168 

1999
74,9

32

15,7

63,6

81

37,3

19,4

:

1999

68,8

27,3

13,3

:

77,5

34,3

17,1

:

1999

72,6

31,3

15

58,8

79,7

36,4

18,5

60,7

2000
75,2

32,4

16

64,6

81,2

37,5

19,6

68

2000

69,6

27,9

13,6

:

78

34,7

17,5

:

2000

73,2

31,6

15,4

60,2

80,2

36,9

18,9

62,2

2001
75,7

32,8

16,3

64,2

81,7

37,9

20

68,5

2001

70

28,1

13,7

:

78,4

35

17,7

:

2001

73,5

31,9

15,7

59,5

80,5

37,1

19,1

62,7

2002
75,8

32,9

16,3

2003
75,9

32,9

16,4

2004
76,4

33,4

16,9

65.6 (e) 

66.2 (e) 

58.1 (b)

81,7

37,8

19,8

81,5

37,7

19,8

82,1

38,3

20,2

69.0 (e) 

69.6 (e) 

60.2 (b)

2002

70,3

28,3

13,9

62,5

78,8

35,3

18

68,9

2002

73,8

31,9

15,7

2003

70,5

28,4

13,9

:

78,8

35,3

18

:

2003

74,2

32

15,7

2004

70,6

28,5

14,2

:

79,2

35,6

18,3

:

2004

75

32,6

16,3

59.7 (e) 

59.8 (e) 

55.1 (b)

80,6

37,2

19,2

80,6

37

19

81,5

37,9

19,7

61.8 (e) 

61.8 (e) 

52 (b)

2005
76,7

33,6

17

57,8

82,3

38,4

20,4

59,6

2005

70,8

28,6

14,3

61

79,3

35,8

18,5

66.6 (b)

2005

74,9

32,4

16,1

58,4

81,3

37,6

19,4

56,7

2006
77,2

34

17,3

58,4

82,8

38,9

20,7

60,8

2006

70,9

28,8

14,5

58,2

79,7

36,1

18,8

62,5

2006

75,5

32,9

16,6

59,6

82,3

38,5

20,2

57,6

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995

65,5

26

12,8

73,5

31,8

15,3

1995

70,8

28,6
13,6

:

78,5

35

17,6

:

1995
68,4

26,7

12,7

:

76,5

33,3

16,2

:

RO
RO
RO
RO

RO
RO
RO
RO

SI
SI
SI
SI

SI
SI
SI
SI

SK
SK
SK
SK

SK
SK
SK
SK

1996

65,1

25,6

12,4

72,8

31,4

14,9

1996

71,1

29
13,8

:

79

35,4

18,1

:

1996
68,8

27

12,8

:

77

33,8

16,6

:

1997

65,2

25,8

12,7

73,3

31,8

15,3

1997

71,1

29
14

:

79,1

35,5

18

:

1997
68,9

27

12,9

:

76,9

33,7

16,5

:

1998

66,3

26,4

13

73,8

32,1

15,5

1998

71,3

29,1
13,9

:

79,2

35,6

18,1

:

1998
68,6

26,9

12,8

:

77

33,8

16,6

:

169 

1999

67,1

26,9

13

74,2

32,3

15,5

1999

71,8

29,3
14,1

:

79,5

35,8

18,3

:

1999
69

27,1

13

:

77,4

34

16,8

:

2000

67,7

27,3

13,4

74,8

32,7

15,9

2000

72,2

29,7
14,2

:

79,9

36,2

18,7

:

2000
69,2

27,2

12,9

:

77,5

34,1

16,7

:

2001

67,5

27

13,3

74,9

32,7

16

2001

72,3

29,8
14,5

:

80,4

36,5

19

:

2001
69,5

27,3

13

:

77,7

34,1

16,8

:

2002

67,3

26,7

12,9

74,7

32,4

15,7

2002

72,6

30
14,5

:

80,5

36,6

19

:

2002
69,8

27,5

13,2

:

77,7

34,3

16,9

:

2003

67,7

26,8

13

75

32,7

15,8

2003

72,5

29,8
14,3

:

80,3

36,5

18,7

:

2003
69,8

27,6

13,2

:

77,7

34,3

16,9

:

2004

68,2

27,3

13,3

75,5

33,1

16,2

2004

73,5

30,7
15

:

80,8

37

19,4

:

2004
70,3

28

13,3

:

78

34,5

17,1

:

2005

68,7

27,4

13,4

75,7

33,1

16,1

2005

73,9

31,1
15,2

56.3 (b)

80,9

37,1

19,3

59.9 (b)

2005
70,2

27,8

13,3

54.9 (b)

78,1

34,5

17,1

56.4 (b)

2006

69,2

27,7

13,6

:

76,2

33,5

16,5

:

2006

74,5

31,6
15,8

57,6

82

37,9

20

61

2006
70,4

28

13,3

54,3

78,4

34,8

17,3

54,4

EN 

 
  
Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

Life expectancy at birth - males
Life expectancy at 45 - males
Life expectancy at 65 - males
Healthy Life Years at birth - males

Life expectancy at birth - females
Life expectancy at 45 - females
Life expectancy at 65 - females
Healthy Life Years at birth - females

EN 

1995
72,8

30,4

14,6

:

80,4

36,7

18,7

:

1995
76,2
33
16
:

81,7
37,8
19,9
:

1995
74
31,2
14,6
60,6

1996
73,1

30,7

14,7

54,6

80,7

37

18,9

57,7

1996
76,6
33,2
16,1
:

81,7
37,8
19,9
:

1996
74,3
31,5
14,9
60,8

79,3
35,7
18,2
61.2 (e) 

79,5
35,9
18,4
61.8 (e) 

1997
73,5

31

15

55,5

80,7

37

19,1

57,6

1997
76,8
33,4
16,3
62,1

82
38,1
20,1
60

1997
74,6
31,8
15,1
60.9 (e) 

79,7
36,1
18,5
61.2 (e) 

FI
FI
FI
FI

FI
FI
FI
FI

SE
SE
SE
SE

SE
SE
SE
SE

UK
UK
UK
UK

UK
UK
UK
UK

1998
73,6

31

15

55,9

81

37,3

19,3

58,3

1998
76,9
33,6
16,4
61,7

82,1
38,2
20,2
61.3 (e) 

1998
74,8
32
15,3
60.8 (e) 

79,8
36,2
18,6
62.2 (e) 

170 

1999
73,8

31,2

15,2

55,8

81,2

37,5

19,5

57,4

1999
77,1
33,8
16,5
62

82
38
20
61,8

2000
74,2

31,6

15,5

56,3

81,2

37,5

19,5

56.8 (e) 

2000
77,4
34,1
16,7
63,1

82
38
20,2
61,9

2001
74,6

32

15,7

56,7

81,7

37,8

19,8

56,9

2001
77,6
34,2
16,9
61,9

82,2
38,1
20,2
61

1999
75
32,1
15,4
61.2 (e) 

79,9
36,2
18,6
61.3 (e) 

2000
75,5
32,6
15,8
61.3 (e) 

80,3
36,7
19
61.2 (e) 

2001
75,8
32,9
16,1
61.1 (e) 

80,5
36,9
19,2
60.8 (e) 

2002
74,9

32,1

15,8

2003
75,1

32,3

16,2

2004
75,4

32,6

16,5

57.0 (e) 

57.3 (e) 

53.1 (b)

81,6

37,8

19,8

81,9

38

20

82,5

38,6

20,7

56.8 (e) 

56.5 (e) 

52.9 (b)

2002
77,7
34,3
16,9
62.4 (e) 

82,1
38,1
20,1
61.9 (e) 

2002
76
33,1
16,2
61.4 (e) 

80,6
36,9
19,2
60.9 (e) 

2003
78
34,5
17,1
62.5 (e) 

82,5
38,5
20,4
62.2 (e) 

2003
76,2
33,2
16,3
61.5 (e)

80,5
36,8
19,1
60.9 (e)

2004
78,4
34,9
17,5
62 (b)

82,8
38,8
20,7
60.9 (b)

2004
76,8
33,8
16,8
:

81
37,2
19,4
:

2005
75,6

32,8

16,8

51,7

82,5

38,8

21

52,4

2005
78,5
34,9
17,4
64,2

82,9
38,8
20,7
63,1

2005
77,1
34
17
63.2 (b)

81,1
37,4
19,5
65 (b)

2006
75,9

33,1

16,9

52,9

83,1

39,2

21,2

52,7

2006
78,8
35,2
17,7
67,1

83,1
39
20,9
67

2006
:
:
:
:

:
:
:
:

EN 

 
  
4. Early school-leavers  (% of the total population aged 18-24 who have at most lower secondary education and not in further education or training)

2000 total

female
male

2004 total

female
male

2005 total

female
male

2006 total

female
male

EU27

17,6e
15,6e
19,7e

EU25
17,3e
15,2e
19,5e

16,1
13,7
18,5

15,6
13,6
17,6

15,3
13,2
17,5

15,6
13,1
18

15,2
13,1
17,3

15,1
12,8
17,4

BE
12,5
10,2
14,8

11,9b
8,3b
15,6b

13
10,6
15,3

12,6
10,2
14,9

BG
:
:
:

21,4
20,7
22,1

20
20,6
19,5

18
17,9
18,2

CZ

:
:
:

6,1
6,5
5,8

6,4
6,6
6,2

5,5
5,4
5,7

DK

11,6
9,9
13,4

8,5
6,7
10,4

8,5
7,5
9,4

10,9
9,1
12,8

DE

14,9
15,2
14,6

12,1
11,9
12,2

13,8
14,1
13,5

13,8
13,6
13,9

EE

14,2
12,1u
16,3

13,7
:
20,5

14
10,7u
17,4u

13,2
:
19,6u

IE
:
:
:

12,9p
9,7p
16,1p

12,3p
9,6p
14,9p

12,3
9
15,6

EL
18,2
13,6
22,9

14,9
11,6
18,3

13,3
9,2
17,5

15,9
11
20,7

ES
29,1
23,4
34,7

31,7
24,6
38,5

30,8b
25b
36,4b

29,9
23,8
35,8

2007 total

female
male

14,8
12,7
16,9

12,3
10,7
13,9
u = data lack reliability due to low sample size / : = not available or unreliable data / b = break / p = provisional
In DK, LU, IS, NO, EE, LV, LT, CY, MT and SI, the high degree of variation of results over time is partly influenced by a low sample size. 
In CY, the reference population (denominator) excludes students abroad. In DE (2004), participation to personnel interest courses is excluded
Source : Eurostat, Labour Force Survey - Quarter 2 results

12.4b
8.9b
15.7b

16,6
16,9
16,3

12,7
11,9
13,4

31
25,6
36,1

14,5
12,3
16,7

14,7
10,7
18,6

14,3
:
21,0

11,5
8,7
14,2

:
:
:

FR
13,3
11,9
14,8

14,2
12,3
16,1

12,6
10,7
14,6

13,1
11,2
15,1

12,7
10,9
14,6

IT
25,3
21,9
28,8

22,3
18,4
26,2

21,9
17,8
25,9

20,8
17,3
24,3

19,3
15,9
22,6

CY
18,5
13,9
25

20,6
14,9
27,2

18,1
10,6
26,6

16
9,2
23,5

12,6
6,8
19,5

LV
:
:
:

15,6
10,7
20,5

11,9
8,2
15,5

19p
16.1p
21.6p

16p
12.3p
19.7p

LT
16,7
14,9
18,5

9,5b
7,4u
11,6u

9,2
6,2u
12,2u

10,3
7u
13,3u

8,7
5.9u
11,4

LU
16,8
17,6
15,9

12,7
12,7
12,6

13,3
9,6
17

17,4
14
20,9

15,1
11.1u
19,2

HU
13,8
13,2
14,3

12,6
11,4
13,7

12,3
11,1
13,5

12,4
10,7
14

10,9
9,3
12,5

MT
54,2
56,1
52,5

42b
39,5b
44,2b

41,2
39,3
43

41,7
38,8
44,6

37,3
32,9
41,1

NL
15,5
14,8
16,2

14
11,9
16,1

13,6
11,2
15,8

12,9
10,7
15,1

12
9,6
14,4

AT
10,2
10,7
9,6

8,7i
7,9i
9,5i

9
8,5
9,4

9,6
9,8
9,3

10,9
10,2
11,6

PL
:
:
:

5,7b
3,7b
7,7b

5,5
4
6,9

5,6
3,8
7,2

5
3,6
6,4

PT
42,6
35,1
50,1

39,4b
30,6b
47,9b

38,6
30,1
46,7

39,2p
31,8p
46,4p

36.3p
30.4p
42.0p

RO
22,3
21,3
23,3

23,6b
22,4b
24,9b

20,8
20,1
21,4

19
18,9
19,1

19,2
19,1
19,2

SL
:
:
:

4,2u
2,6u
5,8u

4,3u
2,8u
5,7u

5,2u
3,3u
6,9u

4.3u
2.7u
5.7u

SK
:
:
:

7,1
6,4
7,8

5,8
5,7
6

6,4
5,5
7,3

7,2
6,3
8,1

FI
8,9b
6,5b
11,3b

8,7
6,9
10,6

9,3
7,3
11,3

8,3p
6,4p
10,4p

7,9
6,3
9,7

SE
7,7
6,2
9,2

8,6
7,9
9,3

11,7b
10,9b
12,4b

12
10,7
13,3

8,6b
7,0b
10,2b

UK
18,4
17,9
19

14,9i
14,2i
15,7i

14
13,2
14,7

13
11,4
14,6

17,0b
15,8b
18,2b

EN 

171 

EN 

 
  
5. People living in jobless households: children (0-17 years) and prime-age adults (18-59 years), selected years (% of population in the relevant age group)

EU27

EU25

2001 Children

Adults (18-59)
Total

Men

Women

2002 Children

Adults (18-59)
Total

Men

Women

2003 Children

Adults (18-59)
Total

Men

Women

2004 Children

Adults (18-59)
Total

Men

Women

2005 Children

9,7e

Adults (18-59)
Total

10,3e

Men

9,3e

Women

11,2e

2006 Children

9,7e

Adults (18-59)
9,9e
Total

Men

8,9e

Women

10,9e

9.5e

10.1e

8.8e

11.4e

9.8e

10.2e

8.9e

11.4e

9.8e

10.2e

9e

11.3e

9.8i

10.3i

9.3i

11.4i

9.6e

10.2e

9.2e

11.2e

9.6e

9.9e

8.9e

10.9e

2007 Children

9.4e

9.3e

Adults (18-59)
Total

Men

Women

9.3e

8,2e

9.2e

8.2e

10.3e

10.2e

BE

12,9

13,8

11,5

16,2

13,8

14,2

11,9

16,6

13,9

14,4

12,7

16,2

13,2

13,7

11,3

16

12,9

13,5

11,6

15,4

13,5

14,3

12,3

16,4

12

12,3

10,6

13,9

BG

19

17.3b

16.8b

17.8b

18,7

16,6

16,1

17

16,6

15,3

14,7

15,8

15,6

13,7

13,2

14,2

14,5

13

12,6

13,5

14,5

11,6

11,1

12

12,8

10,2

10,1

10,3

CZ

8

7,9

6,2

9,5

7,6

7,3

5,6

9,1

8,4

7,7

5,8

9,7

9

8

6,4

9,6

8,1

7,4

5,8

9

8,2

7,3

5,8

8,8

8

6,5

4,9

8,1

DK

:

:

:

:

5,6

7,6

7,2

8

5,7

8,6

7,8

9,3

6

8,5

8,3

8,8

5,7

7,7

7,7

7,8

5

6,9

6,4

7,3

:

:

:

:

DE

8,9

9,7

8,9

10,5

9,3

10

9,4

10,7

10,3

10,6

10

11,2

10,9

11,1

10,8

11,4

10.7p

11p

10.9p

11.2p

10.3p

10.5p

10.3p

10.7p

9,6

9,5

9,1

9,9

EE

11,2

11

10,9

11,1

10,1

10,8

10,6

10,9

9

10,9

11,3

10,5

9,6

9,5

10,2

8,7

9,1

8,5

10,2

7

8,2

6

6,1

5,8

7,2

6

6,1

5,9

IE

10,4

8,8

7,4

10,2

10,8

8,5

7,3

9,7

11,8

8,9

7,6

10,2

11,8

8,6

7,2

10,1

12

8,4

7,2

9,8

11,3

7,9

6,5

9,3

11,5

7,9

6,7

9,3

EL

5,3

8,8

6,4

11,2

5,1

8,9

6,5

11,2

4,6

8,5

6,2

10,8

4,5

8,5

6,2

10,7

4,1

8,5

6,4

10,7

3,6

8,1

6,1

10,1

3,9

8

6

10

ES

6,4

7,4

6,6

8,3

6,6

7,3

6,6

8

6

7,2

6,5

7,8

6,3

7,3

6,7

7,9

5,4

6,7

6,2

7,2

5,1

6,3

5,8

6,8

5,3

6,2

5,8

6,7

FR

9,2

10,3

8,9

11,6

9,6

10,4

9,1

11,8

9,5

10,6

9,5

11,8

9,6

10,8

9,5

12,1

9,5

10,7

9,6

11,8

9.5p

10.9p

9.9p

12p

8,7

10

9

11,1

IT

7

10,8

9,1

12,4

7,2

10,2

8,6

11,8

7

9,7

8,1

11,3

5,7

9,1

7,9

10,4

5,6

9,5

8,3

10,8

5,4

9,2

7,8

10,6

5,8

9,2

7,9

10,6

CY

3,9

4,9

3,4

6,3

3,9

5,3

3,9

6,5

3,4

5,2

4,3

6,1

2,6

5

3,8

6,1

3,5

5,2

4,2

6,2

3,9

4,9

3,7

5,9

3,9

4,7

4,2

5,2

LV

10,7

12,8

12,3

13,2

LT

:

10

10,1

10

10.6b

8,4

10.5b

10.7b

10.3b

7,2

8,7

8,9

8,6

7,2

7,8

7,1

8,4

8,3

8,1

8,7

7,6

7,1

6,8

7,5

6,2

8,3

6,6

6,7

6,6

9.1b

8.5b

9.7b

6,1

7,4

7,4

7,4

6,5

8,1

8,3

8

6,2

6,6

6,9

6,4

5,3

7

7,2

6,9

8,3

7

7,3

6,8

LU

3,4

6,7

5,3

8,1

2,8

6,3

5,6

7

HU

13,5

13,2

12

14,3

14,3

13

12

14

3.9i

12.6b

7.5i

6i

9i

11.6b

10.9b

12.2b

3,4

13,2

7,1

5,7

8,5

2,7

6,7

5,4

8,1

3,7

7,1

5,4

8,9

3,4

7

6

7,9

11,9

11,1

12,7

14,2

12,3

11,6

13,1

13,3

11,6

10,6

12,6

13,9

11,9

10,8

12,9

MT

7,9

NL

6

7,8

5,7

9,9

7,6

7,2

5,8

8,6

8

7,9

6,2

9,7

9,2

8,6

6,8

10,4

8,9

8,2

6,5

9,9

8,2

6,7

5,2

8,2

9,2

7,7

6,2

9,3

6,9

5,4

8,5

6

6,7

5,3

8,1

7

8

6,7

9,3

7

8

6,7

9,3

7

8

6,9

9

6,2

7,4

6,2

8,6

5,9

6,5

5,3

7,6

AT

4,1

7,9

6,2

9,6

4,4

7,5

6,2

8,8

4,3

7,4

6,1

8,6

5.6i

8.8i

7.6i

10i

6,3

8,7

7,7

9,6

7,2

8,8

7,8

9,8

5,3

7,1

5,9

8,4

PL

:

13,8

12,9

14,7

:

15,1

14,1

16,1

:

14,8

13,7

15,9

:

15,8

14,8

16,8

:

15,3

14

16,6

12,8

14,4

13,2

15,6

9,5

11,6

10,4

12,7

PT

3,6

4,3

3,7

4,9

4,2

4,6

3,9

5,2

5

5,5

4,8

6,1

4,3

5,3

5

5,7

4,3

5,5

5,1

5,8

4,7

5,8

5,3

6,4

5,1

5,7

5,3

6,1

RO

6,8

8,7

7,7

9,6

9.8b

11.3b

10.1b

12.5b

10,2

11,1

9,8

12,4

11,1

11,1

10,4

11,7

10,4

10,4

9,4

11,3

10

9,7

8,8

10,6

10

10,4

9,3

11,5

SI

3,8

8,2

7,1

9,4

3,8

8

7

8,9

4

8,7

7,8

9,6

3,8

7,5

7

8

2.7u

6,7

6,3

7,1

3,6

7,2

6,6

7,8

2,2

6,5

5,5

7,5

SK

9.3u

10

9,6

10,5

12,1

10,9

10,4

11,4

11,8

10,1

9,3

10,9

12,8

10,8

10

11,6

13,8

10,2

9,5

10,9

11,8

9,6

9

10,2

10,6

8,9

8,1

9,6

FI

SE

:

:

:

:

:

:

:

:

5,7

10,9

11,6

10,3

5,7

11

11,2

10,9

6,6

10,5

11

10

4,9

9,5

10,1

9

4,4

9,1

9,6

8,6

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

:

UK

16,9

11,2

9,1

13,2

17,4

11,3

9,2

13,3

17

10,9

8,9

12,9

16,8

11

9

13

16,5

11

9,2

12,8

16,2

10,7

8,8

12,5

16,7

10,7

8,8

12,7

u = data lack reliability due to low sample size / : = not available or unreliable data / b = break / p = provisional / e: estimate
In DK, LU, IS, NO, EE, LV, LT, CY, MT and SI, the high degree of variation of results over time is partly influenced by a low sample size. 
In CY, the reference population (denominator) excludes students abroad. In DE (2003 and 2004), participation to personnel interest courses is excluded
Source : Eurostat, Labour Force Survey - Quarter 2 results

EN 

172 

EN 

 
  
6. Projected total public social expenditures
Total age-related public spending: pension, health care, long-term care, education and unemployment transfers (% of GDP) – baseline scenario
http://ec.europa.eu/economy_finance/epc/documents/2006/ageingannex_en.pdf
http://ec.europa.eu/economy_finance/epc/documents/2006/ageingreport_en.pdf

p.7
p.11

EU25
23,4

2004

Change 2004-2010

Change 2004-2020

Change 2004-2030

Change 2004-2040

Change 2004-2050

-0,7

-0,2

1,5

3

3,4

BE
25,4

-0,3

1,2

4,5

6,2

6,3

CZ
19,3

-0,5

-0,1

1,7

4,8

7,1

DK
26,8

0,2

1,8

4

5,3

4,8

DE
23,7

-1,2

-0,8

1

2

2,7

EE
17,1

-0,6

-2

-2,3

-2,8

-2,7

IE
15,5

-0,1

1,6

3,3

5,2

7,8

EL*
8,9

-0,2

-0,2

0,2

0,8

1,3

ES
20,1

-0,4

0,3

3,3

7,2

8,5

FR
26,7

0

0,9

1,9

2,9

2,9

IT
26,2

-0,5

-0,3

1,1

2,5

1,8

CY
16,4

0,1

1,2

4,1

7

11,8

LT
16

-0,7

-0,9

0,3

0,8

1,4

LV
17,5

-2,9

-2,9

-1,5

-1,3

-1,3

LU
19,5

-0,1

2,1

5,5

7,9

8,3

HU
20,7

0,3

1,6

2,8

5,7

7

MT
18,2

0,9

2,2

1,8

1

0,3

NL
20,9

-0,3

1,5

3,8

5,3

4,9

AT
25,2

-1

-1

0,8

0,9

0,1

PL
23,7

-3,5

-5,8

-6,1

-6,4

-6,7

PT
23,8

0,4

2,5

4,2

7,3

9,8

SI
24,2

-0,2

1,3

4,4

7,5

9,6

SK
16,2

-0,8

-0,9

0,3

1,5

2,9

FI
25,4

0,2

2,3

4,7

5,3

5,2

SE
29,6

-1,4

-1

1,3

2,3

2,2

UK

19,6

-0,2

0,3

2,2

3,3

4

1) Total expenditure for GR does not include pension expenditure. The Greek authorities have agreed to provide the pension projections in 2006. In the context of the most recent assessment
 of the sustainability of public finances based on the Greek stability programme, public spending on pensions was projected to increase by 10.3% of GDP between 2004 and 2050.
2) Total expenditure for: GR, FR, PT, CY, EE, HU does not include long-term care
3) The projection results for public spending on long-term care for Germany does not reflect current legislation where benefit levels are fixed. A scenario which comes closer to the current setting
 of legislation projects that public spending would remain constant as a share of GDP over the projection period.
Note: these figures refer to the baseline projections for social security spending on pensions, education and unemployment transfers.
For health care and long-term care, the projections refer to “AWG reference scenarios”

7a. Relative median income ratio of people aged 65+ (relative to the complementary age group 0-64) (%), 2007

EU27

EU25

BE

BG(1)

CZ 

DK

DK(2)

DE

EE

IE

EL

ES

FR

IT

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO(1)

SI

SK

FI

SE

UK

Relative median 
income ratio (65+/0-
64)

Total

0.84ps

0.84p

0,74

0.83i

0,81

0,7

0.62p

0.86p

0.65p

0.69p

0.83p

0,76

0.9p

0,86

0,57

0,65

0,69

0,96

0,97

0,79

0.83p

0,93

1,04

0.79p

0.89p

0,86

0,81

0,74

0,78

0,72

Source: SILC 2007,  Income data 2006; except for UK, income year 2006 and for IE moving income reference period (2005-2006);  (1) BG National HBS 2006, income data 2006; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

7b. Aggregate replacement ratio (%), 2007

EU27

EU25

BE

Aggregate 
replacement ratio  
(Pensions 65-74 
/Earnings 50-59)

Total

Men

Women

:

:

:

0,49

0,52

0,49

0,44

0,46

0,45

BG(1)

0.6i

0.62i

0.58i

CZ 

0,51

0,51

0,56

DK

DK(2)

0,39

0,38

0,43

0.37p

:

:

DE

0,45

0,47

0,48

EE

0,47

0,4

0,57

IE

0,47

0,41

0,53

EL

0,4

0,46

0,42

ES

0,47

0,52

0,48

FR

0,61

0,61

0,54

IT

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO(1)

SI

SK

FI

SE

0,49

0,56

0,37

0,29

0,34

0,34

0,38

0,33

0,43

0,4

0,38

0,44

0,61

0,59

0,58

0,58

0,6

0,57

0,5

0,52

0,48

0,42

0,49

0,54

0,61

0,62

0,68

0,58

0,64

0,57

0,47

0,5

0,48

:

:

:

0,44

0,51

0,39

0,54

0,53

0,57

0,46

0,46

0,48

0,61

0,63

0,54

UK

0,41

0,42

0,44

Source: SILC 2007,  Income data 2006; except for UK, income year 2006 and for IE moving income reference period (2005-2006);  (1) BG National HBS 2006, income data 2006; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

8a. Inequalities in access to health care (unmet need for care by income quintile for 3 reasons: too expensive, too long waiting time, too far to travel), SILC 2006

1st quintile

2nd quintile

3rd quintile

4th quintile

5th quintile

EU-27

EU-25

:
:

:

:

:

:
:

:

:

:

BE
1,8

0,4

0,2

:

0,1

CZ
1,4

0,7

0,5

0,5

0,2

DK
0,2

0,3

0,2

0,2

0,2

DE
:

:

:

:

:

EE
14,4

7

5,9

6,3

3,1

IE
2,7

2,1

2,4

1,9

0,7

EL
7,9

7,8

7,3

4,1

2

ES
0,9

0,9

0,5

0,4

0,2

FR
4,3

1,4

1,2

0,3

0,6

IT
9,2

5,1

4

3,1

2,1

CY
6,6

4,7

2,6

1,5

0,5

LV
28,9

20,5

10,2

9,8

5,9

LT
13,6

10,5

7,9

5,2

3,9

LU
0,8

0,1

0,2

0,2

0,4

HU
3,9

3,2

2,4

1,7

0,8

MT
3,4

1,9

1,6

1,2

0,8

NL
0,9

0,3

0,3

0,3

0,3

AT
1

0,5

0,2

0,3

0,3

PL
13,3

11

8,9

7,2

6,4

PT
9,6

6,8

4,9

2,7

1,1

SI
0,3

0,2

0,1

0,1

0,2

SK
6,4

3,4

2,2

1,5

0,8

FI
4,7

3,3

2,1

1,7

0,9

SE
4,1

3,9

3,3

2

1,1

UK
2,6

1,7

1,5

2,4

1,5

Source: SILC(2006)  
* This data should be interpreted with care when comparing levels of across countries due to a problem in the translation of the questionnaire.

8b. Doctor's consultations

EU-27

EU-25

:

:

BE

7,5

CZ

12,9

DK

7,5

EE

6,9

IE

:

EL

:

ES

8,1

FR

6,4

IT

7,0

CY

2,0

LV

5,2

LT

6,8

LU

6,0

HU

12,9

MT

1,9

NL

5,6

AT

6,7

PL

6,6

PT

3,9

SI

7,2

SK

10,4

FI

4,3

SE

2,8

UK

5,1

Notes:  (:) = data not available
Source: OECD Health Data. Calculated as the number of contacts with an ambulatory care physician divided by the population. Includes contacts in out-patient wards.

EN 

173 

EN 

 
  
9. At-risk of poverty rate anchored at a fixed moment in time (poverty threshold of 2005),  2007

Total population

Children aged 0-17
People aged 18-64

People aged 65+ 

Total
Men
Women
Total
Total
Men
Women
Total
Men
Women

EU27 EU25 BE

:

:

:

:

:

:

:

:

14p

14p

15p

17p

13p

12p

14p

17p

14p

14

14

15

16

12

11

13

22

19

BG(1)
:

CZ  DK DK(2) DE
14p
7

11

:

:

:

:

:

:

:

7

8

13

7

6

7

3

1

10

11

9

10

11

10

16

13

13p

15p

13p

14p

13p

15p

15p

12p

EE

8

8

8

9

8

9

8

6

4

IE

12

11

12

14

11

10

11

13

11

EL

ES

FR

20

19

20

23

18

18

19

22

20

17

16

18

20

14

13

15

23

22

13

12

14

16

12

11

13

13

12

IT

20

18

21

25

17

16

19

22

18

CY LV LT

LU HU MT NL AT

PL

10

9

12

7

6

5

8

39

35

10

10

10

11

10

10

10

9

5

8

7

8

11

7

7

7

5

1

14

13

15

21

13

13

14

8

7

10

10

10

16

10

10

10

4

2

11

10

11

14

9

8

10

13

16

9

9

10

13

8

7

9

8

7

13

12

15

17

11

10

13

16

11

13

13

12

18

12

13

12

4

3

PT RO(1)
18

:

17

19

21

15

14

16

26

24

:

:

:

:

:

:

:

:

SI

10

8

11

9

8

8

8

17

9

SK

5

5

5

9

5

5

5

3

2

FI

11

10

11

9

10

10

9

18

14

20

SE UK

9

9

9

10

9

10

8

8

5

11

16

15

17

19

13

12

13

24

21

27

4
Source: SILC 2007,  Income data 2006; except for UK, income year 2007 and for IE moving income reference period (2006-2007);  (1) BG, RO (:) data not available; (2) with imputed rent (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available n.a.=forthcomimg
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

18p

17p

17

15

14

42

25

22

11

19

24

24

25

10

27

4

7

6

8

6

9

5

:

:

:

10. Employment rate of older workers (% of people aged 55-64)

EU27 EU25

BE

BG CZ DK DE

EE

IE

EL

ES

FR

IT

CY LV LT

LU HU MT NL AT

PL

PT RO SL

SK

FI

SE UK

1998

2000

2002

2004

2005

2006

2007

total
male
female

total
male

female

total

male
female

total
male

female

total

male

female

total
male

female

total

male

female

:
:
:

36,9
47,1

27,4

38,5

48,4
29,1

40,6
50,3

31,6

35,8
46,6
25,5

36,6
46,9

26,9

38,7

48,8
29,2

41
50,7

31,7

42.3p

42.5p

51.5p

51.8p

33.5p

33.7p

43.5p
52.6p

43.6p
52.8p

34.8p

34.9p

44,7

53,9

36

44,9

54,1

36,1

22,9
32,1
14

26,3
36,4

16,6

26,6

36
17,5

30
39,1

21,1

31,8

41,7

22,1

32
40,9

23,2

34,4

42,9

26

b= break in data series u= unreliable or uncertain data
Source : Eurostat - Labour Force Survey, Annual averages.

EN 

:
:
:

37,1
52
53,2 61,3 47,2
42
22,9

37,7 50,2 41,7
60,2
62

39
56

35,1 28,3 27,7
52,6 32,5 41,4
15

:
:
:

36,3 39,5 25,1 17,3
27
48,1 54,4 35,2
9,6
27,5 28,3 15,5

:
:
:

33,9 28,4 32,1 49.6b 51,5 23,9 22,8 36,2
49
47,5 40,5 41,5 62.9b 59,5 31,8 39,1 38,4 66,1 59,1
39,2
44,5 16,1
20,3 17,1 24,1

34,1

38b

9,4

63

60

28,3 41,6 23,1 23,5 18,8 24,4

20,8 36,3 55,7 37,6 46,3 45,3
33,2 51,7 64,1 46,4 55,9 63,2 55,2 54,9 33,6 40,9 67,3 48,4 50,6 37,2 33,2 50,8 50,2 41,2 36,7 62,1

40,4 26,7 22,2 28,5 38,2 28,8 28,4 50,7 49,5 22,7 21,3 41,6 64,9 50.7b
32,3 35,4 42,9 67,8 60.1b

29,9 27,7 49,4

37

56

36

39

10,3 22,4 46,6

29

39

27,2 24,3 20,2 26,3 15,3 32,1 26,7 32,6 16,4 13,3

8,4

26,1 17,2 21,4 40,6 43,8 13,8

9,8

40,4 62,1 41.7b

27

40,8 57,9 38,9 51,6

48

39,2 39,6 34,7 28,9 49,4 41,7 41,6 28,1 25,6 30,1 42,3 29,1 26,1 51,4 37.3b 24,5 22,8 47,8

68

53,4

65
57,2 64,5 47,3 58,4
37
18,2 25,9 50,4 30,6 46,5 30,8

55,9 58,4 38,7 41,3 67,3 50,5 51,5 37,7 35,5 50,8 54,6 39,6 34,5 61,9 42.7b 35,4 39,1 48,5 70,4 62,6
47,2 65,6 44,5
24

21,9 30,8 17,3 32,2 35,2 34,1 18,4 17,6 10,9 29,9 19,3 18,9 42,2 32.6b 14,2

9,5

32,5 42,7 60,3 41,8 52,4 49,5 39,4 41,3 37,3 30.5b 49,9 47,9 47,1 30,4 31,1 31,5 45,2 28.8b 26,2 50,3 36,9
42,2 57,2 67,3 50,7 56,4

26,8 50,9 69,1 56,2
42.2b 70,8 55,8 57,6 38,3 38,4 53,4 56,9 38.9b 34,1 59,1 43,1 40,9 43,8 51,4 71,2 65,7

56,4 58,9

65

41

29

24,2 29,4 53,3

33

49,4 33,7

24

24,6 33,8 19.6b

30

41,9 39,3 22,2

25

11,5 33,4 19.3b 19,4 42,5 31,4 17,8 12,6 50,4

67

47

34,7 44,5 59,5 45.4p 56,1 51,6 41,6 43.1b 37,9 31,4 50,6 49,5 49,2 31,7

33

30,8 46,1 31,8 27,2 50,5 39,4 30,7 30,3 52,7 69.4b 56,9

45,5 59,3 65,6 53.5p 59,3 65,7 58,8 59.7b 40,7 42,7 70,8 55,2 59,1 38,3 40,6 50,8 56,9 41,3 35,9 58,1 46,7 43,1 47,8 52,8

72b

66

25,5 30,9 53,5 37.5p 53,7 37,3 25,8 27.4b 35,2 20,8 31,5 45,3 41,7 24,9 26,7 12,4 35,2 22,9 19,7 43,7 33,1 18,5 15,6 52,7 66.7b 48,1

39,6 45,2 60,7 48.4p 58,5 53,1 42,3 44,1 37.6p 32,5 53,6 53,3 49,6 33,2 33,6
49,5 59,5 67,1 56.4p 57,5

30
59,2 60,4 40.1p 43,7 71,6 59,5 55,7 38,7 41,4 50,4

67

47,7 35,5 28,1 50,1 41,7 32,6 33,1 54,5 69,6 57,4
66
58

44,5 49,8 54,8 72,3

45,3 38,4 58,2

50

31,1 32,1 54,3 40.6p 59,2 39,1 26,6 28,7 35.2p 21,9 36,6 48,7 45,1 27,8 27,1 11,2 37,2 26,3

19

42,8 34,5

21

18,9 54,3 66,9 49,1

42,6

46

58,6 51,5

60

53,8 42,4 44,6 38,3 33,8 55,9 57,7 53,4

32

33,1 28,5 50,9 38,6 29,7 50,9 41,4 33,5 35,6

55

70

57,4

51,8 59,6 64,9 59,7 59,4 67,9 59,1

34,5 33,5 52,4 43,6 60,5 39,6 26,9

60

30

40,5 45,1 72,5 64,6 60,8 35,6 41,7 45,9 61,5 49,8 41,4 58,6 50,3 45,3 52,5 55,1 72,9 66,3

36,2

23

40,3 52,4 47,9 28,6 26,2 11,6 40,1

28

19,4

44

33,6 22,2 21,2

55

67

48,9

174 

EN 

 
  
11. In work at-risk-of-poverty rate after social transfers by gender  (Age 18+), 2007

In work

Total 
Men

Women 

EU27 EU25 BE

8ps 

8ps 

7ps 

8p 

9p 

7p 

4

4

4

BG(1)
:

:

:

CZ  DK DK(2) DE
7p 
3

4

:

3

3

5

3

:

:

7p 

8p 

EE

IE

EL

ES

FR

8

6

9

6

6

6

14

15

12

11

12

9

6

7

6

IT

10

12

7

CY LV LT

LU HU MT NL AT

PL

6

6

7

10

9

10

8

8

8

9

9

9

6

7

5

4

5

2

5

5

5

6

6

6

12

13

10

PT RO(1)
4p 
10

10

9

5p 

3p 

SI

SK

FI

SE UK

5

5

4

5

5

5

5

5

6

7

7

6

8

8

8

Source: SILC 2007, Income data 2006; except for UK, income year 2007 and for IE moving income reference period (2006-2007);  (1) BG National HBS 2007, income data 2007; (2) with imputed rent data 2006 (see methodological 
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

12. Activity rates (% of population aged 15-64)

EU27 EU25

BE

BG CZ DK DE

EE

IE

EL

ES

FR

IT

CY LV LT

LU HU MT NL AT

PL

PT RO SL

SK

FI

SE UK

1998

2000

2002

2004

2005

2006

2007

Total
Male
Female

Total
Male
Female

Total
Male
Female

Total
Male
Female

Total

Male

Female

Total
Male

Female

Total

Male

:
:
:

68,6
77,1
60,1

68,6
76,8
60,5

69,3
77,0
61,6

68,0
77,4
58,7

68,7
77,4
60,0

69,0
77,3
60,7

69,7
77,5
62,0

69.8p

70.3p

77.3p

77.8p

62.3p

62.7p

70.2p
77.5p

70.6p
78p

62.9p

63.2p

70,5

77,7

70,9

78,2

63,7
Source : Eurostat - Labour Force Survey, Annual averages.
(b) break in series

Female

63,4

13. Dispersion of regional employment rates*, selected years (%)
EU27

EU25
13.4

BE
7.9

BG
10.3

12.2

11.9

:

:

8.7

8.4

8,7

8,6

7.0

7.1

7,3

7,1

11,4

11,1

2000

2004

2005

2006

2007

63,5
72,8
54,0

65,1
73,7
56,4

64,8
73,2
56,3

65,9
73,4
58,2

66,7

73,9

59,5

66,5
73,4

59,5

67,1

73,6

60,4

CZ
5.8

5.6

5.5

5,2

4,6

:
:
:

72,0 79,7 70,8 72,2 65,6 63,2 63,0 68,4 59,0
80,0 83,8 79,2 79,0 78,2 77,6 77,3 75,2 73,6
64,0 75,6 62,2 66,4 52,9 49,0 48,9 61,9 44,6

:
:
:

69,8 72,1 62,1 58,7
76,4 78,2 75,9 66,6
63,9 66,5 48,1 51,2

:
:
:

73,0 71,0 65,7 70.6b 68,9 68,2 69,3 72,3 76,2 75,4
82,6 80,3 72,8 79.3b 75,7 72,6 77,2 75,6 79,0 83,2
63,2 61,7 58,8 62.3b 62,3 63,6 61,7 69,1 73,5 67,4

60,7 71,3 80,0 71,1 70,2 68,2 63,8 65,4 68,7 60,1 69,1 67,2 70,8 64,1 60,1 58,0 75,2 71,0 65,8 71,4 68,4 67,5 69,9 74,5 77,3 75.4b
66,2 79,1 84,2 78,9 75,6 79,9 77,4 78,8 75,2 74,1 81,4 72,7 74,5 76,3 67,9 80,5 84,1 80,1 71,7 79,2 75,0 71,9 76,8 77,2 79,8 82.8b
55,6 63,6 75,6 63,3 65,3 56,3 50,5 52,0 62,4 46,3 57,7 62,1 67,3 51,6 52,7 35,2 66,0 62,0 59,9 63,9 61,9 62,9 63,2 71,9 74,8 68.2b

61,9 70,6 79,6 71,7 69,3 68,6 64,2 66,2 69,1 61,1 71,2 68,8 69,6 65,2 59,7 58,5 76,5 71,6 64,6 72,7 63.4b 67,8 69,9 74,9 77,6 75,2
66,4 78,6 83,6 78,8 74,6 79,2 77,6 79,1 75,5 74,3 81,3 74,1 73,6 76,7 67,1 80,1 84,5 79,6 70,6 80,0 70.4b 72,5 76,7 77,0 79,4 82,3
57,5 62,7 75,5 64,4 64,4 57,8 51,0 53,1 63,0 47,9 61,8 63,9 65,8 53,6 52,7 36,7 68,3 63,7 58,7 65,6 56.6b 63,0 63,2 72,8 75,8 68,3

61,8 70,0 80,1 72,6 70,0 69,5 66,5 68,7 69,5 62.7b 72,6 69,7 69,1 65,8 60,5 58,2 76,6 71.3b 64,0 73,0 63,0 69,8 69,7 74,2 77,2 75,2
66,4 77,9 84,0 79,2 74,4 79,9 79,0 80,4 75,3 74.9b 83,0 74,3 72,8 75,6 67,2 80,2 83,9 78.5b 70,1 79,1 70,0 74,5 76,5 76,4 79,1 82,0
57,2 62,2 76,2 65,8 66,0 59,0 54,1 56,8 63,9 50.6b 62,8 65,3 65,6 55,8 54,0 36,0 69,2 64.2b 57,9 67,0 56,2 65,0 63,0 72,0 75,2 68,6

62,1 70,4 79,8 74.3p 70,1 70,8 66,8 69.7b 69,5 62,5 72,4 69,6 68,4 66,6 61,3 58,1 76,9 72,4 64,4 73,4 62,3 70,7 68,9 74,7 78.7b 75,3

67,0 78,4 83,6 80.6p 73,6 80,6 79,2 80.9b 75,1 74,6 82,9 74,4 72,1 76,0 67,9 79,1 83,7 79,3 70,8 79,0 69,4 75,1 76,5 76,6 80.9b 81,9

57,3 62,4 75,9

68p

66,9 60,8 54,5 58.3b 64,1 50,4 62,5 65,1 64,9 57,0 55,1 36,9 70,0 65,6 58,1 67,9 55,3 66,1 61,5 72,8 76.3b 68,8

64,5 70,3 80,6 75.3p 72,4 71,8 67,0 70,8 69.4p 62,7 73,0 71,3 67,4 66,7 62,0 59,2 77,4 73,7 63,4 73,9 63,6 70,9 68,6 75,2 78,8 75,5
68,8 78,3 84,1 81.3p 75,8 81,5 79,1 81,3 74.8p 74,6 82,7 76,2 70,5 75,3 68,7 79,7 83,9 80,5 70,1 79,5 70,7 74,9 76,4 77,1 81,2 82,1

60,2 62,3 77,0 69.2p 69,3 61,9 55,0 60,2 64.1p 50,8 63,8 66,7 64,6 58,2 55,5 38,3 70,7 67,0 56,8 68,4 56,6 66,7 60,9 73,3 76,3 69,2

66,3 69,9 80,2 76,0 72,9 72,4 67,0 71,6 70,2 62,5 73,9 72,8 67,9 66,9 61,9 58,4 78,5 74,7 63,2 74,1 63,0 71,3 68,3 75,6 79,1 75,5

70,6 78,1 83,9 81,8 77,5 81,4 79,1 81,4 74,9 74,4 82,9 77,6 71,0 75,0 69,0 77,6 84,6 81,7 70,0 79,4 70,1 75,8 75,9 77,2 81,4 82,2

62,1 61,5 76,4 70,1 68,7 63,3 54,9 61,4 65,6 50,7 65,4 68,3 65,0 58,9 55,1 38,6 72,2 67,8 56,5 68,8 56,0 66,6 60,8 73,8 76,8 69,0

DK DE
5.7

-

EE
-

IE
-

-

-

:

:

6.2

5.6

5,2

4,8

-

-

-

-

-

-

:

:

EL
5.1

4.1

4.3

3,7

3,5

ES
10.7

8.7

8.3

7,8

7,5

FR
6.9

7.1

7.3

7,5

6,6

IT
17.5

15.6

16.0

16,3

16,3

CY LV LT
-

-

-

LU HU MT NL AT
2.5
-

9.0

2.2

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

9.4

9.9

9,1

9,7

-

-

-

-

2.3

2.0

2,2

2,2

3.5

4.1

3,4

3,8

PL
6.9

6.4

5.6

5,1

4,5

PT RO SL
-
4.6
4.3

3.5

3.3

3,1

3,3

4.9

4.5

3,6

4,6

-

-

:

:

SK
9.1

9.0

9.8

8,6

8,3

FI
6.8

5.5

5.5

5,4

5,6

SE UK
7.1
4.5

4.4

3.0

2,9

2,4

5.8

5.7

5,5

5,4

* Coefficient of variation of employment rates across regions at NUTS2 level
e = estimate; p = provisional figure
Source : Eurostat - Labour Force Survey, Annual averages

EN 

175 

EN 

 
  
14. Total health expenditure per capita

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

EU

1637

1717

1823

1960

2087

2226

2347

2454

BE

1358

1488

1576

1616

1654

1854

1923

1969

2042

2176

2377

2484

2685

3153

3311

3421

BG

244

289

343

386

484

552

609

655

734

560

541

568

768

817

899

917

922

926

938

980

1082

1195

1340

1388

1447

1591

1666

1977

1772

1993

1857

2129

1871

2275

1979

2399

2060

2413

2176

2483

2281

2592

2379

2671

2521

2809

2696

2937

2824

3090

3030

3162

3169

3251

CZ

DK DE

EE

1544

1769

...

FR

IT

CY LV LT

LU HU MT NL AT

1449

1359

...

161

162

1532

...

...

1416

1631

IE

792

887

1009

EL

853

874

974

ES

873

952

1553

1471

1030

1649

1522

1040

1086

1086

1752

1534

1120

1227

1114

1813

1540

1204

1264

1193

1997

1538

1280

1301

1249

2050

1613

1395

1354

1298

2107

1728

474

522

513

519

561

646

740

846

1499

1382

1383

2190

1829

1626

1468

1450

2279

1879

947

984

1801

1429

1536

2421

2053

1074

2128

1669

1636

2590

2215

1140

2360

1792

1745

2780

2223

1228

2515

1928

2019

2988

2272

1335

2724

1991

2128

3117

2401

1335

3126

2283

2260

3306

2496

1550

439

473

482

541

611

653

796

860

489

498

559

598

681

793

756

862

1630

1757

1870

1904

1911

1990

1972

2083

2384

2554

2738

578

615

629

709

660

659

679

763

810

852

971

1518

1728

1604

1870

1673

2014

1719

2183

1799

2259

1862

2351

1916

2439

1058

2054

2598

1103

2178

2726

1247

2337

2859

1294

2556

2890

3081

1114

1492

2833

3068

3582

1302

1586

2988

3206

4083

1327

1608

3156

3397

4153

1440

1733

3192

3507

PL

290

346

366

372

375

411

478

498

559

573

583

642

733

749

808

843

910

PT RO SI

SK

FI

SE UK

636

754

805

842

872

1036

1117

1186

1210

1329

1509

1569

1657

1824

1913

2029

2120

81

311

...

1367

1592

965

1503

1576

1052

1507

1617

1153

1393

1660

1209

1373

1665

1299

1440

1746

1350

1509

1861

1436

1562

1886

1499

1622

1982

1569

1700

2129

1690

1794

2284

1847

1913

2511

2021

2089

2707

2165

2210

2841

2259

564

584

599

603

665

730

792

1226

1303

1447

1581

1693

1767

1863

1058

2412

2964

2509

1959

1130

2523

3012

2580

2668

3202

2760

246

253

275

312

368

415

427

507

2483
Source: OECD health data 2008 for OECD Member States and WHO health for all database for the others

3488

3349

1490

3082

3371

2006

2458

3449

2614

4303

1504

3391

3606

EN 

176 

EN 

 
  
Context 1: Growth rate of GDP at constant prices (2000) - percentage change over previous year

2000

2005

2006

2007

2008f

EU27

EU25

3,9

2,0

3,1

2,9

1,0

3,9

2,0

3,1

2,9

1,0

BE

3,7

1,8

3,0

2,8

1,3

BG

5,4

6,2

6,3

6,2

6,4

CZ

3,6

6,3

6,8

6,0

4,2

DK

3,5

2,4

3,3

1,6

-0,6

DE

3,2

0,8

3,0

2,5

1,3

Source : Eurostat, Structural indicators database
f = forecast
Context 1: GDP per capita in Purchasing Power Standards (PPS), (EU-27 = 100)

2000
2005
2006
2007
2008f

EU27
100,0
100,0
100,0
100,0
100

EU25
105,0
104,1
103,9
103,7
103,6

BE
125,9
119,4
118,5
118,2
114,7

BG
27,8
34,5
36,5
37,3
38,5

CZ
68,5
75,9
77,4
80,2
80,6

DK
131,6
123,6
122,9
120,1
116,3

DE
118,5
116,9
115,8
114,8
112,4

EE

9,6

9,2

10,4

6,3

-2,4

EE
44,6
61,1
65,3
68,0
64,8

f = forecast
Source : Eurostat, Structural indicators database

Context 2a: Employment rate (% of population aged 15-64)

EU27

EU25

BE

BG

CZ

DK

DE

EE

1998

2000

2002

2004

2005

2006

2007

total
male
female

total
male
female

total
male
female

total
male
female

total
male
female

total
male
female

total
male
female

:
:
:

62,2
70,8
53,7

62,3
70,3
54,4

62,9
70,3
55,4

63.4p
70.8p
56.2p

64.4p
71.6p
57.2p

65,4
72,5
58,3

61,2
70,6
51,8

62,4
71,2
53,6

62,8
71,0
54,7

63,3
70,9
55,7

63.9p
71.3p
56.5p

64.7p
72p
57.4p

65,8
73,0
58,6

57,4
67,1
47,6

60,5
69,5
51,5

59,9
68,3
51,4

60,3
67,9
52,6

61,1
68,3
53,8

61,0
67,9
54,0

62,0
68,7
55,3

:
:
:

50,4
54,7
46,3

50,6
53,7
47,5

54,2
57,9
50,6

55,8
60,0
51,7

58,6
62,8
54,6

61,7
66,0
57,6

67,3
76,0
58,7

65,0
73,2
56,9

65,4
73,9
57,0

64,2
72,3
56,0

64,8
73,3
56,3

65,3
73,7
56,8

66,1
74,8
57,3

75,1
79,9
70,2

76,3
80,8
71,6

75,9
80,0
71,7

75,7
79,7
71,6

75,9
79,8
71,9

77,4
81,2
73,4

77,1
81,0
73,2

63,9
71,9
55,8

65,6
72,9
58,1

65,4
71,8
58,9

65,0
70,8
59,2

66p
71.3p
60.6p

67.5p
72.8p
62.2p

69,4
74,7
64,0

64,6
69,6
60,3

60,4
64,3
56,9

62,0
66,5
57,9

63,0
66,4
60,0

64,4
67,0
62,1

68,1
71,0
65,3

69,4
73,2
65,9

Source : Eurostat - Labour Force Survey, Annual averages.
b= break in data series

IE

9,2

6,4

5,7

6,0

-2,0

IE
131,0
144,1
147,4
150,4
140,1

IE

60,6
72,1
49,0

65,2
76,3
53,9

65,5
75,4
55,4

66,3
75,9
56,5

67,6
76,9
58,3

68,6
77,7
59,3

69,1
77,4
60,6

EL

4,5

2,9

4,5

4,0

2,9

EL
84,1
92,8
94,1
94,9
94,1

EL

56,0
71,7
40,5

56,5
71,5
41,7

57,5
72,2
42,9

59,4
73,7
45,2

60,1
74,2
46,1

61,0
74,6
47,4

61,4
74,9
47,9

ES

5,0

3,6

3,9

3,7

1,2

FR

3,9

1,9

2,2

2,2

0,7

IT

3,7

0,6

1,8

1,5

-0,6

ES
97,3
102,0
104,1
105,5
101,7

FR
115,3
110,8
109,5
109,2
105,7

IT
116,9
104,7
103,5
101,5
97,6

CY

5,0

3,9

4,1

4,4

3,6

CY
88,8
90,9
90,3
90,7
89,3

LV

6,9

10,6

11,9

10,2

-2,3

LV
36,7
48,6
52,6
54,7
52,6

LT

4,2

7,8

7,8

8,9

3,4

LT
39,3
52,9
55,5
59,5
59,9

LU

8,4

5,2

6,4

5,2

1,0

LU
243,7
254,1
267,1
266,5
261,1

5,2

4,0

4,1

1,1

0,9

HU
56,1
63,2
63,6
62,6
61,5

HU

MT

NL

3,9

2,0

3,4

3,5

1,9

AT

3,7

2,9

3,4

3,1

1,7

PL

4,3

3,6

6,2

6,6

5,0

:

3,5

3,2

3,9

2,1

MT
83,6
78,2
76,9
77,8
76,4

NL
134,3
130,8
130,9
131,0
129

AT
131,4
124,8
124,3
124,0
121,5

PL
48,2
51,3
52,3
53,4
54,3

PT

3,9

0,9

1,4

1,9

0,2

PT
78,0
76,9
76,4
76,2
73,7

RO

2,1

4,2

7,9

6,2

7,8

RO
25,9
35,0
38,4
42,2
44,3

SL

4,4

4,3

5,9

6,8

4,0

SL
79,8
87,4
87,7
89,3
89,3

SK

1,4

6,5

8,5

10,4

7,1

SK
1,7
2,0
2,1
2,2
69,1

FI

5,0

2,8

4,9

4,5

1,5

SE

4,4

3,3

4,2

2,5

0,5

UK

3,9

2,1

2,8

3,0

0,7

FI
117,3
114,3
114,9
115,9
114,1

SE
126,7
120,3
121,5
122,2
118,1

UK
119,0
121,8
120,4
119,2
115,5

ES

FR

IT

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO

SL

SK

FI

SE

UK

51,3
66,8
35,8

56,3
71,2
41,3

58,5
72,6
44,4

61,1
73,8
48,3

63.3b
75.2b
51.2b

64,8
76,1
53,2

65,6
76,2
54,7

60,2
67,4
53,1

62,1
69,2
55,2

63,0
69,5
56,7

63,1
69,0
57,4

63,1
68,8
57,6

63p
68.5p
57.7p

64,6
69,3
60,0

51,9
66,8
37,3

53,7
68,0
39,6

55,5
69,1
42,0

57.6b
70.1b
45.2b

57,6
69,9
45,3

58,4
70,5
46,3

58,7
70,7
46,6

:
:
:

65,7
78,7
53,5

68,6
78,9
59,1

68,9
79,8
58,7

68,5
79,2
58,4

69,6
79,4
60,3

71,0
80,0
62,4

59,9
65,1
55,1

57,5
61,5
53,8

60,4
64,3
56,8

62,3
66,4
58,5

63,3
67,6
59,3

66,3
70,4
62,4

68,3
72,5
64,4

62,3
66,2
58,6

59,1
60,5
57,7

59,9
62,7
57,2

61,2
64,7
57,8

62,6
66,1
59,4

63,6
66,3
61,0

64,9
67,9
62,2

60,5
74,5
46,2

62,7
75,0
50,1

63,4
75,1
51,6

62,5
72,8
51,9

63,6
73,3
53,7

63,6
72,6
54,6

64,2
72,3
56,1

53,7
60,5
47,2

56,3
63,1
49,7

56,2
62,9
49,8

56,8
63,1
50,7

56,9
63,1
51,0

57,3
63,8
51,1

57,3
64,0
50,9

:
:
:

54,2
75,0
33,1

54,4
74,7
33,9

54,0
75,1
32,7

53,9
73,8
33,7

54,8
74,5
34,9

54,6
72,9
35,7

70,2
80,2
60,1

72,9
82,1
63,5

74,4
82,4
66,2

73,1
80,2
65,8

73,2
79,9
66,4

74,3
80,9
67,7

76,0
82,2
69,6

67,9
77,0
58,8

68,5
77,3
59,6

68,7
76,4
61,3

67.8b
74.9b
60.7b

68,6
75,4
62,0

70,2
76,9
63,5

71,4
78,4
64,4

59,0
66,5
51,7

55,0
61,2
48,9

51,5
56,9
46,2

51,7
57,2
46,2

52,8
58,9
46,8

54,5
60,9
48,2

57,0
63,6
50,6

66.8b
75.9b
58.2b

68,4
76,5
60,5

68,8
76,5
61,4

67,8
74,2
61,7

67,5
73,4
61,7

67,9
73,9
62,0

67,8
73,8
61,9

64,2
70,4
58,2

63,0
68,6
57,5

57.6b
63.6b
51.8b

57,7
63,4
52,1

57,6
63,7
51,5

58,8
64,6
53,0

58,8
64,8
52,8

62,9
67,2
58,6

62,8
67,2
58,4

63,4
68,2
58,6

65,3
70,0
60,5

66,0
70,4
61,3

66,6
71,1
61,8

67,8
72,7
62,6

60,6
67,8
53,5

56,8
62,2
51,5

56,8
62,4
51,4

57,0
63,2
50,9

57,7
64,6
50,9

59,4
67,0
51,9

60,7
68,4
53,0

64,6
67,8
61,2

67,2
70,1
64,2

68,1
70,0
66,2

67,6
69,7
65,6

68,4
70,3
66,5

69,3
71,4
67,3

70,3
72,1
68,5

70,3
72,8
67,9

73,0
75,1
70,9

73,6
74,9
72,2

72,1
73,6
70,5

72.5b
74.4b
70.4b

73,1
75,5
70,7

74,2
76,5
71,8

70,5
77,3
63,6

71.2b
77.8b
64.7b

71,3
77,6
65,2

71,6
77,8
65,6

71,7
77,6
65,9

71,5
77,3
65,8

71,5
77,5
65,5

EN 

177 

EN 

 
  
Context 2b: Unemployment rate (% of labour force aged 15+)

EU27

EU25

BE

BG

1998

2000

2002

2004

2005

2006

2007

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

:
:
:

8,7
7,5
10,1

8,9
8,0
10,0

9,1
8,2
10,1

8,7
7,9
9,7

7,9
7,2
8,9

7,1
6,5
7,8

9,3
8,0
11,2

8,6
7,4
10,2

8,7
7,8
10,0

9,1
8,1
10,2

8,7
7,9
9,8

7,9
7,1
9,0

7,1
6,5
7,9

9,3
7,7
11,6

6,9
5,6
8,5

7,5
6,7
8,6

8,4
7,5
9,5

8,4
7,6
9,5

8,2
7,4
9,3

7,5
6,7
8,4

:
:
:

16,4
16,7
16,2

18,1
18,9
17,3

12,0
12,5
11,5

10,1
10,3
9,8

9,0
8,6
9,3

6,9
6,5
7,3

Source:  Eurostat - Harmonised unemployment series, Annual average
p = provisional value u = unreliable or uncertain data  b= break in data series

Context 2c: Youth unemployment rate (% of labour force aged 15-24)

CZ

6,4
5,0
8,1

8,7
7,3
10,3

7,3
5,9
9,0

8,3
7,1
9,9

7,9
6,5
9,8

7,1
5,8
8,8

5,3
4,2
6,7

DK

DE

4,9
3,9
6,0

4,3
3,9
4,8

4,6
4,3
5,0

5,5
5,1
6,0

4,8
4,4
5,3

3,9
3,3
4,5

3,8
3,5
4,2

8,8
7,1
11,1

7,2
6,0
8,7

8,2
7,1
9,4

9,5
8,7
10,5

9.4p
8.7p
10.3p

8.4p
7.7p
9.2p

8,6
8,5
8,7

EE

9,2
9,9
8,3

12,8
13,8
11,8

10,3
10,8
9,7

9,7
10,4
8,9

7,9
8,8
7,1

5,9
6,2
5,6

4,7
5,4
3.9u

1998

2000

2002

2004

2005

2006

2007

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

EU27

EU25

BE

BG

CZ

DK

DE

EE

:
:
:

17,9
16,7
19,3

18,9
18,1
19,8

19,2
18,7
19,8

18,4
18,1
18,7

17,3
16,9
17,7

15,4
15,1
15,8

19,5
17,7
21,6

17,6
16,2
19,3

18,5
17,5
19,6

19
18,4
19,7

18,3
17,9
18,7

17,1
16,7
17,5

15,3
14,9
15,7

22,1
20,2
24,5

16,7
14,5
19,5

17,7
17,2
18,3

21,2
20,2
22,4

21,5
21
22,1

20,5
18,8
22,6

18,8
17,1
20,9

:
:
:

33,7
36,1
30,7

37
40,1
33,2

25,8
27
24,3

22,3
23,4
21

19,5
18,9
20,3

15,1
14,5
15,9

12,8
11,5
14,4

17,8
18,5
17

16,9
16,6
17,2

21
22,2
19,5

19,2
19,3
19,1

17,5
16,6
18,7

10,7
10,6
11

7,3
7,1
7,4

6,2
6,6
5,7

7,4
7,3
7,5

8,2
8,9
7,4

8,6
8,6
8,6

7,7
7,9
7,5

7,9
8,2
7,5

15
12,3
17,9

10,6
9,4
11,9

14,2
13
15,4

15
15,2
14,8

14,1p
14,4p
13,8p

13,7
14,8
12,5

11,9
12,6
11,1

15,2
16,7
13,1

23,9
23,8
24,1

17,6
14,3
22,5

21,7
21,2
22,4

15,9
16,6
14,9

12u
10
14,7

10u
:
:

IE

7,5
7,7
7,3

4,2
4,3
4,2

4,5
4,7
4,1

4,5
4,9
4,1

4,3
4,6
4,0

4,4
4,6
4,1

4,6
4,9
4,2

IE

11,3
11,6
11

6,8
6,8
7

8,5
9,3
7,6

8,9
9,3
8,5

8,6
9,1
8

8,6
9,1
8

9,1
10
8,1

EL

10,8
7,0
16,7

11,2
7,4
17,1

10,3
6,8
15,6

10,5
6,6
16,2

9,8
6,1
15,3

8,9
5,6
13,6

8,3
5,2
12,8

EL

29,9
21,3
40,2

29,1
21,5
38,1

26,8
19,9
35,3

26,9
19,1
36,3

26
18,7
34,8

25,2
17,7
34,7

22,9
15,7
32,1

15,0
11,2
21,1

11,1
7,9
16,0

11,1
8,1
15,7

10,6
8,0
14,3

9,2
7,0
12,2

8,5
6,3
11,6

8,3
6,4
10,9

ES

33,1
25,9
42,4

24,3
18,1
32,5

24,2
19,2
31,1

23,9
19,4
30,1

19,7
16,7
23,4

17,9
15
21,6

18,2
15,2
21,9

ES

FR

IT

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO

11,1
9,5
12,9

9,1
7,6
10,9

8,7
7,8
9,8

9,6
8,7
10,6

9.7p
8.8p
10.7p

9.5p
8.8p
10.4p

7,9
7,4
8,5

11,3
8,8
15,4

10,1
7,8
13,6

8,6
6,7
11,5

8b
6.4b
10.5b

7,7
6,2
10,1

6,8
5,4
8,8

6,1
4,9
7,9

:
:
:

4,9
3,2
7,2

3,6
2,9
4,5

4,6
3,6
6,0

5,2
4,3
6,5

4,6
4,0
5,4

3,9
3,4
4,6

14,3
15,1
13,6

13,7
14,4
12,9

12,2
13,3
11,0

10,4
10,6
10,2

8,9
9,1
8,7

6,8
7,4
6,2

6,0
6,4
5,6

13,2
14,6
11,7

16,4
18,6
14,1

13,5
14,2
12,8

11,4
11,0
11,8

8,3
8,2
8,3

5,6
5,8
5,4

4,3
4,3
4,3

2,7
1,9
4,0

2,3
1,8
3,1

2,7
2,0
3,7

5,1
3,7
7,1

4,5
3,5
5,8

4,7
3,5
6,2

4,1
3,6
4,7

8,4
9,0
7,8

6,4
7,0
5,6

5,8
6,2
5,4

6,1
6,1
6,1

7,2
7,0
7,4

7,5
7,2
7,8

7,4
7,1
7,7

:
:
:

6,7
6,4
7,4

7,5
6,6
9,3

7,4
6,6
9,0

7,3
6,5
9,0

7,3
6,5
8,9

6,5
6,0
7,6

3,8
3,0
5,0

2,8
2,2
3,6

2,8
2,5
3,1

4,6
4,3
4,8

4,7
4,4
5,1

3,9
3,5
4,4

3,2
2,8
3,6

4,5
3,8
5,4

3,6
3,1
4,3

4,2
4,0
4,4

4.8b
4.4b
5.3b

5,2
4,9
5,5

4,7
4,4
5,2

4,4
3,9
5,0

10,2
8,5
12,2

16,1
14,4
18,1

19,9
19,1
20,9

19,0
18,2
19,9

17,7
16,6
19,1

13,8
13,0
14,9

9,6
9,0
10,3

5,1
4,1
6,3

4,0
3,2
4,9

5,0
4,1
6,0

6,7
5,8
7,6

7,6
6,7
8,7

7,7
6,5
9,0

8,0
6,6
9,6

5,4
5,5
5,3

7,2
7,8
6,4

8,4
9,1
7,7

8,1
9,1
6,9

7,2
7,8
6,4

7,3
8,2
6,1

6,4
7,2
5,4

SL

7,4
7,3
7,5

6,7
6,5
7,0

6,3
5,9
6,8

6,3
5,8
6,8

6,5
6,1
7,0

6,0
4,9
7,2

4,8
4,0
5,8

SK

FI

12,6
12,2
13,1

18,8
18,9
18,6

18,7
18,6
18,7

18,2
17,4
19,2

16,3
15,5
17,2

13,4
12,3
14,7

6,9
6,5
7,2

11,4
10,9
12,0

9,8
9,1
10,6

9,1
9,1
9,1

8,8
8,7
8,9

8,4
8,2
8,6

7,7
7,4
8,1

6,2
5,9
6,5

SE

8,2
8,4
8,0

5,6
5,9
5,3

4,9
5,3
4,6

6,3
6,5
6,1

7.4b
7.5b
7.3b

7,1
6,9
7,2

5,3
5,6
4,9

UK

6,1
6,8
5,3

5,5
6,0
4,9

5,1
5,6
4,5

4,7
5,0
4,2

4,8
5,1
4,3

5,3
5,7
4,9

5,3
5,6
5,0

FR

IT

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO

SL

SK

FI

SE

UK

25,6
23,3
28,3

20,1
18
22,5

19,7
18,2
21,7

21,8
20,8
23

22,7p
21,3p
24,4p

21,3
20,1
22,9

18,7
18
19,6

29,9
25,4
35,5

27
23,1
31,9

23,1
19,4
27,8

23,5b
20,6b
27,2b

24
21,5
27,4

21,6
19,1
25,3

20,3
18,2
23,3

:
:
:

10,1
6,9
13

8,1
7,9
8,3

10,5
9,4
11,6

13
11,9
14,2

10
8,9
11,1

10,2
11
9,4

26,8
27,4
26

21,4
21,2
21,6

22
20,4
24,3

18,1
16
21,3

13,6
11,8
16,2

12,2
10,5
14,7

10,7
11,2
10u

25,5
30,1
18,4

30,6
32,3
28,3

22,5
22,6
22,2

22,7
22,5
22,9

15,7
15,9
15,3

9,8
10u
9,6

8.2u
7u
10u

6,9
6,5
7,3

7,1
6,5
7,9

7,7
6,1
9,6

16,8
12
22,3

13,7
11,7
16,2

16,2
17u
15,2

15.2u
13.5u
17.5u

15
16,6
13

12,4
13,6
10,8

12,7
13,2
11,9

15,5
16,2
14,4

19,4
19,6
19

19,1
18,6
19,8

18
17,6
18,6

:
:
:

13,7
14,9
12,3

17,1
17,6
16,7

16,8
16,3
17,4

16,4
16,8
16

15,9
17,2u
14,3u

13,9
15,8u
11,6u

7,6
7,4
7,9

5,7
4,9
6,5

5
5,2
4,8

8
7,9
8,1

8,2
8
8,4

6,6
6,1
7,1

5,9
5,6
6,2

6,4
5
7,9

5,3
4,7
6

6,7
6,4
7,1

9,4b
9b
9,8b

10,3
10,5
10,1

9,1
8,9
9,3

8,7
8,3
9,1

22,5
20,2
25,1

35,1
33,3
37,2

42,5
41,9
43,3

39,6
37,7
41,9

36,9
35,7
38,3

29,8
28,3
31,6

21,7
20
23,8

10,7
8,5
13,2

8,8
6,6
11,5

11,6
9,8
13,9

15,3
13,5
17,6

16,1
13,6
19,1

16,3
14,5
18,4

16,6
13,5
20,3

15,8
15,6
16,1

20
22,2
17,2

23,2
24,3
21,8

21,9
24,2
18,9

20,2
21,6
18,4

21,4
22,3
20,2

20,1
21,1
18,7

17,8
16,9
18,8

16,3
14,6
18,3

16,5
15
18,6

16,1
13,9
19,2

15,9
14,5
17,8

13,9
11,6u
16,8u

10,1
9.4u
11.2u

25,1
26,6
23,4

36,9
39,7
33,8

37,7
39,5
35,5

33,1
34,7
31

30,1
31
28,8

26,6
26,4
27

20,3
20,4
20,2

23,5
22,8
24,3

21,4
21,1
21,6

21
21,2
20,9

20,7
22
19,4

20,1
20,6
19,5

18,7
19
18,4

16,5
16,4
16,6

16,1
16,4
15,8

10,5
11
9,9

11,9
12
11,8

16,3
15,7
16,9

21,1b
21,1b
21,1b

21,5
21
22

19,3
18,8
19,8

13,1
14,8
11,3

12,6
13,7
11,4

12
13,7
10,2

12,1
13,4
10,7

12,9
14,5
11,1

14
15,7
12

14,4
15,8
12,5

Source:  Eurostat - Harmonised unemployment series, Annual average
p = provisional value u = unreliable or uncertain data  b= break in data series

EN 

178 

EN 

 
  
CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

RO

SL

SK

FI

SE

UK

Context 2d: Long-term unemployment rate by gender, selected years (% of the labour force 15+)
EU27

EU25

DK

BG

CZ

BE

1998

2000

2002

2004

2005

2006

2007

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

Total
Males
Females

:
:
:

4,1
4,2
4

4,6
4,6
4,5

4,2
3,7
4,7

4p
3,6p
4,5p

3,6p
3,3p
4p

3.1
2.8

3.3

4,4
3,6
5,5

3,9
3,3
4,8

3,9
3,3
4,6

4,1
3,6
4,7

3,9p
3,5p
4,5p

3,6p
3,2p
4p

3.0
2.8

3.3

5,6
4,5
7,1

3,7
3
4,6

3,7
3,2
4,3

4,1
3,7
4,7

4,4
3,8
5

4,2
3,7
4,9

3.8
3.3

4.3

:
:
:

9,4
9,6
9,2

12
12,5
11,4

7,2
7,3
7

6
6,1
6

5
4,8
5,2

4.1
3.7

4.5

2
1,5
2,6

4,2
3,5
5,2

3,7
3
4,6

4,2
3,4
5,3

4,2
3,4
5,3

3,9
3,1
4,9

2.8
2.1

3.6

1,3
0,9
1,7

0,9
0,8
1,1

0,9
0,7
1

1,2
1,1
1,3

1,1
1,1
1,2

0,8
0,7
0,9

0.6
0.5

0.7

DE

EE

4,5
3,4
6

3,7
3
4,6

3,9
3,3
4,8

5,4
4,8
6,1

5p
4,7p
5,5p

4,7p
4,4p
5,2p

4.7
4.8

4.7

4,2
4,4
4,1

5,9
6,7
5

5,4
6,3
4,4

5
5,6
4,4

4,2
4,2
4,2

2,8
3,1
2,6

2.3
2.9

1.7

IE

3,9
4,7
2,8

1,6
2
1

1,4
1,8
0,8

1,6
2
1

1,5
1,9
0,8

1,4
1,8
0,9

1.4
1.8

0.9

EL

5,8
3,1
10

6,2
3,6
10,2

5,3
3,1
8,6

5,6
3
9,4

5,1
2,6
8,9

4,8
2,6
8

4.1
2.2

7.0

ES

FR

7,5
4,9
11,6

4,6
2,8
7,4

3,7
2,3
5,9

3,4
2,2
5,1

2,2b
1,4b
3,4b

1,8
1,2
2,8

1.7
1.1

2.5

4,5
3,8
5,3

3,5
2,9
4,3

3,1
2,6
3,5

3,9
3,5
4,3

4
3,5
4,5

4p
3,7p
4,3p

3.3
3.1

3.6

IT

6,8
5,3
9,1

6,3
4,8
8,4

5,1
4
6,9

4b
2,9b
5,5b

3,9
2,9
5,2

3,4
2,6
4,5

2.9
2.2

3.9

:
:
:

1,2
0,5
2,2

0,8
0,5
1

1,2
0,9
1,6

1,2
0,8
1,7

0,9
0,7
1,2

0.7
0.8

0.7

7,9
8,3
7,5

7,9
8,3
7,5

5,5
6,4
4,6

4,6
4,8
4,3

4,1
4,4
3,7

2,5
3
1,9

1.6
1.9

1.2

7,5
7,9
7

8
9,4
6,5

7,2
7,6
6,8

5,8
5,5
6,2

4,3
4,2
4,5

2,5
2,5
2,4

1.4
1.4

1.3

Source : Eurostat - Labour Force Survey, Annual averages
p = provisional value u = unreliable or uncertain data  b= break in data series

Context 4: Old age dependency ratio (current and projected) - ratio between the total number of people aged 65 and over and the number of persons of working age (from 15 to 64)

2010

2020

2030

2040

2050

EU27 

25,9

31,1

38,0

45,4

50,4

BE

26,1

30,6

37,6

42,3

43,9

BG

25,3

31,1

36,3

43,6

55,4

63,5
Source : Eurostat - EUROPOP2008 Trend scenario - baseline variant

2060

45,8

53,5

CZ

21,8

31,1

35,7

42,7

54,8

61,4

DK

25,0

31,9

37,9

42,7

41,3

42,7

DE

31,2

35,3

46,2

54,7

56,4

59,1

EE

25,0

29,2

34,4

39,0

47,2

55,6

IE

16,7

20,2

24,6

30,6

40,4

43,6

EL

28,2

32,8

38,5

48,3

57,0

57,1

ES

24,4

27,4

34,3

46,4

58,7

59,1

FR

25,8

32,8

39,0

44,0

44,7

45,2

IT

31,0

35,5

42,5

54,1

59,2

59,3

CY

18,0

22,3

27,4

30,8

37,7

44,5

LV

25,2

28,1

34,6

40,7

51,2

64,5

LT

23,2

26,0

34,7

42,8

51,1

65,7

LU

21,1

24,2

30,8

36,3

37,8

39,1

0,9
0,7
1,1

0,6
0,5
0,6

0,7
0,6
0,9

1,1
0,8
1,4

1,2p
1,2p
1,2p

1,4p
1,2p
1,6p

1.2
1.2

1.1

HU

24,2

30,3

34,1

40,1

50,8

57,6

1,9
2,4
1,2

1,4
1,9
0,9

1,1
1,4
0,7

1
1,2
0,6

1
1,3
0,7

1,2
1,5
0,8

1.3
1.6

0.9

4,2
4,5
3,8

3,1
3,5
2,5

2,5
2,8
2,2

2,7
2,8
2,6

3,2
3,3
3,2

3,4
3,3
3,4

3.4
3.3

3.6

:
:
:

4,4
4,5
4,2

3,3
3,5
2,4

3,4
3,7
3

3,4
3,4
3,2

2,9
3,1
2,5

2.7
2.8

2.4

1,5
1,3
1,8

0,8
0,6
1

0,7
0,6
0,9

1,6
1,5
1,6

1,9
1,9
1,9

1,7
1,6
1,8

1.3
1.2

1.4

MT

21,2

31,3

39,1

41,7

49,8

59,1

NL

22,8

30,7

40,0

46,8

45,6

47,2

AT

26,0

29,2

38,1

46,0

48,3

50,7

1,3
1
1,8

1
0,9
1,2

1,1
1
1,2

1,3b
1,3b
1,4b

1,3
1,2
1,4

1,3
1,3
1,3

1.2
1.0

1.4

PL

19,0

27,2

36,0

41,3

55,7

69,0

4,7
3,5
6,3

7,4
6
9,1

10,9
9,7
12,3

10,3
9,6
11

10,2
9,3
11,4

7,8
7,1
8,6

4.9
4.6

5.4

PT

26,6

30,7

36,6

44,6

53,0

54,8

2,2
1,7
2,8

1,7
1,4
2

1,7
1,4
2,1

3
2,6
3,4

3,7
3,2
4,2

3,8
3,3
4,4

3.8
3.2

4.5

2,3
2,2
2,5

3,5
3,6
3,4

4
4,1
4

4,5
5,2
3,6

4
4,6
3,4

4,2
4,7
3,6

3.2
3.6

2.7

3,3
3,3
3,3

4,1
4,1
4,2

3,5
3,4
3,6

3,2
3,1
3,4

3,1
2,9
3,3

2,9
2,4
3,5

2.2
1.8

2.7

RO

21,3

25,7

30,3

40,8

54,0

65,3

SI

23,9

31,2

40,8

49,4

59,4

62,2

SK

17,0

23,9

32,3

40,0

55,5

68,5

6,5
6
7,1

10,3
10,3
10,2

12,2
11,9
12,5

11,8
11,3
12,4

11,7
11,2
12,3

10,2
9,4
11,2

8.3
7.4

9.3

FI

25,7

36,8

43,9

45,1

46,6

49,3

4,1
4,3
3,9

2,8
2,8
2,7

2,3
2,5
2

2,1
2,3
2

2,2
2,4
1,9

1,9
2,1
1,8

1.6
1.7

1.4

SE

27,8

33,7

37,4

40,8

41,9

46,7

2,6
3,2
1,8

1,4
1,7
1

1
1,2
0,8

1,2
1,4
1

1,2p
1,4p
1p

1,1
1,2
0,9

0.9
0.9

0.8

UK

24,7

28,6

33,2

36,9

38,0

42,1

EN 

179 

EN 

 
  
Context 5a: Distribution of households by age and household type (private/institutional)

Total

Children (0-17)

18-64

65+

75+

Total ('000)
Private households (%)
Institutional household (%
Total ('000)
Private households (%)
Institutional household (%
Total ('000)
Private households (%)
Institutional household (%
Total ('000)
Private households (%)
Institutional household (%
Total ('000)
Private households (%)
Institutional household (%
   Hospitals (%)
   Old people's homes (%)

EU25 

BE

441467

10296

98,7 

1,3 

90525

99,4 

0,6 

279593

99,0 

1,0 

71306

96,4 

3,6 

30917

93,3 

6,7 

19,9 

68,0 

98,6 

1,4 

2162

99,9 

0,1 

6390

99,5 

0,5 

1744

93,9 

6,1 

774

88,4 

11,5 

5,3 

85,1 

BG

7904

99,3 

0,7 

1531

97,9 

2,1 

5586

99,4 

0,6 

1322

99,6 

0,4 

481

99,3 

0,7 

14,0 

83,8 

CZ

10230

99,3 

0,7 

2057

99,8 

0,2 

6759

99,5 

0,5 

1411

97,7 

2,3 

570

95,7 

4,3 

4,9 

86,3 

DK

5349

98,7 

1,3 

DE

82277

99,0 

1,0 

1161

15251

99,4 

0,6 

99,7 

:

3396

52516

98,9 

1,1 

792

96,7 

3,3 

379

94,2 

5,8 

:

:

99,6 

:

14510

96,3 

:

6191

92,5 

7,5 

:

:

EE

1370

98,8 

0,9 

312

99,2 

0,6 

852

98,9 

0,9 

205

98,1 

1,7 

75

96,9 

2,9 

3,6 

95,4 

EL

10628

96,6 

3,4 

2011

97,8 

2,2 

ES

40847

99,4 

0,6 

FR

58514

97,8 

2,2 

IE

3852

98,4 

1,6 

7341

13426

1009

99,9 

0,1 

99,2 

0,8 

99,6 

0,4 

6824

26547

35788

2420

96,0 

4,0 

1792

97,5 

2,5 

642

96,7 

3,3 

20,4 

34,3 

99,7 

0,3 

6974

97,7 

2,3 

3036

96,1 

3,9 

12,5 

56,6 

98,2 

1,8 

9299

94,3 

5,7 

4133

89,5 

10,5 

13,8 

79,5 

98,9 

1,1 

423

92,8 

7,2 

184

87,6 

12,4 

27,8 

56,4 

Source: Eurostat Census data collection 2000-01

Context 5b: Population living in private households by household type, 2007 (percentage of total population)

IE

EL

ES

- Single adults, no children
of which:
- Single men
- Single women

- Under 65
- 65 and over

- Single parents
- 2 adults below 65, no children

- 2 adults, at least one aged 65+, no children

- 3 or more adults, no children
- 2 adults, 1 child
- 2 adults, 2 children
- 2 adults, 3 or more children
- 3 or more adults, with children

EU25 
13

BE

15

5
8

7
5

5
13

11
12
12
18
7
10

7
8

9
6

6
15

10
9
11
16
11
7

BG

CZ

9

4
6

5
4

4
14

9
15
12
21
5
11

DK

22

DE

18

EE

14

10
11

15
7

7
18

10
3
10
19
10
2

7
11

12
6

6
16

13
7
12
15
6
6

5
9

8
6

7
11

9
10
15
14
6
14

EU aggregates based on available country data
Source : Eurostat - European Labour Force Survey

8

4
4

4
4

8
10

7
12
10
15
14
17

Context 6a: General government debt - General government consolidated gross debt as a percentage of GDP

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

EU-27 BE
107,8

61,7

60,8

60,2

61,8

62,2

62,7

61,3

58,7

59,8

60,9

61,8

106,5

103,4

98,6

94,3

92,1

87,8

83,9

86,5

86,1

85,6

BG
74,3

67,3

53,6

45,9

37,9

29,2

22,7

18,2

13,8

10,6

7,9

CZ
18,5

25,1

28,5

30,1

30,4

29,8

29,6

28,9

26,6

26,4

26,3

DK
51,7

47,4

46,8

45,8

43,8

36,4

30,5

26,2

21,1

21,1

20,1

DE
59,7

58,8

60,3

63,8

65,6

67,8

67,6

65,1

64,3

63,2

61,9

EE
5,2

4,8

5,6

5,5

5

4,5

4,3

3,5

4,2

5

6,1

IE
37,7

35,5

32,2

31,1

29,4

27,3

24,7

24,8

31,6

39,2

46,2

Source:  Eurostat - General Government data (2000 to 2007) and ECFIN forecasts (2008-2009)

EN 

7

2
5

4
4

2
9

12
23
10
25
3
10

EL
101,8

102,9

101,5

97,8

98,6

98,8

95,9

94,8

93,4

92,2

91,9

6

2
4

3
3

2
10

9
23
13
20
3
14

ES
59,2

55,5

52,5

48,7

46,2

43,0

39,6

36,2

37,5

41,1

44,4

FR

15

6
9

8
6

5
16

11
5
13
24
7
4

FR
56,7

56,2

58,2

62,9

64,9

66,4

63,6

63,9

65,4

67,7

69,9

HU

10198

97,5 

2,4 

2087

96,9 

3,1 

6565

97,7 

2,2 

1546

97,5 

2,5 

619

95,8 

4,2 

11,8 

83,4 

MT

0

-

-

0

-

-

0

-

-

0

-

-

0

-

-

-

-

HU

MT

7

3
4

3
4

2
9

8
20
11
17
8
18

9

3
7

5
5

5
11

9
14
12
16
9
15

HU
54,2

52,1

55,8

58,1

59,4

61,7

65,6

65,8

65,4

66

66,2

LV

2377

99,0 

1,0 

541

99,4 

0,6 

LT

3484

99,3 

0,7 

846

99,3 

0,7 

1485

2148

99,0 

1,0 

352

98,7 

1,3 

126

98,1 

1,9 

2,0 

97,7 

99,4 

0,6 

489

98,9 

1,1 

178

98,3 

1,7 

5,2 

89,1 

LU

440

98,3 

1,7 

98

99,0 

1,0 

281

99,0 

1,0 

61

93,7 

6,3 

25

87,0 

13,0 

9,8 

69,2 

LV

10

LT

11

LU

12

3
7

5
5

5
10

9
13
14
13
5
21

LV
12,3

14,0

13,5

14,6

14,9

12,4

10,7

9,5

12,3

17,7

23

3
8

6
5

6
9

9
10
16
17
7
16

LT
23,7

23,1

22,3

21,1

19,4

18,4

18

17

17,5

20

23,3

5
7

8
4

4
12

9
11
13
25
7
8

LU
6,4

6,5

6,5

6,2

6,3

6,1

6,6

7

14,1

14,6

14,5

IT

56996

99,3 

0,7 

9833

99,9 

0,1 

36517

99,5 

0,5 

10646

97,9 

2,1 

4762

96,5 

3,5 

1,5 

73,2 

IT

12

5
7

6
6

3
9

12
18
13
19
5
11

IT
109,2

108,8

105,7

104,4

103,8

105,9

106,9

104,1

104,1

104,3

103,8

CY

690

99,4 

0,6 

180

99,9 

0,1 

428

99,7 

0,3 

80

96,4 

3,6 

34

92,7 

7,3 

5,8 

91,0 

CY

5

2
3

3
2

2
8

9
13
10
26
10
16

CY
58,8

60,7

64,6

68,9

70,2

69,1

64,6

59,5

48,2

44,7

41,3

180 

NL

15986

98,6 

1,4 

3532

99,7 

0,3 

10279

99,4 

0,6 

2174

93,5 

6,5 

972

87,2 

12,8 

20,8 

75,9 

AT

8033

98,9 

1,1 

1639

99,7 

0,3 

5152

99,4 

0,6 

1242

95,8 

4,2 

582

92,4 

7,6 

19,4 

76,3 

NL

16

AT

15

7
9

11
5

4
17

10
7
11
20
12
5

6
9

9
6

4
13

9
13
11
15
8
12

PL

PT

RO

38230

10356

21681

SI

1964

99,3 

0,7 

376

:

:

98,5 

1,5 

4847

98,3 

1,7 

15420

1299

98,0 

2,0 

3050

99,6 

0,4 

1063

99,4 

0,6 

30,7 

59,4 

:

:

289

:

:

110

88,4 

5,3 

:

:

98,9 

1,1 

8851

99,2 

0,8 

24522

98,8 

1,2 

4853

98,8 

1,2 

1841

98,1 

1,9 

18,5 

65,8 

99,0 

1,0 

2053

99,5 

0,5 

6610

99,6 

0,4 

1693

96,4 

3,6 

701

93,1 

6,9 

3,3 

85,8 

PL

PT

SI

SK

9

3
6

4
5

3
8

7
13
12
15
7
25

6

2
4

2
4

3
9

11
18
17
16
4
17

7

2
5

3
4

3
8

8
19
11
19
5
19

8

2
7

3
5

3
7

7
17
9
17
8
24

MT
55,9

62,1

60,1

69,3

72,1

69,9

63,9

62,2

63,1

63,2

63,1

NL
53,8

50,7

50,5

52

52,4

51,8

47,4

45,7

48,2

47

45,9

AT
66,4

67,0

66,4

65,4

64,8

63,7

62

59,5

57,4

57,1

56,9

PL
36,8

37,6

42,2

47,1

45,7

47,1

47,7

44,9

43,7

43,4

42,9

PT
50,4

52,9

55,5

56,9

58,3

63,6

64,7

63,6

64,3

65,2

66,6

RO
24,7

26,0

25,0

21,5

18,8

15,8

12,4

12,9

13,4

15,4

17,1

SI
26,8

27,4

28,1

27,5

27,2

27

26,7

23,4

21,8

21,1

20,1

SK

5379

98,4 

0,8 

1277

98,3 

0,4 

3444

98,7 

0,6 

611

97,0 

2,7 

238

95,4 

4,2 

13,3 

75,1 

FI

18

8
11

12
6

5
19

10
5
12
16
12
3

SK
50,3

48,9

43,4

42,4

41,4

34,2

30,4

29,4

28,8

29

29,3

FI

5181

98,1 

0,7 

1135

99,1 

0,4 

3269

98,4 

0,3 

777

95,1 

3,1 

340

90,8 

6,0 

27,9 

58,5 

SE

20
:
9
10
:
12
7

8
16

10
2
11
19
10
4

FI
43,8

42,3

41,3

44,3

44,1

41,3

39,2

35,1

31,6

30,2

29,8

UK

58789

98,2 

1,8 

13346

99,3 

0,7 

36103

98,5 

1,5 

9341

95,4 

4,6 

4405

91,5 

8,5 

44,6 

46,0 

SE

0

0

0

0

0

-

-

-

-

-

-

-

-

-

-

-

-

UK

14

6
7

8
6

8
17

11
11
10
16
8
7

SE
53,6

54,4

52,6

52,3

51,2

50,9

45,9

40,4

34,7

33,8

32,4

UK
41,0

37,7

37,5

38,7

40,6

42,3

43,4

44,2

50,1

55,1

60,3

EN 

 
  
      
   
   
      
        
         
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
   
 
     
   
        
     
     
       
          
           
        
          
            
          
            
        
        
          
          
        
            
 
       
     
     
     
     
     
     
     
     
 
     
     
      
   
   
      
        
         
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
 
     
   
        
     
     
       
          
        
          
            
          
            
        
        
          
          
        
            
 
       
     
     
     
     
     
     
     
 
     
     
      
   
   
      
        
         
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
 
     
   
        
     
     
       
          
        
          
            
          
            
        
        
          
          
        
            
 
       
     
     
     
     
     
     
     
 
     
     
      
   
   
      
        
         
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
 
     
   
        
     
     
       
          
        
          
            
          
            
        
        
          
          
        
            
 
       
     
     
     
     
     
     
     
 
     
     
      
   
   
      
        
         
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
   
 
     
   
        
   
     
       
          
           
        
          
            
        
          
        
        
          
          
      
            
 
       
   
     
     
     
     
     
     
     
 
     
     
      
     
   
       
        
        
          
        
          
        
        
          
          
        
          
 
       
   
   
   
     
   
   
   
 
     
   
      
   
   
      
      
        
          
        
          
      
      
        
        
      
          
 
       
   
   
   
   
   
   
   
 
     
   
Context 6b: Projected evolution of debt levels up to 2050 (in % of GDP)
Programme scenario

2005

2010

2030

2050

2005 budget scenario

2010

2030

2050

* Adjusted gross debt.

EU-25** BE
93,3

63

61

79

180

55

33

76

72

31

83

74

52

129

BG

:

:

:

:

:

:

:

CZ

30,5

30

43

188

43,2

95,7

DK

35,8

18

23

98

14,4

-61,2

320,3

-135,5

DE

67,7

64

37

65

73,6

116,2

232,4

** aggregates exclude Greece
Source: Commission services, 2005/06 updated stability and convergence programmes.

Context 7a: Social protection benefits by group of functions (as a percentage of total benefits) - 2006

Sickness, health care
Disability
Family and children
Unemployment 
Old age and survivors benefits
Housing and social exclusion
e: Eurostat estimate; p: provisional

EU-27 EU-25
29.2p
29.2p

7.5p

8.0p

5.6p

7.5p

8.0p

5.6p

46.2p

46.2p

3.6p

3.6p

BE

25,7

6,4

7,1

11,9

47

2

BG

26

9,1

7,4

2,2

52,9

2,5

CZ

34,4

8,6

7,6

3,2

43,1

3,1

DK

21,6

14,9

13,1

7,2

37,9

5,3

Context 7b: Social protection benefits by group of functions (as a percentage of GDP) - 2006

EU-27 EU-25
27,0p
26,9p

BE

30,1

28,7

7,5p

7,6p

26,0p

25,8p

Total expenditure*
Social protection benefits
Sickness/Health care
Disability
Family/Children
Unemployment
Old age and survivors
Housing and Social exclusion n.e.c.
Administration costs
Other expenditure
0,4
* including administrative costs; e: Eurostat estimate; p: provisional

11,9p

12,0p

1,5p

0,9p

2,1p

1,9p

0,8p

0,2p

0,9p

1,9p

2,1p

1,4p

0,8p

0,2p

3,4

0,6

7,4

1,8

2,0

1,0

13,5

BG

15,0

14,5

3,8

1,3

1,1

0,3

7,7

0,4

0,4

0,1

CZ

18,7

18,1

6,2

1,5

1,4

0,6

7,8

0,6

0,6

0,0

DK

29,1

28,3

6,1

4,2

3,7

2,0

10,7

12,2p

1,5

0,8

:

0,8p

1,0p

0,1p

EE

4,8

0

-25

-82

0,9

-39,3

-117

DE

29.1p

6.2p

11.1p

6.3p

44.3p

3.0p

DE

28,7p

27,6p

8,0p

1,7p

3,1p

1,7p

IE

27,6

17

37

157

13,6

7,9

100,4

EE

31,2

9,5

12,1

0,9

45,2

1

EE

12,4

12,2

3,8

1,2

1,5

0,1

5,5

0,1

0,2

:

EL

107,5

90

18

-56

96,9

165,2

451,3

IE

41,1

5,4

14,7

7,6

27,4

3,8

IE

18,2

16,9

7,0

0,9

2,5

1,3

4,6

0,6

1,3

0,0

ES

43,2

30

33

198

25,7

-13,5

42,6

EL

28,7

4,7

6,2

4,6

51,3

4,5

EL

24,2

23,6

6,8

1,1

1,5

1,1

12,1

1,1

0,6

0,0

FR

66,8

60

41

66

69,2

132,8

269,9

ES

31.2p

7.3p

5.7p

12.5p

41.3p

2.0p

ES

20,9p

20,4p

6,4p

1,5p

1,2p

2,6p

8,4p

0,4p

0,5p

0,0p

IT

106,4

97

32

1

108,9

127,6

208,9

CY

70,3

57

42

172

64,3

116,3

269,9

FR

IT

29.9p

26.8p

6.1p

8.6p

6.9p

44.3p

4.3p

FR

31,1p

29,2p

8,7p

1,8p

2,5p

2,0p

5.9p

4.5p

2.0p

60.5p

0.3p

IT

26,6p

25,7p

6,9p

1,5p

1,2p

0,5p

12,9p

15,5p

1,2p

1,3p

0,6p

0,1p

0,7p

0,2p

LV

11,9

9

26

92

13

14,9

49,6

CY

25,7

3,9

10,8

6,1

46,1

7,4

CY

18,4

18,1

4,6

0,7

1,9

1,1

8,3

1,3

0,3

0,1

LT

18,7

16

22

76

22,4

46,7

LU

6,2

10

74

240

11,5

56,1

135,7

179,1

LV

29.1p

7.3p

10.2p

3.7p

48.3p

1.4p

LV

12,2p

11,9p

3,5p

0,9p

1,2p

0,4p

5,7p

0,2p

0,3p

0,1p

LT

32.1p

10.7p

9.0p

1.9p

44.8p

1.6p

LT

13,2p

12,8p

4,1p

1,4p

1,1p

0,2p

5,7p

0,2p

0,4p

0,0p

HU

58,4

61

51

155

76,1

143,6

247,6

LU

25,4

13,2

16,9

4,9

36,7

2,9

LU

20,4

20,0

5,1

2,6

3,4

1,0

7,3

0,6

0,3

0,1

MT

74,7

65

16

-58

80,2

92,9

79,6

HU

29

9,6

13

3,1

42,2

3,1

HU

22,3

21,8

6,3

2,1

2,8

0,7

9,2

0,7

0,5

:

RO

:

:

:

:

:

:

:

PT

29,2

10

5,1

5,5

49,1

1,2

PT

25,4

23,8

6,9

2,4

1,2

1,3

NL

52,9

46

70

176

44,2

67,8

177,7

AT

62,9

54

23

18

58,9

54,9

67,5

PL

42.5

45

-33

PT

63,9

65

64

-163

208

53,2

20

-42,5

76,3

195,4

517,4

SI

29,1

27

65

270

25,1

68,5

SK

34,5

31

16

66

38,7

66,8

287,2

176,9

FI

41,1

25

26

96

23,7

7,9

61,6

SE

50,3

34

-3

-1

30,3

8

UK

42,8

42

44

114

47

90,1

58,8

186,7

MT

28,4

6,3

6,3

3,4

52,8

2,8

MT

18,1

17,9

5,1

1,1

1,1

0,6

9,5

0,5

0,2

:

NL

31.8p

8.5p

5.8p

5.0p

41.4p

7.5p

NL

29,3p

27,5p

8,7p

2,3p

1,6p

1,4p

AT

25,5

8,2

10,4

5,8

48,6

1,5

AT

28,5

27,6

7,1

2,3

2,9

1,6

PL

20,4

9,3

4,4

3

61,2

1,8

PL

19,2

18,8

3,8

1,7

0,8

0,6

11,4p

13,4

11,5

11,7

2,0p

1,5p

0,4p

0,4

0,5

0,4

0,3

0,4

0,0

0,3

0,5

1,0

7,4

8,9

2,7

45

1,2

RO

14,0

13,7

4,8

1,0

1,2

0,4

6,2

0,2

0,2

0,0

RO

34,8

SL

SK

32.1p

31.0p

8.5p

8.6p

3.0p

8.7p

7.8p

3.5p

45.4p

45.3p

2.5p

3.6p

FI

26,2

12,7

11,6

8,5

37,8

3,2

SE

26.0p

14.9p

9.8p

5.5p

UK

31.8p

8.7p

6.1p

2.4p

40.2p

44.7p

3.6p

6.3p

SL

22,8p

22,2p

7,1p

1,9p

1,9p

0,7p

10,1p

0,6p

0,5p

0,0p

SK

15,9p

15,3p

FI

26,2

25,4

4,7p

1,3p

1,2p

0,5p

6,9p

0,6p

0,6p

0,0p

6,6

3,2

2,9

2,2

9,6

0,8

0,8

:

SE

30,7p

30,0p

7,8p

4,5p

2,9p

1,6p

UK

26,4p

25,9p

8,2p

2,2p

1,6p

0,6p

12,1p

11,6p

1,1p

0,7p

0,0p

1,6p

0,5p

0,0p

EN 

181 

EN 

 
  
Context 8a: Adults aged 18-59 living in jobless households by household types, 2006, in % of total number of adults living in jobless households

EU27

Alone without children
Alone with child(ren)
Couple without children
Couple with child(ren)
Other households without children - total
    - without elderly (65+)
    - with at least 1 elderly (65+)
Other households with child(ren) - total
    - without elderly (65+)
    - with at least 1 elderly (65+)
Total number in 1000
Source : Eurostat - European Labour Force Survey 2006, Spring results. Annual averages for FI.

EU25 
24,1
10,9
22,1
15,0
19,8
9,5
10,4
8,1
6,4
1,7
19386,3 17763 799,9

CZ
23,2
12,9
24,0
14,5
19,4
8,3
11,2
5,9
4,6
1,2
437,256

BG
15,3
3,9
19,5
19,6
22,0
8,9
13,1
19,7
13,6
6,1
482,1

BE
32,2
14,9
25,2
9,6
11,5
6,3
5,2
6,5
5,6
0,9

23,1
10,3
22,0
15,6
20,0
9,5
10,4
8,9
6,9
2,1

DK
:
:
:
:
:
:
:
:
:
:

DE
38,5
12,1
22,5
17,4
6,9
3,6
3,3
2,6
2,3
0,2

EE
31,8
12,0
15,5
13,5
19,0
4,1
14,9
8,2
3,6
4,6

IE
:
:
:
:
:
:
:
:
:
:

EL
19,0
3,6
28,1
10,2
33,7
13,3
20,4
5,5
3,6
1,9

ES
11,5
5,6
14,4
20,3
37,7
13,8
23,9
10,6
7,3
3,3

FR
30,3
10,7
28,9
15,3
10,8
5,4
5,4
4,1
3,5
0,6

IT
18,2
3,4
19,4
15,0
34,5
16,1
18,4
9,4
7,8
1,6

CY
15,2
11,8
30,3
18,3
20,9
10,4
10,5
3,5
2,3
1,2

LV
19,0
5,4
13,6
15,8
30,0
8,6
21,4
16,2
12,6
3,6

LT
26,7
10,7
6,9
12,0
30,2
9,0
21,2
13,4
6,0
7,4

LU
33,3
6,1
31,4
12,2
12,7
7,1
5,6
4,3
3,5
0,8

581,56 44,4749

467,909 233,7121 3486,4 2912,8 20,3106 87,6593 126,44 17,52665

HU
15,9
6,2
21,9
19,4
23,8
10,6
13,2
12,8
10,7
2,2
640,3

MT
12,1
10,6
17,9
26,7
28,4
11,6
16,8
4,4
3,0
1,4

NL
41,9
11,7
24,4
14,0
7,6
4,8
2,8
0,4
0,2
0,2
15,38 217,5 406,1

AT
36,0
5,6
24,4
16,3
13,2
5,9
7,3
4,5
3,5
1,0

Context 8b: Children aged 0-17 living in jobless households by household types, 2006, in % of total number of children living in jobless households
BG
15,8
1,2
50,1
47,9
2,2
32,9
19,9
13,0
189,76

Alone with child(ren) - no elderly
Alone with child(ren) - at least 1 elderly
Couple with child(ren) - total
    - without elderly (65+)
    - with at least 1 elderly (65+)
Other households with child(ren) - no elderly
    - without elderly (65+)
    - with at least 1 elderly (65+)
Total number in 1000
Source : Eurostat - European Labour Force Survey 2006, Spring results. Annual averages for  FI.

EU25 
47,5
0,3
38,4
37,3
1,1
13,7
9,9
3,9
7036,67 6438

ES
26,8
0,8
49,5
45,5
4,0
22,8
15,5
7,3
63,63202

BE
61,6
0,0
25,4
24,8
0,6
13,1
11,5
1,5
289,6

EU27
44,6
0,4
39,9
38,8
1,1
15,1
10,5
4,6

EL
30,0
1,2
52,5
46,2
6,3
16,2
7,2
9,0

CZ
50,8
0,3
35,9
35,7
0,2
13,1
10,2
2,9

EE
48,3
10,7
25,6
25,6
0,0
15,4
5,0
10,3

DE
45,0
0,2
48,4
48,0
0,4
6,4
5,8
0,7

DK
:
:
:
:
:
:
:
:

203,751 18,92742 117,92024 67,10845

IE
:
:
:
:
:
:
:
:

148,0428 59,58677

FR
47,2
0,3
44,8
43,3
1,5
7,7
6,0
1,7
1261,13

IT
21,8
0,2
59,2
57,5
1,7
18,9
13,0
5,8
523,48

CY
56,8
1,1
38,7
37,6
1,1
3,4
1,1
2,3
7,01462

LV
26,8
0,0
41,8
36,7
5,2
31,3
25,8
5,5

LT
38,9
1,1
24,6
23,0
1,6
35,5
11,7
23,7

27,52685 36,5547

LU
49,7
0,7
41,1
35,9
5,2
8,6
6,0
2,6
3,60966

HU
23,2
0,1
52,5
51,9
0,6
24,2
19,3
5,0
247,037

MT
41,9
1,2
46,4
45,5
0,9
10,5
6,0
4,5
8,075

NL
57,8
0,0
40,9
39,8
1,0
1,3
0,6
0,7

AT
28,2
0,2
58,1
56,4
1,7
13,5
9,2
4,2

PL
14,3
7,9
21,9
14,9
25,2
12,2
13,0
15,8
11,6
4,1
2835

PL
34,7
0,2
35,7
34,7
0,9
29,3
18,7
10,7

PT
14,3
6,2
22,3
14,1
33,5
12,7
20,8
9,7
7,1
2,6
337,8

PT
33,2
1,4
39,3
36,9
2,4
26,1
15,9
10,2

RO
11,5
3,8
21,0
24,3
21,5
11,0
10,5
17,9
11,3
6,6
1142

RO
12,9
0,6
58,2
57,2
1,1
28,2
15,8
12,5

SI
29,4
5,5
27,6
9,6
23,6
11,6
12,0
4,3
3,7
0,5

SK
11,8
4,0
19,1
16,8
26,2
12,4
13,8
22,1
18,7
3,5
84,94 305,3 276,7

FI
48,5
3,1
25,3
11,2
11,0
3,5
7,5
0,9
0,7
0,2

SI
40,5
0,0
47,8
47,3
0,5
11,7
5,7
6,0

SK
12,4
0,0
51,8
51,3
0,5
35,8
28,9
7,0
129,1

FI
23,2
0,0
73,4
72,8
0,5
3,4
2,3
1,1
53,446

SE
:
:
:
:
:
:
:
:
:
:

SE
:
:
:
:
:
:
:
:
0

UK
27,2
23,5
16,6
15,4
12,0
7,1
4,9
5,3
4,6
0,7
3427,1

UK
66,5
0,3
26,1
25,4
0,7
7,0
5,7
1,3
2038,4

69,681 112,52 854,32 85,391 409,05 12,074

EN 

182 

EN 

 
  
Context 9a. Unemployment traps, 2006

For unemployed persons (previous work at 67% of Average Wage, full-time) returning to full-time 
work at 2 different wage levels. Including social assistance where applicable. 

Single person, no 
children

Lone parent

One-earner couple, 
2 children

Two-earner couple, 
2 children

moving to % of AW

50

BE
CZ
DK
DE
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
SI
SK
FI
SE
UK

86%
66%
94%
79%
64%
93%
68%
78%
80%
64%
63%
86%
82%
86%
77%
70%
96%
70%
98%
79%
87%
40%
84%
92%
78%

67

83%
63%
91%
76%
64%
77%
57%
80%
81%
72%
61%
88%
79%
88%
78%
61%
86%
67%
82%
82%
94%
44%
76%
87%
68%

50

67

50

67

75%
62%
85%
97%
64%
-13%
83%
75%
89%
59%
35%
100%
78%
92%
74%
80%
77%
78%
81%
86%
84%
29%
84%
91%
66%

77%
62%
91%
87%
64%
12%
66%
80%
86%
63%
72%
100%
76%
86%
79%
64%
83%
72%
99%
87%
83%
35%
85%
91%
72%

72%
84%
73%
97%
61%
97%
86%
75%
89%
59%
91%
100%
92%
104%
88%
85%
92%
93%
100%
94%
100%
39%
89%
100%
74%

73%
69%
89%
85%
61%
88%
69%
79%
85%
61%
82%
100%
77%
102%
78%
68%
87%
81%
89%
85%
86%
30%
92%
95%
78%

50

76%
74%
97%
91%
64%
61%
57%
79%
81%
78%
77%
83%
82%
80%
74%
35%
72%
76%
81%
83%
92%
47%
77%
87%
44%

67

75%
73%
94%
90%
64%
53%
49%
82%
79%
71%
72%
85%
79%
86%
78%
34%
76%
76%
71%
85%
84%
49%
74%
87%
41%

Context 9b. Inactivity Trap at 67% of AW,  2005
Total increase in effective tax burden with and without childcare costs, 
Lone parents and two-earner couples with two children

Lone Parents 
with two 
children, no 
childcare

Lone Parents    
with two 
children, with 
childcare

Two-earner 
Couple with 2 
children, no 
childcare

Two-earner Couple 
with 2 children, 
with childcare

% of gross earnings in new job

81

71

93

45

77

45

79

100

74
69
85
84
57
16

76
84
94
90
123
20

49
36
54
52
23
16
29
24
50
37
54
43
23
64
50
30
23

BE
CZ
DK
DE
IE
EL
FR
LU
HU
NL
AT
PL
PT
SK
FI
SE
UK
Transitions from labour-market inactivity to a full-time low-wage job (67% of AW). 
Person assumed to be aged 40 with 22 years of employment, children  aged two and three. 
For couples the % of AW relates to 1 spouse only. Assumes full-time centre based care 
while in work and no childcare costs while out of work. Benefits available only on a 
temporary basis immediately following the transition into work are not taken into 
account. 

56
51
67
65
90
26
51
37
63
58
83
51
32
81
63
41
88

64

73

70

64

56

66

70

81

72

68

73

75

69

85

Source: Joint Commission -OECD project using tax-benefit Models

Notes:
AETR = 1 - (change in net income / change in gross income). AETRx% is that part of additional gross earnings that is "taxed away" when moving from unemployment (full-time with previous earnings of x% AW) to 
full time employent (with current earnings of x% AW). AETRs are measure at the household level and take into account increasing taxes and contributions as well as reduced benefits.

Weekly working hours are 0/40 for the out-of-work/in-work situations.
Results do not take into account national minimum wage legislation. As a result, the "33%" and "50%" scenarios may in fact not be relevant for employees covered by minimum wage rules.
For one earner couple households the first spouse is inactive with 0 earnings. The 'x%' therefore relate to the second spouse only.
For two-earners couple households the first spouse's earnings are held fixed at 67% of AW. The 'x%' therefore relate to the second spouse only.

EN 

183 

EN 

 
  
9c. Inactivity traps, 2006
For inactive persons entering work at 2 different wage levels1,  2006

Single person, no 
children

Lone parent

One-earner couple, 
2 children

Two-earner couple, 
2 children

moving to % of AW

50

67

50

67

50

67

50

67

BE
CZ
DK
DE
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
SI
SK
FI
SE
UK

Notes:

66%
62%
104%
73%
46%
93%
16%
48%
66%
14%
68%
61%
39%
80%
44%
71%
98%
70%
67%
41%
71%
28%
84%
92%
78%

65%
53%
88%
68%
40%
77%
18%
44%
62%
22%
52%
54%
37%
67%
43%
62%
85%
64%
59%
37%
73%
29%
72%
77%
68%

75%
62%
90%
97%
46%
-13%
16%
62%
79%
-10%
56%
100%
64%
88%
51%
81%
77%
78%
50%
58%
84%
35%
62%
65%
66%

71%
62%
84%
87%
40%
12%
16%
54%
73%
-1%
75%
100%
55%
69%
49%
64%
74%
70%
75%
55%
75%
34%
64%
63%
72%

68%
84%
90%
97%
61%
97%
16%
62%
89%
-17%
126%
100%
85%
82%
69%
86%
93%
93%
68%
58%
100%
47%
89%
100%
74%

65%
69%
92%
85%
52%
88%
16%
52%
81%
-8%
96%
100%
71%
89%
61%
69%
88%
81%
66%
57%
86%
38%
92%
95%
78%

42%
49%
65%
50%
25%
33%
16%
18%
21%
40%
6%
45%
19%
16%
5%
35%
41%
25%
52%
18%
68%
22%
31%
29%
40%

47%
48%
63%
50%
25%
32%
18%
20%
25%
42%
6%
41%
22%
20%
13%
34%
44%
30%
50%
20%
63%
24%
32%
30%
38%

AETR = 1 - (change in net income / change in gross income). AETRx% is that part of additional gross earnings that is "taxed away" when moving from inactivity (without entitlements to unemeployment benefits) to 
full time employent (with current earnings of x% AW). AETRs are measure at the household level and take into account increasing taxes and contributions as well as reduced benefits.

Weekly working hours are 0/40 for the out-of-work/in-work situations.
Results do not take into account national minimum wage legislation. As a result, the "33%" and "50%" scenarios may in fact not be relevant for employees covered by minimum wage rules.
For one earner couple households the first spouse is inactive with 0 earnings. The 'x%' therefore relate to the second spouse only.
For two-earners couple households the first spouse's earnings are held fixed at 67% of AW. The 'x%' therefore relate to the second spouse only.

EN 

184 

EN 

 
  
Context 9d. Low wage traps - 2006

METR as wage increases by 33% of the AW wage level from two starting low wages

from 33 to 67% of AW

from 67 to 100% of AW

Single 
person, 
no 
children

Lone 
parent

One-
earner 
couple, 2 
children

Two-
earner 
couple, 2 
children

Single 
person, 
no 
children

Lone 
parent

One-
earner 
couple, 2 
children

Two-
earner 
couple, 2 
children

Income ranges:

BE
CZ
DK
DE
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
SI
SK
FI
SE
UK

Notes:

58%
31%
82%
50%
25%
54%
20%
26%
64%
34%
6%
32%
30%
50%
32%
24%
71%
37%
66%
22%
67%
24%
61%
55%
58%

52%
43%
74%
66%
25%
-34%
16%
19%
96%
-2%
93%
100%
30%
58%
35%
60%
49%
41%
94%
54%
50%
24%
62%
53%
85%

47%
53%
92%
65%
19%
77%
16%
17%
111%
-11%
91%
100%
52%
110%
32%
30%
77%
62%
79%
56%
73%
28%
100%
89%
85%

58%
24%
49%
51%
25%
23%
20%
26%
37%
40%
6%
32%
30%
29%
32%
33%
41%
37%
35%
25%
34%
35%
33%
34%
33%

56%
29%
51%
55%
25%
30%
41%
29%
35%
38%
15%
32%
30%
42%
59%
43%
46%
45%
35%
35%
58%
30%
43%
36%
33%

56%
55%
61%
54%
25%
84%
41%
27%
25%
52%
15%
40%
30%
30%
64%
39%
56%
45%
57%
35%
89%
30%
55%
50%
56%

50%
50%
59%
51%
25%
57%
41%
25%
23%
49%
15%
65%
30%
18%
67%
39%
58%
45%
58%
55%
54%
18%
60%
39%
60%

55%
29%
43%
54%
25%
30%
41%
29%
33%
38%
15%
32%
30%
36%
59%
32%
46%
45%
35%
35%
43%
30%
43%
36%
33%

For one earner couple households the second spouse's earnings are varied while the first spouse's earnings are held fixed at 0% AW (inactive).
For two earner couple households the second spouse's earnings are varied while the first spouse's earnings are held fixed at 67% AW.
1 In computing METRs, weekly working hours are increased by the same fraction as earnings, i.e., it is assumed that hourly earnings remain at weekly AW / 40.
2 In computing METRs, working hours are held constant at 40, i.e., earnings above 100% AW are a result of increasing hourly earnings rather than working hours.

EN 

185 

EN 

 
  
Context 10: Net income of social assistance recipients as % of the at-risk of poverty rate threshold for 3 jobless households types, 2006

LT

SK

PT

MT

EE

HU

ES

LV

CZ

BE

PL

LU

CY

FR

SI

AT

DE

single
lone parent, 2 children
couple with two children
0,5 
Source : Joint EC-OECD project using OECD tax-benefit models, and Eurostat.

0,5 

0,6 

0,7 

0,3 

0,5 

0,5 

0,5 

0,3 

0,7 

0,6 

0,4 

0,5 

0,8 

0,7 

0,5 

0,9 

0,9 

0,6 

0,6 

0,4 

0,6 

1,3 

1,1 

0,6 

0,8 

0,8 

0,7 

0,9 

0,6 

0,7 

0,9 

0,7 

0,8 

0,8 

0,7 

0,8 

0,8 

0,7 

0,8 

0,8 

0,7 

0,8 

1,0 

0,9 

0,8 

0,9 

0,8 

0,9 

1,2 

1,1 

FI

1,0 

0,9 

0,9 

SE

1,1 

0,9 

0,8 

DK

1,1 

1,0 

0,9 

UK

1,2 

1,2 

1,0 

IE

1,2 

1,0 

1,0 

NL

1,3 

1,1 

0,9 

Context 11: At-risk-of-poverty rate before social transfers by gender and selected age groups
Before all social transfers except old-age and survivors' benefits

Total population

Total
Men
Women

Children aged 0-17 years
People aged 18-64 yeaTotal
Men
Women

People aged 65 years aTotal
Men
Women

EU27

EU25

BE

25ps
24ps
26ps
33ps
24ps
23ps
25ps
23ps
20ps
26ps

26p
24p
27p
33p
24p
23p
25p
24p
20p
26p

28
26
29
31
26
25
28
27
24
29

BG(1)
17i
15i
19i
21i
15i
15i
15i
20i
10i
27i

CZ 

DK

20
19
21
31
19
18
20
12
9
14

27
26
29
24
27
25
28
34
34
35

DK(2)
28p
27p
29p
24p
27p
26p
29p
37p
34p
39p

DE

25p
24p
26p
30p
25p
24p
27p
18p
15p
21p

EE

25
23
27
28
21
21
22
36
23
42

IE

33
31
35
39
29
27
31
42
37
47

EL

ES

FR

24
23
25
27
22
21
22
28
24
31

24
23
25
29
21
20
22
31
29
33

26
25
27
36
24
23
26
18
17
19

IT

24
23
25
32
22
21
23
24
20
27

CY

LV

LT

LU

HU

MT

NL

AT

PL

PT

21
19
23
20
15
13
18
55
50
59

27
25
29
30
24
23
25
37
25
43

26
24
27
29
22
22
23
34
18
41

23
23
24
33
23
22
24
10
9
10

29
30
29
44
29
29
28
11
7
13

22
21
22
29
19
17
21
23
26
21

21
20
22
25
20
18
22
17
15
19

25
23
26
36
23
22
24
17
12
21

27
27
26
35
27
28
26
12
9
13

24
24
25
27
22
21
23
29
27
31

RO(1)
24p
24p
24p
34p
21p
22p
20p
21p
15p
25p

SI

23
21
25
25
21
20
22
30
23
35

SK

18
18
19
27
17
17
17
13
6
17

FI

29
27
31
31
28
27
29
31
26
35

SE

UK

28
26
30
33
27
26
28
23
12
31

30
28
32
40
25
23
27
38
34
41

Source: SILC 2007,  Income data 2006; except for UK, income year 2007 and for IE moving income reference period (2006-2007);  (1) BG National HBS 2006, income data 2006 and RO National HBS 2007, income data 2007; (2) with imputed rent data 2006 (see methodological note).
Notes: i See explanatory text (Eurostat website) p = provisional value  s = Eurostat estimate  u = unreliable or uncertain data  (:) = data not available 
EU Aggregates: Eurostat estimates are obtained as a population size weighted average of national data.

EN 

186 

EN 

 
  
        
     
     
       
          
           
        
          
            
          
            
        
        
          
          
        
            
       
     
     
     
     
     
        
     
     
       
          
           
        
          
            
          
            
        
        
          
          
        
            
       
     
     
     
     
     
        
     
     
       
          
           
        
          
            
          
            
        
        
          
          
        
            
       
     
     
     
     
     
Context 12 already in 2.1

EN 

187 

EN 

 
  
1. Employment rate gap by country of birth, 2005, 2006, 2007 annual averages

Employment rate gap 
between persons born 
inside and outside the 
country

2005

2006

2007

Employment rates by country of birth

Distribution of the population aged 15-64 by country of birth

2005
Born in 
another 
EU25 
country

Born in 
the 
country

Born 
outside 
the 
EU25

Born in 
the 
country

2006
Born in 
another 
EU25 
country

Born 
outside 
the 
EU25

Born in 
the 
country

2007
Born in 
another 
EU25 
country

Born 
outside 
the 
EU25

Born in 
the 
country

2005
Born in 
another 
EU25 
country

Born 
outside 
the 
EU25

Born in 
the 
country

2006
Born in 
another 
EU25 
country

Born 
outside 
the 
EU25

Born in 
the 
country

2007
Born in 
another 
EU25 
country

Born 
outside 
the 
EU25

BE
BG
CZ
DK
DE *
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
RO
SI
SK
FI
SE
UK

12,5
:
3,4
13,6
14,4
-5,3
:
-6,4
-6,8
7,9
:
-2,2
-4,2
-5,1
-9,4
-5,8
-4,1
14,5
7,7
22,9
-5,4
(-1.9)
-1,3
6,4
11,7
13,8
7,7

12,5
-2,4
4,8
14,5
14,9
-4,7
:
-6,6
-6,9
7,5
-7,3
-1,6
-6,0
-6,7
-8,9
-3,4
-0,5
14,2
8,2
19,1
-4,3
:
-0,2
4,3
9,2
13,5
5,9

12,7
2,1
-2,3
16,0
14,8
-5,9
:
-5,1
-4,6
7,3
-7,8
-0,6
-5,0
-6,4
-11,9
-7,6
-3,4
13,2
7,7
21,7
-5,8
(-4.3)
-0,2
-5,6
6,8
13,1
5,6

62,7
:
64,9
76,9
67,5
63,7
:
59,6
62,5
64,1
:
68,1
62,8
62,4
59,8
56,8
53,7
75,2
69,9
52,9
67,1
57,6
65,9
57,8
68,8
74,3
72,5

57,5
:
59,0
72,2
65,5
64,1
:
55,0
64,2
63,5
:
57,4
56,1
:
70,7
53,1
(48,9)
70,2
65,3
29,8
65,1
:
59,4
49,0
65,4
71,8
72,1

44,2
:
67,2
60,1
47,0
69,3
:
67,9
70,2
53,5
:
75,8
68,4
68,7
60,0
64,5
61,9
58,5
61,0
30,1
74,5
:
67,9
61,6
50,8
54,8
62,2

62,7
58,6
65,4
78,4
69,1
67,4
68,2
60,5
63,8
64,7
57,9
69,3
65,7
63,3
60,0
57,3
54,8
76,2
71,6
54,6
67,6
58,8
66,6
59,5
69,7
75,1
72,2

56,2
:
58,3
70,8
66,3
64,9
:
55,5
65,7
65,4
58,9
62,1
(62,1)
73,2
71,2
(53,5)
56,1
72,5
67,8
36,2
:
51,9
51,3
54,8
69,4
72,5
75,1

45,2
61,8
65,2
61,5
48,1
72,6
:
68,8
71,6
54,0
66,4
75,3
72,7
69,7
55,3
62,4
54,9
59,5
61,6
35,0
72,9
:
68,4
(57,5)
53,7
56,9
63,1

63,5
61,7
66,1
78,8
70,9
68,6
68,4
60,9
64,9
65,5
58,0
70,8
67,7
64,7
59,2
57,2
55,5
77,7
72,7
57,1
67,3
58,8
67,8
60,7
70,5
76,2
72,0

57,9
:
61,2
74,8
68,2
75,4
:
58,2
69,9
64,6
64,9
64,8
(69,4)
72,3
72,9
(65,7)
55,8
73,1
(69,4)
30,7
:
67,7
64,1
67,7
74,8
72,7
75,4

45,2
61,0
71,4
59,6
49,6
74,4
:
67,5
69,4
55,8
66,2
75,2
73,1
70,9
60,0
62,6
60,2
62,2
63,0
38,7
73,7
(62,4)
68,2
(60,9)
55,8
58,9
62,8

87,1
:
98,1
93,1
89,5
85,6
:
92,0
88,0
88,4
:
82,9
88,0
(96,3)
59,7
98,2
95,3
86,9
83,7
99,4
92,9
:
92,1
99,1
96,9
86,4
88,9

5,8
:
1,4
1,8
3,4
0,9
:
1,2
1,9
3,1
:
5,1
1,4
(0,2)
34,6
0,3
1,5
2,5
4,7
0,3
1,5
:
0,6
0,7
1,3
4,6
3,0

7,1
:
0,6
5,1
7,0
13,5
:
6,9
10,1
8,5
:
12,0
10,7
(3,5)
5,8
1,5
3,2
10,7
11,5
0,4
5,6
:
7,2
0,2
1,8
9,0
8,2

86,5
:
98,1
93,2
89,7
85,7
:
92,5
86,4
89,0
92,4
82,7
89,4
95,9
59,6
98,3
95,4
87,0
83,0
99,5
92,6
:
92,5
99,3
96,7
85,1
88,2

2,7
3,1
4,7

4,6
5,1
7,2

91,3
66,6
EU-27
90,8
66,6
EU-25
EU-15
89,3
67,1
Source: EU labour Force Survey, quarter 2. Data marked 'u' lack reliabilty due to small sample size. Empty cells correspond to data not avaialble or not reliable due to smal sample size
(1) In case "born in another EU25 country" is not reliable due to small sample size, the cell "Born outside the EU25" refers to "Born outside the country".
(2) Country of birth is not available for BG, DE and RO. Nationality is used instead. 

65,6
66,1
67,4

91,1
90,6
88,9

65,6
65,6
66,2

64,8
65,2
67,4

68,6
68,6
68,8

58,2
58,2
57,9

60,8
60,8
60,5

60,4
60,4
60,2

64,7
65,1
66,7

2,4
2,6
3,1

6,4
6,8
8,0

2,6
3,0
4,5

6,1
:
1,3
1,8
3,5
0,9
:
1,0
2,0
3,0
1,3
5,6
1,0
0,4
34,4
0,3
1,7
2,5
4,9
0,2
1,6
:
0,7
0,6
1,4
4,6
3,1

2,2
2,4
2,7

7,5
:
0,6
5,0
6,8
13,5
:
6,5
11,7
8,0
6,3
11,7
9,6
3,8
6,0
1,3
3,0
10,5
12,1
0,3
5,8
:
6,7
0,1
1,9
10,3
8,7

6,4
6,9
7,9

88,4
:
99,1
90,6
89,7
86,2
:
92,3
84,9
88,5
92,0
82,3
87,8
95,9
58,3
98,5
95,5
87,1
82,8
99,6
92,3
:
91,9
99,5
96,6
84,7
87,4

91,0
90,4
88,8

5,2
:
0,3
1,9
3,6
0,6
:
1,2
4,0
3,1
2,1
6,4
1,3
0,4
35,6
1,1
1,4
2,7
5,4
0,2
1,6
:
0,5
0,4
1,4
4,7
3,7

2,6
2,8
3,2

6,5
:
0,6
7,5
6,7
13,1
:
6,4
11,1
8,3
5,9
11,2
10,9
3,8
6,0
0,4
3,1
10,3
11,7
0,2
6,1
:
7,6
0,1
2,0
10,6
9,0

6,4
6,8
7,9

EN 

188 

EN 

 
  
2. Distrbution of the population by age and country of birth

2005

2006

2007

Born in the country

Born in another EU25 
country

Born in another country 
outside the EU25

Born in the country

Born in another EU27 
country

Born in another country 
outside the EU25

Born in the country

Born in another EU27 
country

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

15-24

25-49

50-64

Born in another 
country outside the 
EU25

15-
24

25-49 50-64

BE
BG
CZ
DK
DE
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
RO
SI
SK
FI
SE
UK

19,4
19,8
18,9
16,7
17,7
25,6
23,3
17,1
17,6
20,5

19,5
25,2
23,2
21,5
18,8
22,5
18,4
18,4
22,6
18,6

20,2
23,0
18,1
19,7
19,4

53,3
52,1
51,8
52,6
53,7
52,0
52,8
55,0
56,8
53,0

53,4
52,6
53,2
52,2
52,1
50,4
52,7
55,0
51,7
54,3

54,0
53,2
50,0
49,8
52,3

27,3
28,1
29,3
30,6
28,7
22,4
23,9
27,9
25,7
26,5

27,1
22,2
23,5
26,4
29,2
27,1
28,9
26,6
25,7
27,2

25,8
23,8
32,0
30,5
28,3

8,3

54,1

37,6

14,2

67,4

18,4

6,7
12,1
13,3

16,5
19,2
7,8
6,4

14,2
11,3

9,7
12,2 u

8,9
12,0

50,7
55,7
59,4

68,8
66,9
69,4
50,2

61,1
38,7

64,9
40,9

60,8
55,9

42,6
32,3
27,3

14,7
13,9
22,8
43,4

24,8
50,0

25,3
46,9

30,3
32,1

22,3

70,5

7,2

13,3
16,8
19,5
3,4

18,4
19,6
10,7

16,9
3,4
5,7 u
14,8
12,0

13,1
16,2
5,8 u
15,4

71,0
68,9
61,2
47,8

67,4
71,3
56,6

72,0
45,3
55,4
70,4
63,9

66,2
62,5
27,6
72,2

15,7
14,3
19,3
48,8

14,2
9,1
32,8

11,1
51,3
39,0
14,7
24,1

20,7
21,3
66,6
12,3

6,3 u

53,1

40,6 u

5,0

58,0

37,0

24,1
4,8
15,8

61,0
48,3
59,5

14,8
46,9
24,7

22,1
18,7
14,4

64,6
63,6
64,8

13,3
17,7
20,8

19,4
:
18,6
17,1
18,4
26,0
22,5
16,8
16,9
20,5
15,7
19,6
25,0
23,5
21,7
18,5
22,6
18,6
18,6
22,2
18,1
21,6
19,6
22,3
18,0
20,0
19,4
:
19,1
18,9
18,2

52,8
:
51,8
52,2
53,8
51,6
53,1
55,1
56,6
52,5
55,2
53,3
52,3
53,0
51,0
51,6
50,3
52,2
54,9
51,3
54,3
53,2
53,9
53,0
49,4
49,5
51,9
:
53,2
53,2
53,6

27,8
:
29,6
30,7
27,8
22,3
24,4
28,0
26,6
27,0
29,0
27,1
22,7
23,5
27,3
29,9
27,1
29,2
26,6
26,5
27,6
25,2
26,5
24,7
32,5
30,5
28,7
:
27,7
27,9
28,2

10,3
:
8,4
12,3
:
:
:
15,8
13,7
5,5
11,8
15,4
:
:
9,4
11,9
:
10,2
10,4
:
18,2
:
(6.7)
(9.2)
17,8
4,6
18,2
:
11,7
11,7
11,8

53,1
:
49,5
56,1
:
49,1
:
70,3
69,0
51,2
73,3
62,1
42,3
(72.4)
64,8
61,1
(58.5)
60,7
59,6
(25.0)
76,6
:
53,9
46,8
70,9
48,8
60,9
:
61,0
61,0
61,6

36,6
:
42,1
31,6
:
41,5
:
13,9
17,3
43,3
14,9
22,5
52,4
:
25,8
27,0
:
29,2
30,0
71,4
5,2
:
(39.4)
43,9
11,4
46,6
21,0
:
27,3
27,3
26,6

13,5
:
13,8
20,0
:
2,9
:
18,5
18,3
10,6
15,1
14,6
4,1
(6.8)
15,6
16,2
(22.1)
13,2
16,2
(10.6)
15,4
:
6,1
:
23,9
18,5
14,1
:
14,4
14,4
14,8

67,0
:
70,5
64,1
:
46,7
:
68,7
72,9
56,7
74,0
74,6
46,1
51,5
64,9
59,4
67,6
65,3
62,2
33,0
70,6
:
55,2
:
61,7
62,0
64,9
:
65,5
65,5
66,1

19,5
:
15,7
16,0
:
50,5
:
12,7
8,8
32,7
10,9
10,8
49,9
41,7
19,5
24,5
:
21,5
21,6
56,5
14,0
:
38,7
:
14,4
19,6
21,0
:
20,0
20,0
19,1

19,0
:
18,4
17,0
18,4
25,8
21,9
16,2
16,5
20,4
15,7
18,7
25,3
23,7
21,7
18,4
22,8
18,7
18,6
21,5
17,6
21,3
19,3
22,0
18,3
20,5
19,6
:
18,9
18,8
18,2

52,5
:
51,8
51,6
53,2
52,3
53,3
55,1
56,1
52,0
55,0
53,5
52,5
52,8
51,7
51,7
49,8
51,6
54,5
51,0
54,3
53,0
53,8
52,9
48,8
49,2
51,2
:
52,8
52,8
53,2

28,5
:
29,8
31,4
28,4
21,9
24,7
28,7
27,4
27,6
29,3
27,8
22,2
23,5
26,5
29,9
27,4
29,7
26,8
27,5
28,1
25,7
26,9
25,1
33,0
30,3
29,2
:
28,2
28,4
28,7

11,4
:
11,1
13,8
:
:
:
15,3
13,3
7,2
10,5
15,3
(6.1)
:
9,6
10,4
:
11,2
11,0
:
16,5
:
:
:
13,4
5,1
19,0
:
12,3
12,3
12,4

52,8
:
49,7
55,0
:
51,1
:
68,6
72,6
48,5
75,1
60,6
40,7
(59.3)
65,9
62,3
(57.5)
59,7
61,7
(18.5)
79,1
:
61,6
39,7
73,7
47,7
61,9
:
61,7
61,7
62,3

35,8
:
39,1
31,2
:
42,8
:
16,2
14,1
44,3
14,4
24,2
53,2
:
24,5
27,3
:
29,2
27,2
74,3
4,4
:
(34.3)
55,2
12,9
47,2
19,1
:
26,0
26,0
25,3

14,6 66,1

:

:

12,2 71,9
19,2 63,6

:
2,5
:

:
43,8
:

17,5 69,4
17,6 72,0
10,1 58,5
14,5 73,6
15,4 74,2
4,2
46,3
(5.9) 52,2
16,1 66,3
20,0 58,7
(22.2) 66,7
12,4 65,0
15,6 62,2
35,1
14,1 70,6
(77.2)
53,3
68,6
23,0 60,6
18,8 61,0
14,0 65,6

:
5,1
:

:

:

:

14,1 65,8
14,1 65,8
14,4 66,3

19,2
:
15,8
17,2
:
53,7
:
13,1
10,4
31,5
11,9
10,4
49,5
42,0
17,6
21,3
:
22,6
22,2
57,9
15,3
:
41,5
:
16,3
20,2
20,3
:
20,2
20,2
19,3

19,3
19,3
18,7

53,2
53,3
53,6

63,4
EU-27
63,4
EU-25
EU-15
63,9
Source: EU labour Force Survey, quarter 2. Data marked 'u' lack reliabilty due to small sample size. Empty cells correspond to data not avaialble or not reliable due to smal sample size
(1) In case "born in another EU25 country" is not reliable due to small sample size, the cell "Born outside the EU25" refers to "Born outside the country".
(2) Country of birth is not available for BG, DE and RO. Nationality is used instead. 

27,5
27,5
27,8

15,6
15,6
16,0

57,4
57,4
58,1

11,2
11,2
11,3

21,0
21,0
20,1

31,4
31,4
30,5

EN 

189 

EN 

 
  
3. Distribution of the 15-64 by sex and country of birth

2005

2006

2007

Born in the country

Born in another 
EU25 country

Born outside the 
EU25

Born in the country

Born in another 
EU25 country

Born outside the 
EU25

Born in the country

Born in another 
EU25 country

Born outside the 
EU25

Men

49,5
50,5
49,9
49,3
49,8
51,6
49,8
50,1
49,4
50,5

50,1
51,2
51,7
49,2
51,1
49,7
49,3
49,8
50,5
50,5

49,2
50,3
49,7
48,9
50,6

BE
BG
CZ
DK
DE
EE
IE
EL
ES
FR
IT
CY
LV
LT
LU
HU
MT
NL
AT
PL
PT
RO
SI
SK
FI
SE
UK

Wo
men

50,5
49,5
50,1
50,7
50,2
48,4
50,2
49,9
50,6
49,5

49,9
48,8
48,3
50,8
48,9
50,3
50,7
50,2
49,5
49,5

50,8
49,7
50,3
51,1
49,4

Men

Wo
men

51,6

48,4

49,6
45,2
47,5
52,7
48,1
62,0
53,2
53,2

53,3
57,2

49,6
56,3
53,0 u
56,1
57,5
46,8
52,1

54,9
53,3
48,3
53,0
53,1

50,4
54,8
52,5
47,3
51,9
38,0
46,8
46,8

46,7
42,8

50,4
43,7
47,0 u
43,9
42,5
53,2
47,9

45,1
46,7
51,7
47,0
46,9

Men

50,8
55,4 u
45,8
55,7
49,1
57,1
48,3
49,2
50,1
51,0

60,6
56,5
53,9
53,4
53,3
47,7
50,1
50,5
53,8
52,4

49,0
53,9
53,8
50,5
51,6

Wo
men

49,2
44,6 u
54,2
44,3
50,9
42,9
51,7
50,8
49,9
49,0

39,4
43,5
46,1
46,6
46,7
52,3
49,9
49,5
46,2
47,6

51,0
46,1
46,2
49,5
48,4

Men

49,2
48,4
48,9
49,8
48,8
47,4
49,7
49,1
49,4
48,7
48,7
50,0
46,8
46,8
51,2
47,4
49,7
49,8
48,8
48,3
48,4
48,7
48,9
48,6
48,8
50,9
48,9

Wo
men

50,8
51,6
51,1
50,2
51,2
52,6
50,3
50,9
50,6
51,3
51,3
50,0
53,2
53,2
48,8
52,6
50,3
50,2
51,2
51,7
51,6
51,3
51,1
51,4
51,2
49,1
51,1

Men

46,1
41,7
45,8
50,4
52,7
35,8
:
35,0
48,5
46,3
36,4
45,9
46,5
54,9
50,4
41,6
51,8
41,9
43,0
43,8
48,0
58,0
45,1
46,4
51,2
44,7
46,4

Wo
men

53,9
58,3
54,2
49,6
47,3
64,2
:
65,0
51,5
53,7
63,6
54,1
53,5
45,1
49,6
58,4
48,2
58,1
57,0
56,2
52,0
42,0
54,9
53,6
48,8
55,3
53,6

Men

48,2
37,8
47,4
44,3
51,2
38,0
:
50,1
49,4
48,6
49,6
39,3
40,5
42,7
46,3
44,3
44,9
49,3
49,5
37,6
48,1
65,7
51,8
37,2
43,9
49,4
48,4

Wo
men

51,8
62,2
52,6
55,7
48,8
62,0
:
49,9
50,6
51,4
50,4
60,7
59,5
57,3
53,7
55,7
55,1
50,7
50,5
62,4
51,9
34,3
48,2
62,8
56,1
50,6
51,6

Men

49,1
48,4
48,9
49,8
48,8
47,4
49,8
49,2
49,5
48,7
48,7
50,1
47,1
46,7
50,5
47,4
49,7
49,8
48,9
48,2
48,5
48,7
49,0
48,6
48,8
51,0
48,8

Wo
men

50,9
51,6
51,1
50,2
51,2
52,6
50,2
50,8
50,5
51,3
51,3
49,9
52,9
53,3
49,5
52,6
50,3
50,2
51,1
51,8
51,5
51,3
51,0
51,4
51,2
49,0
51,2

Men

47,2
41,8
44,4
43,3
52,6
33,4
:
39,9
49,7
45,4
40,4
43,7
43,0
49,1
51,2
44,0
43,2
44,1
43,2
46,4
47,5
63,4
38,3
43,1
53,2
45,5
47,4

Wo
men

52,8
58,2
55,6
56,7
47,4
66,6
:
60,1
50,3
54,6
59,6
56,3
57,0
50,9
48,8
56,0
56,8
55,9
56,8
53,6
52,5
36,6
61,7
56,9
46,8
54,5
52,6

50,1
50,1
50,0

49,9
49,9
50,0

52,6
51,2
EU-27
52,6
51,2
EU-25
EU-15
52,5
51,1
Source: EU labour Force Survey, quarter 2. Data marked 'u' lack reliabilty due to small sample size. Empty cells correspond to data not avaialble or not reliable due to smal sample size
(1) In case "born in another EU25 country" is not reliable due to small sample size, the cell "Born outside the EU25" refers to "Born outside the country".
(2) Country of birth is not available for BG, DE and RO. Nationality is used instead. 

53,0
53,0
52,9

51,6
51,6
51,6

50,6
50,6
50,5

51,0
51,0
50,6

49,0
49,0
49,4

48,8
48,8
49,0

47,4
47,4
47,5

51,2
51,2
51,0

47,0
47,0
47,1

48,4
48,4
48,4

49,4
49,4
49,5

48,8
48,8
48,9

Men

47,4
46,6
48,5
46,9
51,1
38,5
:
51,4
49,0
49,3
49,8
39,8
39,5
42,7
44,9
42,8
48,9
48,5
49,6
37,1
47,6
54,8
53,2
53,2
46,3
48,8
48,5

49,0
49,0
49,4

Wo
men

52,6
53,4
51,5
53,1
48,9
61,5
:
48,6
51,0
50,7
50,2
60,2
60,5
57,3
55,1
57,2
51,1
51,5
50,4
62,9
52,4
45,2
46,8
46,8
53,7
51,2
51,5

51,0
51,0
50,6

EN 

190 

EN