Regulated Competition in Social Health Insurance: A Three-Country Comparison

The objectives guiding healthcare reforms in Germany, Switzerland and the Netherlands were to increase efficiency and consumer satisfaction in the provision of healthcare services. This paper reviews the incentives for and instruments of competition for consumers, sickness funds and healthcare providers in these three countries which are necessary to fulfil these objectives. Incentives for risk selection of sickness funds are high in Germany and Switzerland while they are low in the Netherlands. Incentives for consumer choice are also highest in Germany and Switzerland. In all three countries sickness funds have only a few instruments of competition. The effects of competition have been disappointing so far. The objectives of competitive healthcare reforms can be achieved only if incentives for and instruments of competition consistently support competitive behaviour on the part of market actors.     

Continental Drift: On Unemployment Policy Change in Bismarckian Welfare States

This article analyses the development of unemployment policies over the past 20 years in four continental European countries: Belgium, France, Germany and the Netherlands. It shows that, far from being as ‘frozen’ as many analysts have suggested, each of these Bismarckian welfare states has in fact seen considerable change in this policy sector in recent decades. In Belgium, France and Germany, significant changes in unemployment policy reforms have unfolded gradually, through an accumulation of small changes. This finding offers some support to recent theorizing on the potential for policy changes that are both incremental and transformative. However, while such processes have led to shifts in unemployment policy that are far from negligible, the article also argues that they fall short of those seen in this policy sector in other welfare institutional contexts as well as in the Netherlands, where substantive reforms have in the last decade been complemented with changes to the institutional framework for unemployment policy. Through its analysis of the relationship between the institutional features of these welfare states and the possibility frontier of unemployment policy reform, the article develops a nuanced perspective on the scope for and resistance to social policy change in continental Europe.     

Work incapacity and reintegration: Theory and design of a cross-national study

This article presents the theory and design of a prospective cross-national study on work incapacity and reintegration with cohorts of low back pain patients from Denmark, Germany, Israel, the Netherlands, Norway, Sweden, and the United States. The aim of the project, which is being coordinated by the ISSA, is to learn how social security, labour, and healthcare systems address problems of work incapacity and reintegration and to measure and evaluate the effectiveness of various interventions, incentives, and disincentives on return to work. The article includes discussion of common problems that motivated the sponsors to join the project, the benefit programmes and services currently available in the participating countries, the theoretical model for the research, the project's core research design, and some key elements of its methodology.     

Explaining Different Paths in Social Health Insurance Countries – Health System Change and Cross‐border Lesson‐drawing between Germany,Austria and the Netherlands

The issues of ‘policy diffusion’ or ‘policy transfer’ and ‘mutual learning’ have become important topics in comparative research on social policy and health systems. In current debates on explaining reform in ‘Bismarckian’ social (health) insurance systems, however, these issues have been neglected. In particular, the role of ‘negative lesson‐drawing’ in the sense of avoiding mistakes of others has not often been considered. This article compares health system change in Germany, Austria and the Netherlands, three countries with health systems of the social insurance type. In contrast to the existing literature, our analysis stresses that these countries have taken different reform paths since the 1990s. By applying a most similar systems design, we analyze how far cross‐border lesson‐drawing has contributed to health system divergence in the three countries. The empirical basis of the analysis is semi‐structured qualitative expert interviews, a method appropriate for tracing processes of lesson‐drawing. We argue that in order to fully understand the diverging reform trajectories, we need to take into account how political decision‐makers refer to (negative) experiences of other countries. Generally, national driving forces for health system change were at the heart of many crucial reforms during the period studied. Nevertheless, we claim that it was the German bad practice role model that kept the reform paths of Austria and Germany apart in the Austrian health reform discussion between 2000 and 2005.     

Upskilling as integration policy: Making the most of refugees' human capital in a context of skill shortage

The integration of refugees is a serious social policy problem in many advanced countries, and current trends suggest that this issue is unlikely to disappear soon. At the same time, these countries are also experiencing skill shortages in expanding sectors. These twin pressures create an opportunity to use education as a tool to pursue refugee integration. We investigate how refugees are trained in a country, Switzerland, where employers play an important role in vocational training. We discuss the national strategy for refugee integration and then focus on the implementation in one French speaking Canton (Vaud) on the basis of a qualitative vignette survey among case workers in charge of supporting refugee integration. At implementation, we do not find much evidence of a generalised upskilling strategy being applied in Switzerland. On the contrary, the main emphasis is on quick access to employment, supported by vocational training mostly in the low-skill segment. We conclude that the lack of an upskilling strategy is due to lack of coordination among policy areas and limited interest by employers.     

Care for Elderly People in the European Community

All EEC countries are faced with an ageing population, which means an increase of people in some way handicapped in everyday activities. A comparison of the solutions adopted by several EEC countries in the sectors of housing, home care services, residential and nursing homes shows that a real medico-social policy has been worked out only in Denmark and the Netherlands. In France and the United Kingdom, public authorities have certainly defined policies which lay claim to providing overall coverage but they have not provided corresponding resources. In Germany and in Italy there is no clearly defined policy. Here we discuss the various factors which may account for these differences.     

Activation as a Common Framework for Social Policies towards Lone Parents

This article compares recent social policy reforms in respect of lone-parent families in three different national contexts: France, the Netherlands and the UK. In all three countries there is an increasing focus on activation policies to promote employment among lone parents. The authors examine whether this common framework of activation has led to a policy convergence across these three countries.     

Morality policy processes in advanced industrial democracies

In recent years, several countries have experienced widespread, intense debates about morality issues such as the death penalty, abortion, ART/stem cell research, same-sex marriage, and euthanasia. Assuming the distinctiveness of morality policies from other policy fields, this article analyses three alternative institutional models for explaining variations in the amount of conflict over these morality issues across 24 Western democracies. Is either the US-developed “policy type” model or the European-developed “two worlds” of morality politics, based on religious and secular party systems, applicable more broadly? Are there regional patterns (Europe and non-Europe) to any institutional findings? How does each model contribute to our understanding of morality policy comparatively across Western democracies? We find broader cross-national support for the policy type model, with the two worlds model largely restricted to Europe. The US has more morality policy conflict because of its unusual combination of a political party targeting religiously oriented voters within an institutional framework of multiple venues. The US and other non-European countries have similar patterns of institutional deliberation through decentralization, and the US also has similarities in multiple venues with religious party systems in Europe. Secular European party systems with centralized institutions have the fewest venues for morality policy debate.     

对外直接投资、比较优势与我国的发展模式

对外直接投资正日益成为国际间经济联系的主要途径。我国在融入世界经济的进程中,对外开放政策正从主要靠“引进来”为主,转向“引进来”和“走出去”并重的新阶段。用比较优势理论结合发展中国家对外直接投资现状,我国现阶段发展对外直接投资可有宏观、中观及微观三类不同层次的可选择模式。     

西方发达国家意识形态掌控特点评析

西方发达国家对意识形态的掌控从来都没有放松过,并且随着国内外形势的发展和变化而不断地调整着实施的战略和具体政策,其表现出来的手段多样性、实施的灵活性、实用性等特点具有较强的针对性与迷惑性。通过对西方发达国家意识形态掌控特点的梳理,有利于加深对其掌控本质的认识。     

A model for the coordination of recovery policies in the OECD region

The paper presents a world econometric model of the LINK type, which is then applied to the study of the recovery prospects of the OECD economies. Specifically, several policy packages coordinated at the international level are assessed for the period 1978–1980.The model includes country specific macroeconomic structures for eight developed economies, and different type structures for five additional developing countries. The obvious policy and behavioral differences that exist between these two groups of countries are highlighted through the specification, in one case, of demand-oriented Keynessian models able to capture short-term cyclical phenomena. The supply orientation with several resource gaps (savings, foreign exchange, etc.) prevails for the developing economies. The two sections after the introduction review broadly the main modeling features of the project, including the international comparison of structural parameters. In the following sections several policy experiments are attempted. The underlying behavioral assumptions stress the community of interest that prevails among OECD economies. These experiments consider the case of stimulative policies adopted in (1) the United States alone, (2) three engine countries (United States, Federal Republic of Germany, and Japan), and (3) several developed countries that are part of the OECD system. Other experiments assume additional policy packages to correct present current account imbalances. The general conclusion of the study is that the prospects for economic recovery in the OECD area depend to a crucial extent on the ability of the member countries to agree on policies able to make the major economic indicators of each economy converge toward levels that are domestically manageable and mutually supporting.     

US foreign aid and economic policy concessions*

Why do donors continue to provide foreign aid despite its failure to help poor countries over the past several decades? While some scholars argue that foreign aid is purely for humanitarian purposes, others assert that such aid serves as a tool to pressure recipient countries into accepting policy concessions. In this study, we subject these arguments to empirical testing using a dataset that integrates the amount of US aid and economic policies of recipient countries for 1995–2012. The findings suggest that aid decisions correspond to the interests of the United States, such as policy concessions in economic and business liberalization. However, an increase in US aid is not directly associated with further economic reforms in recipient countries. We conclude that US foreign aid programmes are strategic in nature and successful not in alleviating economic problems in recipient countries but, at the very least, in buying their policy compliance.     

Family Policies in Germany and France: The Role of Enterprises and Social Partners

Although France and Germany are commonly classified as Bismarckian welfare regimes, they differ significantly in terms of family policy. For a long time, social and family policy in (West) Germany was focused on the male-breadwinner model of married couples. This was based on the expectation that women, in particular married women with children, would withdraw from the labour market permanently, or at least temporarily. Whereas care by mothers was massively subsidized by state family policy, the expansion of the childcare infrastructure was neglected and progressed only very slowly compared to the situation in many other countries of Europe. France, on the contrary, is one of the European countries where childcare services are particularly widespread, giving mothers the option to combine paid work and motherhood. Nevertheless, significant changes are happening in both countries. Concern over the demographic trends and low birth rates (in particular in Germany) have refocused attention on family policy in recent years. In Germany, it has now become a key field of debate and policy, and new actors have appeared on the scene. This article proposes to compare the latest developments in both countries, highlighting the contribution of enterprises and social partners to work–life balance, re-analysing the different types of familialism characterizing both countries.     

The challenge of youth unemployment

This article was prepared as a contribution to the ILO's Action Programme on Youth Unemployment. It presents an overview of the youth unemployment problem and youth employment policy principally from a European perspective, although it is hoped that much of the comment and analysis is relevant to afar broader range of countries. In the first section, which considers the nature and causes of youth unemployment, it is shown that its basic cause is aggregate demand rather than high youth wages or the size of the youth cohort, and suggests that a successful strategy for dealing with the problem must take this into account. In the second section, dealing principally with the examples of Germany and the United Kingdom, a number of factors are identified which influence the effectiveness of youth employment policy. In particular, it is found that precise targeting of programmes and the involvement of employers' and workers' organizations, as well as government, in the design and implementation of policy are both important determinants of an effective policy. A third section attempts to set the analysis in a more general context.     

Visibility and 'child view' in the assessment process of social work: cross-national comparisons

In Western societies, national and international legislation and agreements are giving increasing support to the principle that children must be regarded as subjects, with the right to be in focus and to express their own views in the assessment process of social work. The empirical data in the present study, collected from more than 700 social workers through open-ended questions, and generated in a cross-national vignette study of child protection cases in Denmark, Germany, Sweden, Britain and Texas, are analysed within a conceptual framework of 'child visibility' and 'child view'. The results reveal a number of systematic patterns within and between the areas under study. The child is visible to different extents but also with varying emphasis across the countries. The possibility for the views of the child to be included in assessment processes differs due to the age of the child and across the countries.     

Human rights and the allocation of foreign aid: A cross-national analysis of the last years of the Cold War, 1980–1989

Studies of conflict behavior show that states act differently based on changes in the global system. However, studies of other types of foreign policy behavior, such as aid allocation, have neglected to focus on similar system effects. This study is among the first to look at the impact of the cold war system on the relationship between recipient human rights practices and foreign aid disbursements for eight major aid donors, Canada, France, Germany, the Netherlands, Norway, Sweden, the United Kingdom, and the United States. Through an analysis of aid allocations to a sample of 72 recipients from 1980 to 1989 (the only Cold War years for which reliable and valid human rights data are available) this paper reveals striking and unique findings. Contrary to previous studies, it appears that recipient human rights are a significant factor in whether or not a recipient gets any aid, the so-called gatekeeping stage, but are not a significant factor in how much aid a country receives in the level stage. This paper makes three major contributions to the field. It is the first direct test of the effect of the Cold War system on the relationship between recipient country human rights and aid. It also extends this analysis to donors other than the United States. Finally, the results serve as a baseline for assessing the relationship between human rights and aid during the post-Cold War period (1990–2001) and the so-called “age of terror” (2002 onwards).     

Smaller net or just fewer to catch? Disentangling the causes for the varying sizes of minimum income schemes

The number of social assistance recipients varies significantly between welfare states. Social assistance is a last-resort residual benefit, so a high number of receipts may be related to policies for first-tier benefits, social assistance and their implementation, as well as need factors (unemployment rate and low income). Considering the strong political will to diminish the receipt of last-resort benefits, we demonstrated a way to decompose the reasons for eligibility in a cross-national analysis of two Nordic countries, namely Finland and Sweden. By using administrative register microdata, eligibility simulations and policy swaps, we found that the legislative features of social assistance, such as more extensive benefit norms and earning disregard, contribute to Finland's higher eligibility rate and likely explain some of the reasons for its higher number of recipients. Finland also exhibited lower non-take-up rates among those eligible, which implies better access to benefits than in Sweden.     

Sheltered Employment Strategies In Five Countries

The paper outlines sheltered employment strategies drawn from five countries (USA, Sweden, The Netherlands, Britain, and New Zealand) with a view to articulating policy options. The focus for the study was at the level of individual organizations in each country and personnel at all managerial levels were interviewed to ascertain their orientation with respect to the organisation of sheltered employment at three individual, yet interdependent structural levels: the national industry, the individual enterprise, and work itself. Work activity was observed and official documentation was studied to strengthen the validity of interview data. The results indicate that successful workshops were not only well informed of the dominant industry philosophy but also had their own clearly articulated interpretation of that philosophy. A number of policy options were seen to emerge from the patterns observed.     

Marketisation policies in different contexts: Consequences for home‐care workers in Germany,Japan and Sweden

Market‐oriented restructurings of long‐term care policies contribute significantly to the aggravation of care workers’ situations. This article focuses on the effects of broader long‐term care policy developments on market‐oriented reforms. Germany, Japan and Sweden are three countries that have introduced market‐oriented reforms into home‐based care provision embedded in distinct long‐term care policy developments. Conceptually, this article draws on comparative research on care to define the institutional dimensions of long‐term care policies. Empirically, the research is based on policy analyses, as well as on national statistics and a comparative research project on home‐care workers in the aforementioned countries. The findings reveal the mediating impact of the extension and decline of long‐term public care support and the corresponding development of the care infrastructure on both the restructuring of care work and the assessments of the care workers themselves.     

The Great Recession and Welfare State Reform: Is Retrenchment Really the Only Game Left in Town?

By 2010, when the Greek sovereign debt crisis changed into an existential crisis of the euro, all developed democracies entered a phase in which they had to consolidate their budgets, typically implying a politics of austerity. The scholarly literature, as well as the popular press, suggests that – consequently – welfare retrenchment and cost containment became the only games left in town. In this article, we study the welfare state reform measures taken between 2010 and 2012 in four countries characteristic of mature welfare state regimes (liberal, UK; conservative, Germany; social democratic, Denmark; and hybrid, the Netherlands) to examine empirically whether austerity has indeed become the only item left on the policy menu. Our analysis reveals that retrenchment features prominently on the agenda everywhere, but nowhere by itself. While compensation for income loss is rare since 2010, this still happens. More unexpectedly, reforms in line with a social investment agenda (like expansion of child care or active labour market policies) are still being pursued in all our four cases.