Public Satisfaction with the Health System and Popular Support for State Involvement in an East Asian Welfare Regime: Health Policy Legitimacy of Hong Kong

The legitimacy of social policies has gained increasing attention in the past decade, against the backdrop of fiscal austerity and retrenchment in many nations. Policy legitimacy encompasses public preferences for the underlying principles of policies and the actual outcomes as perceived by citizens. Scholarly knowledge concerning the legitimacy of health policy – a major element of modern social policy architecture – is, unfortunately, limited. This article seeks to extend the scholarly debates on health policy legitimacy from the West to Hong Kong, a member of the East Asian welfare state cluster. A bi‐dimensional definition of health policy legitimacy – encompassing both public satisfaction with the health system and the normative expectation as to the extent of state involvement in health care – is adopted. Based on analysis of data collected from a telephone survey of adult Hong Kong citizens between late 2014 and early 2015, the findings of this study demonstrate a fairly high level of satisfaction with the territory's health system, but popular support for government responsibility presents a clear residual characteristic. The study also tests the self‐interest thesis and the ideology thesis – major theoretical frameworks for explaining social policy legitimacy – in the Hong Kong context. Egalitarian ideology and trust in government are closely related to both public satisfaction with the system and popular support for governmental provision of care. However, the self‐interest thesis receives partial support. The findings are interpreted in the context of Hong Kong's health system arrangements, while implications for the territory's ongoing health policy reform are discussed.     

Learning to love (the state) again? Money,legitimacy and community sector politics

The erosion and dismantling of the post‐war welfare settlement has entailed an expanded role for the community sector, as a complex ‘mixed economy of service provision’ has developed. Critiques from both right and left have undermined the legitimacy of a statist model of welfare; state funding of non‐government community organisations is one aspect of the move away from centralised delivery. Despite their important role in this process, the distinctive perspectives of community sector organisations are rarely considered in broader theoretical and political debates. These organisations face significant dilemmas in struggling to maintain their viability and independence. Analysis of three major arguments for funding shows how organisations challenge the state's legitimacy by insisting on their own independent role but precariously rely on traditional sources of welfare state funding. This analysis draws into question the possibility of satisfactory non‐statist theories of welfare. It also suggests that the community sector might need to reposition itself as part of a broader public system of welfare, rather than in opposition to government, but that this strategy entails obvious risks for organisations' independence.     

Levels or worlds of welfare? Assessing social rights and social stratification in Northern and Southern countries

Since Esping‐Andersen's Three Worlds, it has become a truism of welfare state research that welfare states do not vary linearly along a single dimension but have to be conceptualized as multidimensional phenomena that cluster into types caused by the political economy of class coalitions. However, when moving beyond the 18 original countries of Esping‐Andersen's analysis, the situation is less clear. Although additional worlds have been identified in the Global North and the Global South, these are usually not conceptualized along the same dimensions as the original three worlds and are rarely empirically compared with them. This paper tackles these omissions by explicitly comparing Northern and Southern countries within Esping‐Andersen's framework. It poses the question whether the central insight of welfare state research, namely, that there are not just gradual differences between welfare states, but different types with qualitative differences, expands beyond classic welfare states. Based on newly generated data on social rights and social stratification, we employ cluster analysis with 45 Northern and Southern countries. This analysis produces mixed results. We do find different types of welfare states with qualitative differences, but these do not fully correspond to Esping‐Andersen's Three Worlds. Moreover, our findings also point to a conceptual issue in welfare regime research: regimes are not just defined and measured in terms of different logics of welfare provision but also take into account degrees of welfare stateism. We argue that this issue is poised to become ever more pressing with the geographical expansion of welfare state research.     

The Middle‐class in the German Welfare State: Beneficial Involvement at Stake?

The working‐class is typically regarded as the driving force of welfare state development. Yet, some argue that the middle‐classes' beneficial involvement in the welfare state is crucial for its financial sustainability and popular legitimacy. Against this backdrop, we investigate how recent welfare state reforms in Germany which affect the status of the middle‐class are viewed and discussed by this group. Germany is a particularly interesting case because its welfare state is seen to be centred on the desires of the middle‐class, especially through its focus on status maintenance and horizontal redistribution over the life‐course. However, the move from status maintenance to minimum income support in unemployment provision and the strengthening of private old age provision challenge this assumption. Thus, we ask how the German middle‐class views the emerging abandonment of the principle of status maintenance and the shift from collective to individual responsibility. Based on qualitative material from focus groups, we find that individual responsibility is generally supported, but that the state is still assigned responsibility for providing basic levels of social security. Furthermore, for those groups seen as less capable of acting individually responsible (e.g. the poor or long‐term unemployed) the ‘inducement’ of – or assistance for – individually responsible behaviour by the state is demanded. Overall, while the principle of ‘individual responsibility’ seems to find some resonance among the middle‐class members interviewed, they still try to balance individual and collective responsibility.     

Attitudes towards the welfare state have several dimensions

The dimensions and structures of opinions on the welfare state are not well known. This study distinguishes five dimensions based on previous literature: responsibility for welfare, financing of the welfare state, the use of benefits, the adequacy of the welfare state benefits and the effects of the welfare state. One or more attitude indicators are formed for each dimension by means of factor analysis of empirical material. Examination of the correlations between the dimensions and attitudes yields two opinion structures. A supportive attitude structure is founded on the concept that public authorities have responsibility for welfare services, a positive attitude towards public financing of welfare services, and on the concepts that the amount and quality of services and the level of income transfers is not adequate. The critical cluster of attitudes is formed by the reliance on private responsibility, negative attitude towards public financing and on the concepts that benefits are overused and that the welfare state makes its clients passive. Finally, the variation in attitudes among the population of Finland are studied by means of regression analysis. Social class, age and political party sympathies are the most important explanatory factors for a range of attitudes.     

The state of the German social insurance state: Reform and resilience

At the core of the German system of welfare provision stand social insurance schemes whose central role contributes to Germany being labelled a social insurance state. In recent decades, Germany has been experiencing major social policy reforms that are often evaluated as paradigm changes. These changes have been reflected in analyses that sometimes even questioned common classifications of the German welfare state. The article sheds light on recent developments that have affected the German system of social insurance. It focuses on four aspects of social insurance: benefits, financing, governance, and coverage. Although confirming many earlier analyses of reforms in detail and sharing assessments of changes such as retrenchment and marketization, the article nevertheless stresses that social insurance remains structurally intact and that the work–welfare nexus underlying welfare provision has been reinterpreted but not surrendered.     

Mobilising the welfare machine: Questioning the resurgent socialist concern in China’s Public Rental Housing Scheme

This study examined the resurgence of public housing provision in China since 2007 by situating it in a broad welfare regime analysis. Based on insights from Productivist Welfare Capitalism (Holliday, 2000. Productivist Welfare Capitalism, 706?723) and Graduated Sovereignty (Ong, 2006a. Neoliberalism as exception), we have sought to shed new light on the productivist approach through a study on Chinese cases. Using the examples of Chongqing and Nanjing, we argue in the study that the proactive action of the state to further commodify labour power has led to the flexible de‐articulation and re‐articulation of welfare and citizenship in an ongoing process of de‐territorialisation and re‐territorialisation of various segments of the population that own parcels of land. Another aspect of flexibility in the welfare regime is the double segmentation of population and territory, which is also contingent on, and subject to, alteration upon government decision.     

Emotions, self-interest and support for social welfare in a Chinese society with reference to a Dutch study on welfare legitimacy

This article aims at contributing to a better understanding of welfare legitimacy in different institutional contexts. It examines whether or not emotions are important for welfare legitimacy by using survey findings from a representative sample of Chinese residents in Hong Kong. It follows a Dutch study of a similar nature, but finds that the Chinese exhibit a different response pattern towards the emotional motives of moral obligation and empathy and the non-emotional motives of self-interest, probably as a result of the perception of the residual nature of the Chinese welfare system. In the Chinese case, personal characteristics carry different effects compared with those found in the Dutch study. A further finding is that both emotional motives and self-interest motives are significant for hypothetical choices of welfare alternatives. But their effects are marginal, though striking in comparison with other determinant variables. In conclusion, the article argues that reciprocal self-interest is progressive, an idea that is unlikely to be honoured by many welfare state theorists such as Richard Titmuss.     

The impact of the use of the social welfare services or social security benefits on attitudes to social welfare policies

Muuri A. The impact of the use of the social welfare services or social security benefits on attitudes to social welfare policies
Int J Soc Welfare 2010: 19: 182–193 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article investigates the attitudes of citizens and clients to social welfare services and social security benefits. The data come from a Finnish national survey conducted at the end of 2006. First, the article overviews the previous welfare‐state studies relating especially to the theoretical perspectives of self‐interest and legitimacy. The empirical analysis indicates (i) that a different operation of self‐interest can only weakly explain the differences in attitudes between services and benefits; (ii) that there is general support for Finnish social welfare services and social security benefits, which, however, is mixed with growing criticism among women and pensioners who are supposed to benefit most from the welfare policies; and (iii) that such determinants of attitude as gender, use and, to some extent, lifecycle have become as important as class‐related factors such as income and education.     

The “Exceptional”United States: First New Nation or Last Welfare State?

The author discusses the American welfare state in the context of Lash and Urry's thesis on ‘disorganized capitalism’. Attention is directed to the claim that the US welfare state has been the laggard of organized capitalism but is becoming the pathbreaker in defining patterns of public welfare provision under an increasingly disorganized capitalism. In this context the US may be “showing the way” to the welfare states of Western Europe. A number of claims about the “exceptional” nature of US development are reviewed and a number of reservations are entered against the “disorganization” thesis as applied to the welfare state. It is suggested that attention should be focussed upon contemporary patterns of welfare state re-organization rather than dis-organization.     

Post-Fordism, the welfare state and the personal social services: a comparison of Australia and Britain

Summary The Post-Fordist welfare state thesis locates contemporary socialwelfare change within a wider analysis of the transformationof capitalist accumulation regimes. Whilst this analysis isuseful in directing attention to macro socio-economic change,it has for the most part contained three shortcomings. First,the Post-Fordist thesis has overemphasized the role of historical'breaks' in the development of social welfare as it purportedlypasses from Fordism to Post-Fordism. Second, the thesis hasassumed a degree of convergence between welfare states as aresult of global economic forces. In doing so, it has underemphasizedthe mediating impact of existing institutional arrangementswithin nations. Third, the thesis has assumed, rather than demonstrated,the specific changes which are alleged to be taking place invarious fields of social welfare. As a consequence, aspectsof continuity in social welfare have been neglected. These threelacunae are addressed through a comparative analysis of developmentsin the personal social services in Australia and Britain. Servicesto older people are employed as the specific context of comparisonin relation to three dimensions of measuring transformationalong a Post-Fordist trajectory: a shift from a unitary economyto a mixed economy of service provision; changes in the modelof service delivery and consumption; and strengthening the governancefunction of the central state. This comparative analysis suggeststhe need for refinement of the Post-Fordist welfare state thesisconcerning the restructuring of social welfare and its impacton the personal social services.     

The Development of State Welfare in the Asian NICs with Special Reference to Taiwan

This paper explores Taiwan's welfare development from its specific politico-economic situation. Although education and public health are well developed in Taiwan and social insurance is expanding to cover more and more Taiwanese people, the govenmental welfare effort is still too low to meet the welfare needs of the public. This is especially so given our discovery that military servicemen and related groups receive over 70% of the welfare expenditure of the central government while the disadvantaged receive only around 3%. Furthermore, political crises are often accompanied by a significant growth in social expenditure, implying that the purpose of state welfare is to maintain the stability of the Taiwanese state rather than to protect the well-being of Taiwanese people. Political isolation forces the Kuomintang (KMT) to secure Taiwan's role in the international community via economic growth. The development of state welfare cannot be allowed to have a negative effect on this highest priority. The limited resources, therefore, are allocated to economic goals as well as to the KMT–state apparatus in order to keep the KMT in power. However, the democratization of Taiwanese politics since the 1980s has forced the KMT to consolidate its legitimacy from the people and the improvement of social welfare is one measure for this purpose. Whether or not Taiwan becomes a Western-style welfare state through the expansion of state welfare in the near future, it furnishes a useful example with which to examine existing welfare theories.     

Taking social policy personally: How does neuroticism affect welfare state attitudes?

The role of the “Big Five” personality traits in driving welfare state attitudes has received scant attention in social policy research. Yet neuroticism in particular—a disposition to stress, worry, and get nervous easily—is theoretically likely to be an important driver of welfare attitudes precisely because welfare states deliver social “security” and “safety” nets. Using cross-sectional data from the German Socio-Economic Panel, we study three distinct attitude types (dissatisfaction with the social security system, feelings of personal financial insecurity, and preferences for state provision) and multiple social need contexts (including unemployment, ill health, old age, and nursing care). Controlling for established explanations such as self-interest, partisanship, and socialization, neuroticism does not systematically affect support for state provision. But it robustly increases general dissatisfaction with social security, as well as financial insecurity across various need contexts. Neurotic people are thus less happy with welfare state programmes across the board, yet they also appear to need these programmes more. This trait may be an important deeper layer driving other social attitudes.     

The welfare state and globalisation: down and out or too tough to die?

Politicians as well as researchers frequently claim that globalisation – and in particular its economic dimension – poses a threat to the welfare state. This article examines whether such a claim is justified by the empirical studies that investigate the relationship between economic openness and the welfare state. Based on the literature, two contrasting hypotheses are distinguished: the first states that economic openness does threaten the welfare state and the second argues that this is not the case. The empirical studies are systematically reviewed in this article: the analysis shows that the second hypothesis is supported most often and it is therefore concluded that economic openness does not threaten the welfare state.     

Swedish Family Policy – Continuity and Change in the Nordic Welfare State Model

The main question addressed in this regional issue is whether or not the Nordic welfare states can still be considered a distinct welfare regime cluster given recent changes, such as the introduction of more private elements into the welfare state. The Nordic welfare states are often described as emphasizing full employment, economic and gender equality, and universal access to cradle‐to‐grave welfare state benefits and services. In the case of Sweden, often pointed to as the model of a social democratic welfare state, such elements remain intact in most aspects of the welfare state, even given the challenges presented by the global neo‐liberal economic paradigm since the 1970s. One way to determine whether or not the Nordic welfare states remain a distinct cluster is to provide an in‐depth examination of various welfare state policies in each Nordic country. To contribute to this analysis, an investigation of family policy in the Swedish context will be provided. Even given recent challenges, such as the introduction of private for‐profit childcare providers and a home care allowance, I argue that Swedish family policy has remained largely social democratic in its underlying goals, and thus acts to support the case for a distinct Nordic welfare regime cluster.     

城市发展战略三维空问架构研究

城市是一个复杂系统,城市发展包括经济、文化、社会等多个方面,所以影响城市发展战略制定的因素也就复杂多样。但是如此众多的要素并不是孤立存在的,各要素之间存在关联性,因此在对影响城市发展战略制定的因素进行提炼的基础上,将影响因素归类于资源维、人力维和组织维三个维度。资源维指能够推动城市经济,文化政治等各方面发展,为人类创造福利的维度。人力维描述城市中不同类别人力资源的构成,衡量城市人力资源的竞争力度。组织维存在于城市本身内部因素构成的有机整体之中,用于刻画城市整体运作产生的不同内在机制。在三维度基础上,构建城市发展战略空间,在空间中描述城市发展战略的动态变化,通过对三个维度分别构建指标体系对城市发展战略三维空间进行评价,从而为城市发展战略的制定提出全新的理论指导。     

Interaction between Voluntary and Statutory Social Service Provision in Sweden: A Matter of Welfare Pluralism,Substitution or Complementarity?

Many welfare states have met with criticism and it has been argued that they are in crisis. Simultaneously, there has been a greater openness to voluntary work as an alternative to statutory services, for example in Sweden. Sometimes the activities of voluntary organizations have been seen as complementary to those of local authorities; at other times this issue has been addressed in terms of welfare pluralism. However, countries with strong welfare states have often been assumed to have insignificant voluntary work—as claimed in substitution theory. The purpose of this article is to examine variation in welfare service provision in the light of welfare pluralism, substitution theory and complementarity theory. The study was carried out in the area of support for relatives of older people in Sweden. It was conducted by means of national questionnaire surveys of voluntary organizations and local authorities in 1999 and 2002. In this period, there was an increase in statutory service provision and more voluntary organizations were involved in service provision. However, it is yet too early to describe this in terms of welfare pluralism. Neither was any evidence found for substitution theory. Furthermore, overlaps in service provision from voluntary organizations and local authorities question complementarity theory, which assumes that different actors specialize in different tasks. Nevertheless, the actors tended to be complementary at a local level. It is suggested that this complementarity might be explained by ideological support for a norm of complementarity.     

"Many Helping Hands": A Review and Analysis of Long-term Care Policies, Programs, and Practices in Singapore

Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.     

‘Active Families’: Familization,Housing and Welfare across Generations in East Asia

Debates around welfare change have tended to concentrate on the balance between market and state provision. Although there is increasing reference to a mixed economy of welfare, this generally signifies a greater emphasis on a third sector of voluntary/community level provision. However, the family sphere has been, and still remains, an important and dynamic source of welfare provision across changing regimes and between generations. With this as background, the article addresses three particular questions. First, how has the role of families in the welfare mix changed over time? Second, how do family ‘strategies’ adapt to structural changes in order to maximize collective/individual benefits in certain areas and how do these strategies evolve over generations? Third, is such family engagement in welfare influenced by policy shifts appropriately conceptualized as ‘re‐familization’ or ‘de‐familization'? These issues are explored in the comparative socio‐economic and cultural contexts of China and Japan and draw on qualitative research with three generations of families in Shanghai and Tokyo.     

AUSTRALIAN WELFARE REFORM: FROM CITIZENSHIP TO SOCIAL ENGINEERING

This paper examines the changes in the terms of citizen‐state relations that are coded in Australia's current program of welfare reform. It argues that welfare reform entails a shift from welfare as a limited social right of citizenship to welfare as a form of support conditional upon completing specified obligations, and from the provision of support as a cash payment to support coupling cash with personal services. Together, these shifts have the scope transform the relation between citizen and state fundamentally. This is no less than a shift from social policy citizenship in which claimants are presumed to act on their own behalf to paternalistic support and care directed to reforming character and values as well as to meeting need. The paper argues that this shift violates the fundamental equality essential to social policy citizenship.