The Swiss social insurance system: Social security and grass‐roots democracy

The foundations of Switzerland's social insurance system can be traced to 1890 when a public referendum voted the inclusion of an article into the Federal Constitution that gave the executive the task of creating a sickness and accident insurance scheme. Currently, as in other European countries, the Swiss social insurance system is facing challenges as a result of rising health costs and demographic shifts, which are placing a growing burden on both public finances and private households. To reach policy decisions to address these challenges, the Swiss system is distinguishable from those of its European neighbours because of a continuing tradition of political decision‐making based on grass‐roots democracy: through referenda, the Swiss people remain directly responsible for the development of the national social insurance system. Importantly, not only might this unique feature of Swiss democracy lead the Swiss people more readily to accept and identify with their social insurance system but it may offer a sound democratic base upon which to build a consensual approach to address the policy challenges that lie ahead.     

Healthcare Provision for Elderly People in Argentina: The Crisis of PAMI

This paper highlights the problems of administering health insurance programmes in Latin America and the difficulties of imposing effective reforms. It examines the development, financial collapse and subsequent restructuring of a health insurance programme specifically targeting elderly people in Argentina. By the 1990s the Integrated Healthcare Programme (PAMI) had become one of the largest components of the country's public welfare system, managing an annual budget of US $2.5 billion. It provided elderly people with a wide range of services, including free and discounted medical care and a national network of day centres. The Programme was widely praised as efficient and innovative both within Argentina and beyond and was considered a model which other developing countries might emulate.
However, in 1994 it was discovered that PAMI had accumulated a deficit of US $1.3 billion and was suffering from a large number of serious structural weaknesses. These included a complete absence of financial accountability (both internally and externally), the piecemeal expansion of services, employment featherbedding, political patronage and corruption. Also, the Programme had contributed to long-standing inequalities between different geographical regions and between insured and uninsured populations. Since then, numerous attempts have been made to reform the Programme, some of which have received funding from the World Bank, but these initiatives are only being very gradually implemented.     

Health and welfare of immigrants and access to services in Australia

The main issues in relation to the provision of health and social welfare services for migrants in Australia are: (a) to ensure access and equity; (b) concern about the relatively high proportions of some groups from specific birthplaces requiring support; and (c) the complexity and costs of ethnically specific services. This article focuses on the major pensions and benefits paid by the Department of Social Security, particularly the age pension and unemployment benefit. It also examines the interrelationship between mortality, morbidity, private health insurance, use of health services and the proportions on health-related pensions. Linked with these issues is the debate about an appropriate level of immigration when the unemployment rate is high, as in the current recession, and when new arrivals have little prospect of finding a job. A second major concern is the cost of caring for elderly immigrant parents who have come to Australia under the family reunion program.     

Social Policy in Greece: Rhetoric versus Reform

This paper reviews the major social policy developments in Greece during the 1980s and 1990s, focusing on social security, health and employment policies. It argues that the concept of social policy and the practice of politics have been distorted in this country. Social policy reflects the legacy of a heavily politicized and centralized policy‐making system, an impoverished administrative infrastructure and poorly developed social services. Its emergence is characterized by the pursuit of late and ineffective policies. It lacks continuity, planning and coordination, being oriented towards short‐term political expediency. It is largely insurance‐based, reproducing huge inequalities and institutional arrangements which are behind the times. It provides mainly cash benefits, low‐quality but rather expensive health services and marginal social welfare protection. Moreover, the lack of a minimum income safety net confirms the country's weak culture of universalism and social citizenship. By implication, complex policy and interlocking interest linkages have tarnished the “system” with a reputation for strong resistance to progressive change. At the same time, sources of change such as globalization, demographic developments, new household and family/gender patterns, unstable economic growth, fiscal imperatives, programme maturation, as well as persisting unemployment, changing labour markets and rising health care costs, have produced mounting pressures for welfare reform.     

Informal workers and Kenya’s National Hospital Insurance Fund: Identifying barriers to voluntary participation

This article investigates the barriers to informal workers’ voluntary participation in Kenya’s national health insurance scheme – the National Hospital Insurance Fund. Based on primary data from both qualitative and quantitative methods, we find that the key determinants of enrolment include social factors, such as marital status, which create demand for insurance, and the role of informal workers’ associations that promote the voluntary uptake of health insurance and prevent default through contribution support. Participation barriers and reasons for inactiveness stem from the nature of informal work characterized by irregular earnings, which combine with apprehension about having to pay penalty charges for the late payment of premiums, inadequate levels of knowledge about health insurance schemes, institutional constraints such as complex registration procedures, as well as premium costs and poor-quality services, all of which discourage enrolment or the reactivation of lapsed membership. There is thus a need for health insurance schemes, such as Kenya’s National Hospital Insurance Fund, to educate informal workers on insurance services and protocols and to improve services to encourage uptake and reduce default behaviour.     

Welfare program participation among rural‐to‐urban migrant workers in China

Xu Q, Guan X, Yao F. Welfare program participation among rural‐to‐urban migrant workers in China Int J Soc Welfare 2011: 20: 10–21 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. An estimated 225 million Chinese people have migrated to cities from China's rural areas over the past two decades. These rural‐to‐urban migrant workers have greatly challenged China's welfare system. The pre‐reform welfare system was a duel scheme with an urban–rural distinction in which rural residents were not covered by state‐run welfare programs and had to rely on their families and rural collectives. The development of employment‐based social insurance programs in 1999 made social welfare programs available for rural‐to‐urban migrant workers. Using an anonymous survey conducted in seven cities across China in 2006, we found that social insurance program participation rates were low among rural‐to‐urban migrant workers. Individual factors, including lack of knowledge of welfare programs and of a willingness to participate, and macro‐level factors, including type of employer and industry, are critical in determining migrant workers' participation in welfare programs. Implications for policies and practice are discussed.     

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual's need, since income levels and the family's ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual's rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.     

Families on the brink: the effectiveness of family support services

This paper presents findings from a study of the costs and effectiveness of family support services offered to 40 families with a high level of need, in two neighbouring local authorities in North Wales. It describes the level and type of services offered by different agencies in each of the authorities, estimates the costs of these services, and assesses outcomes for the families receiving them after three months. Information is also provided about families’ experience of the support they received, and the kind of help they would have liked. Parents’ well‐being and family functioning were found to improve over the intervention period in both authorities, although only to a limited extent. Improvements were greater among those who were living with partners, and less among families identified by social workers as having financial difficulties or problems with drug or alcohol abuse. Respondents who rated their problems as very severe showed less improvement. The pattern of service provision and the costs involved turned out to be similar in both authorities, so it was not possible to reach conclusions about the relationship between services and outcomes. However, a number of themes emerging from the data are discussed, including the role of day care services in supporting families with young children, the impact of poverty and deprivation on parents’ ability to provide good care for their children, and the importance of an interagency response to children's and parents’ needs. The article also includes a discussion of problems encountered in undertaking comparative outcomes‐based research and cost‐effectiveness analyses in the social welfare field.     

Implications of Subsidiarity for the Care of Older People in Germany

This paper examines definitions and origins of the principle of subsidiarity and its application to welfare systems of the Federal Republic of Germany (FRG) with particular reference to the care of older people. The German corporatist welfare system is influenced by conservative views about status relations and Catholic teachings on family responsibilities. Since unification of Germany in 1990 new care systems based on the principle of subsidiarity have been imposed in eastern Germany. The FRG's social insurance system based on entitlement benefits those fully employed, while women and marginalized groups with low status in the labour market are poorly covered by insurance and may have to rely on stigmatizing means-tested social welfare based on subsidiarity. Access to pluralist, fragmented care services depends on eligibility for funding through insurance or social welfare or else on ability to pay. Social care is poorly developed because of the emphasis on insurance and the medical model as well as on the principles of subsidiarity and self help which place an explicit duty on the family, mainly women, to care.     

浅析奥巴马政府的医疗改革政策及其对中国的启示

针对美国医疗领域长期存在的医疗费用快速上涨、医疗保险制度性障碍和医疗服务质量等问题,奥巴马政府提出了以控制医疗费用、扩大医疗保险覆盖面、提高医疗服务质量为主要内容的医疗改革方案,意在实现"向全美国民众提供可承受的、可进入性的医疗保健"之目标。相关法案虽然几经修改,但最终在美国国会众、参两院获得微弱通过,并在日前由奥巴马总统签署。尽管其效果目前还无法判断,但方案本身在一定程度上已经能够为我国的医疗改革提供一些启示。     

Extension of social insurance coverage to informal economy workers in China: An administrative and institutional perspective

This article reviews administrative issues in the context of decentralized social protection in China. In particular, what are the main obstacles to expanding social insurance coverage for workers in the informal economy? Over the last two decades, China has achieved remarkable progress toward universal social protection when this target was set as a national policy priority. However, the social insurance enrolment of informal economy workers still lags significantly behind. This article reviews the application of the International Labour Organization’s definition of informality in the Chinese context and overviews existing pension and health insurances in China. This article discusses the impact of China’s inter‐governmental fiscal relations and decentralized social protection in the multilevel government system. The article highlights that under a system of decentralized managed social insurance many informal economy workers choose to opt out of the system because of low benefits and high compliance costs. This result in deficits in social insurance coverage amongst informal economy workers.     

Enhancing Social Support for Migrant Families: A Case Study of Community Services in a Shanghai Urban Village and Implications for Intervention

Recent years have witnessed the growing emphasis of the Chinese central government to develop community services as a method of building communities and strengthening social solidarity. With the increased involvement of multi‐generation households in China's internal rural‐to‐urban migration, however, little is known about what community services are available for migrant families. Nor do we know much about how such services can enhance social support for migrants, which is crucial for their psychological well‐being in managing the ongoing challenges that arise from migration and further integration into cities. This article presents a case study conducted in Shanghai where social services are emerging in a few urban villages. We begin with a brief background on China's rural‐to‐urban migration and the emergence of urban villages, followed by a discussion of community services and social support for Chinese migrant families. We then document existing services in an urban village to explore how they can influence migrant families' social support. Drawing on the perspective of service providers, we highlight the effects social work interventions can have on improving social support for migrant families. Finally, we propose an intervention framework based on multi‐dimensions of social support, emphasizing an integration of formal and informal social support through community services for migrant populations.     

Health insurance system financing reforms in the Netherlands,Germany and France: Repercussions for coverage and redistribution?

For a number of years, the Dutch, German and French health insurance systems have been attempting to contain costs and diversify their sources of finance, which traditionally have come mainly from social contributions. Diversification may involve broader‐based public finance, as well as greater recourse to private resources and operators. In the case of the Netherlands and Germany, the reforms go hand in hand with efforts to introduce competition between health insurance bodies. In France, private complementary insurance has become indispensable for adequate access to health care. However, these measures have repercussions for redistribution, which social assistance programmes have difficulty in addressing.     

Estimating the fiscal costs of long‐term jobless families in Australia

Despite substantial costs to society associated with the adverse consequences of joblessness, studies estimating actual costs are rare. This paper identifies the main costs to the Government of long‐term jobless families in Australia. The costs were split into three groups: immediate support costs, immediate opportunity costs, and indirect/intergenerational costs. Using a microsimulation model, the paper estimates the fiscal costs, which include immediate support costs such as the welfare system, and the immediate opportunity costs such as potential revenue from the tax system. We estimate that welfare payments and lost taxation revenue from long‐term joblessness cost the Government AU$5.55 billion per year.     

The impact of social security reform on the labor market: The case of Colombia

This paper simulates the effects of three increasingly bolder reforms in the Colombian social protection system: the equalization of salaried and self-employed labor contributions; the removal of payroll taxes, parafiscales; and the complete delinking of social protection benefits from labor status. We collect nationally representative information concerning individual willingness to pay for several packages of social security benefits; identify and quantify – for the first time – three specific distortions caused by existing social security and social assistance systems; and simulate the gains that social protection reforms would bring about in terms of reduced labor distortions. We find that workers in Colombia, regardless of occupation, have a very similar willingness to pay for the full insurance package – below 20% of their labor earnings – and very similar valuation of social protection services – about 50% below par. Labor distortions are large, as expected from very high labor costs, but we quantify an implicit formality tax and informality subsidy ranging between 2 and 27 percent of different representative workers’ earnings. Critically, the long-discussed reforms in Colombia – including the elimination of parafiscales – will not reduce substantially the multiple distortions in its labor market.     

Longevity insurance annuities: China adopts a benefit innovation from the past

Longevity insurance annuities are deferred annuities that begin payment at advanced older ages, such as at age 80. Such annuities would benefit some older retirees who have drawn down their savings, but the private sector has problems in providing them. Originally, social insurance old‐age benefits programmes in some countries were structured as longevity insurance programmes, with 50 per cent or less of those entering the workforce surviving to receive the benefits. Over time, however, as life expectancy has improved, the benefits these programmes provide have slowly transformed into benefits that most people entering the workforce ultimately receive. This article argues that the reintroduction of longevity insurance benefits as part of social insurance old‐age benefit programmes could be an important policy innovation, in particular because this benefit is generally not provided by the private sector. China has introduced longevity insurance benefits as part of its social insurance system, offering a model for other countries, particularly those providing modest social insurance old‐age benefits.     

The school‐community partnership: Helping at‐risk youth

Abstract

Innovative service delivery models are needed in our schools to help at‐risk youth and to ameliorate family dysfunction so that children have an increased potential to learn. In the model described herein, a consortium of three Long Island school districts contracts with community‐based social service agencies to provide prevention and intervention services which the schools cannot provide. The mechanisms developed to form and implement these partnerships as well as the specific services offered are described. The role ofthe social worker as a program advocate within the school's administrative structures is discussed and techniques that help bridge the gap between client‐focused concerns and administrative and school board imperatives are presented.     

Valuing a homeland security policy: Countermeasures for the threats from shoulder mounted missiles

This paper reports estimates for the ex ante tradeoffs for three specific homeland security policies that all address a terrorist attack on commercial aircraft with shoulder mounted missiles. Our analysis focuses on the willingness to pay for anti-missile laser jamming countermeasures mounted on commercial aircraft compared with two other policies as well as the prospect of remaining with the status quo. Our findings are based a stated preference conjoint survey conducted in 2006 and administered to a sample from Knowledge Networks’ national internet panel. The estimates range from $100 to $220 annually per household. Von Winterfeldt and O’Sullivan’s (2006) analysis of the same laser jamming plan suggests that the countermeasures would be preferred if economic losses are above $74 billion, the probability of attack is larger than 0.37 in 10 years, and if the cost of the measures is less than about $14 billion. Our results imply that, using the most conservative of our estimates, a program with a cost consistent with their thresholds would yield significant aggregate net benefits.

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash P, Shih Y.‐C. Introducing social insurance for long‐term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long‐term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform. Key Practitioner Message: ?Emphasizes the importance of policy learning from other environments; ?Highlights the need for a strong regulatory and provider infrastructure for delivering long‐term care services; ?Emphasizes the need for training, support, and appropriate regulation of the long‐term care workforce.     

Patterns of individual change and program satisfaction in a positive parenting program for parents at psychosocial risk

Despite the evidence of effectiveness of positive parenting programs, little is known about the typology of changes that parents at psychosocial risk undergo after an intervention. We compared individual patterns of change in three parenting outcomes in 256 at risk parents with young children attending the group‐based Growing Up Happily in the Family program delivered in municipal social services. We identified four clusters of individual change: Cluster 1 (30.6%) had negative changes in parental child‐rearing attitudes and parenting stress, Cluster 2 (27.7%) had positive changes in child‐rearing attitudes and negative results in parental perceived competence, and Cluster 3 (24.1%) and Cluster 4 (17.6%) showed overall better results. Residential area, type of social support, and quality of implementation characterized cluster membership. Participants in clusters with better results were more satisfied with the program than those with worse results. Practical recommendations are provided for the successful implementation of group parenting programs in family preservation services.