Health care as a social security benefit: Institutional approaches to extending coverage

Reaching universal health‐care coverage requires an appropriate mix of compulsory contributory social insurance schemes, with mechanisms to include the informal‐economy population, and tax‐based social assistance for those whose incomes preclude their own contributions. This article urges a reversal of the trend that favours the separate development of social health insurance by separate health authorities and makes the case for the extension of health‐care coverage using existing formal‐sector social security schemes, not least because they have the necessary political backing and institutional structures. The article reviews reasons for the slow pace of coverage extension to date, and stresses the added value of incorporating health care as a social security benefit while also acknowledging the importance of retaining linkages between statutory and well‐regulated community‐based or micro health‐insurance schemes.     

The role of mutuals and community-based insurance in social health protection systems: International experience on delegated functions

The institutional architecture for the provision of social health protection varies across countries, as do the actors and organizations involved. In some countries, mutual benefit societies and community-based health insurance organizations (CBHI) play a role in this area. In the 1990s, these were promoted particularly as a means of extending social security coverage, especially in sub-Saharan Africa. In the current context, the adoption of the 2030 Agenda for sustainable development, as well as renewed political will to realize universal coverage, has led to a questioning of the role of mutuals/CBHI. However, the literature on the roles they play in national social security systems remains limited. For this scoping review, 49 documents were analysed, covering 18 countries worldwide, focused on the delegation of functions to mutuals/CBHI in national social health protection systems. The results reveal the dynamics of the delegation of functions within social protection systems over time and their implementation processes. These provide areas for reflection that can inform policy processes.     

Social security coverage extension: A review of recent evidence

This article reports the findings of 13 studies undertaken as part of the International Social Security Association (ISSA) project on “Examining the existing knowledge on coverage extension”. It reviews recent evidence that highlights how cash benefits and health‐care coverage, financed on the basis of contributions or tax revenue or both, can be extended and maintained in low‐, middle‐ and high‐income countries. The article also highlights a number of priority areas and issues for coverage extension, including realizing improved protection for informal‐economy and migrant workers.     

The recent evolution of social security coverage in Brazil

Abstract   This article describes and assesses indicators of social security coverage in Brazil over the period 1992 to 2006 for employed workers and the elderly. While the coverage of retired workers has shown some degree of stability over the past years, that of employed workers changed significantly over the period, showing clear signs of deterioration between 1992 and 2002, and of recovery since then. Fewer self-employed persons in agriculture in rural areas (Special Insured Persons, workers with specific social security schemes) accounts for most of the deterioration. The economic recovery and an increase in new registered jobs accounts for most of the improvement in coverage between 2003 and 2006. Administrative and institutional factors also played a relevant role, especially in promoting the inclusion of domestic and self-employed workers as social security contributors.     

The "X component" in Shanghai's social security reforms

In 2003, the Shanghai Bureau of Labour and Social Security launched the zhenbao (town insurance) programme, now widely known as 25 plus X. This scheme is regarded as an important experiment in social security reform and has been lauded for extending social security to areas where previously only segments of the population had mandatory coverage. Using data from 103,000 individuals enrolled in 25 plus X, we examine the extent to which the scheme represents an extension in social security coverage. Our analysis suggests that while it does represent an extension of benefits for some, for many it represents a considerable dilution in benefits.     

Including informal economy workers in contributory social protection: Current challenges in Latin America

Owing to a favourable economic situation and to national labour market and social protection policy reforms, Latin America has witnessed significant progress in social protection coverage. Some countries, however, have seen weaker progress, with stagnant coverage levels. Several factors underlie the extension of pensions and health care coverage and the formalization of the labour market: substantial improvements in the quality of employment, more flexible eligibility criteria for contributory coverage, and the strengthening of the supervisory and regulatory roles of the State. This article first addresses the link between social protection and informality in Latin America to show the relationship between informal labour markets, the lack of social protection and the scale of unpaid contributions. Also highlighted is regional progress in extending social protection as a result of labour market formalization. Countries in the region have used various policies to encourage formalization and these have also helped to reduce wage inequalities, since formalization has had especially beneficial effects on low‐income sectors. Finally, we discuss dichotomous views on social protection financing in the region that tend to place contributory and non‐contributory financing in opposition to one another but do so in favour of the latter, tend to support proposals for limited coverage, and which do not challenge the stratification of access to social protection. The move towards a convergence of benefits is deemed essential: strategies to universalize social protection in the region should not focus exclusively on increasing resources, but must address institutional change as a crucial part of the locus of innovation.     

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps,and social equity considerations

The Royal Government of Cambodia recently launched its National Social Protection Policy framework to strengthen and expand social security and assistance. To inform social health protection policy, we examine socio-economic survey data and administrative coverage data to assess the coverage potential of existing coverage mechanisms and current gaps; and compare equitable contribution rates. Over 53 per cent of the population currently has no social health protection coverage mechanism, and about 16 per cent of the population who do have access to a mechanism are not yet enrolled. Current expansion efforts focus on the formal employee scheme, primarily benefiting individuals from higher income households. In addition, recent coverage expansion to some informal workers leaves significant gaps, particularly among the informal sector. We find out-of-pocket health care expenditure to be an excessive share of income among lower wealth quintile individuals and conclude they are financially vulnerable. Finally, we illustrate that an equitable approach to individual, monthly health care contributions among the lower three quintiles has a severely limited potential for revenue generation, and collection costs could exceed the amount collected. Therefore, we recommend that vulnerable groups should be exempted from contribution payments as social health protection is expanded.     

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.     

Mental health in postgraduate social work curriculum: Review of training contents in Indian schools of social work

Training of social workers according to the changing needs of the society is important. To this end, we decided to review the adequacy of mental health training in postgraduate programme in social work. The Mental Health Care Act 2017 defines psychiatric social worker (PSW) in India to have additional higher qualification beyond post‐graduation in social work. The number of such qualified PSWs appears to be limited due to small number of institutes that offer advanced training in the country. Though, the number of available PSWs with such qualifications is rising, the manpower in proportion to the mental health needs in the country continues to remain low. It is therefore, relevant to review the quality of psychiatric social work education at postgraduate level if this level is to be considered as the desirable qualification for PSW. In this context, postgraduate social work syllabi from 71 universities including autonomous institutions were reviewed using semi‐structured assessment. The results show a lack of uniform teaching components, training methods and insufficient skill orientation towards mental health interventions. These observations suggest that curricula and training are modified with strengthening and enhancing the quality of training of mental health at post‐graduate level in Social Work.     

Promoting the concept of prevention in social security: issues and challenges for the International Social Security Association1

McKinnon R. Promoting the concept of prevention in social security: issues and challenges for the International Social Security Association Int J Soc Welfare 2010: 19: 455–462 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. The history of the relationship between institutional social security and the concept of prevention is a chequered one. Across much of the 20th century, the imputed importance in social policy agendas accorded to prevention, alongside protection and rehabilitation, was only rarely, and somewhat inconsistently, matched in practice. Currently, efforts are underway internationally to promote the importance of the concept in social security more systematically. A key actor in this regard is the International Social Security Association (ISSA). Focusing on the role of the ISSA, the article argues against any possible endeavours, no matter how tentative, that might seek to mainstream the concept of prevention in social security, and concludes as preferable a narrower, but more vigorous, selective approach based on institutional practice to date.     

Help or hindrance? Social policy and the ‘social determinants of health’

In recent years, public health research has become increasingly focused on issues of social inequality and social disadvantage. This is because social issues, such as poor housing and unemployment, have been found to impact health significantly, and are now referred to as ‘the social determinants of health‘. As a result of this shift, public health is now principally concerned with what are historically considered to be social policy issues. This paper discusses the confluence of public health and social policy; it examines the opportunities and risks posed by this convergence for those working in social policy seeking to reduce poverty and inequality. We argue that, while much can be gained in the two fields by working more closely together, there remain fundamental differences in perspectives and approaches. In order to maximise benefits, these points of difference need to be thought through sooner rather than later.     

社会保障立法与社会保障制度建设

我国在计划经济体制向社会主义市场经济体制转换过程中建立的社会保障制度,目前尚存在内容不健全、法制化程度低、实施机制脆弱的不足.比较国外较为成熟的传统型、福利型、储蓄型三种社会保障制度模式,我们可以从中吸取经验,受到启发,进而建立具有中国特色的、保障面宽、保障程度适中的社会保障制度.为此目的,我们必须加强社会保障立法,既要健全社会保障法律体系,又要严格社会保障执行的法律监督.     

Extending social security in developing countries: a review of three main strategies

The article discusses strategies to extend social security cover-age in developing and newly industrialised countries. The three major options are to extend social insurance coverage , to rely on mutuals or micro-insurance or to bring in social assistance in one form or another. Social insurance usually covers small population segments. Insiders are seldom willing to extend coverage to poorer groups, as poorer groups are usually higher-risk groups. Micro-insurance and mutual societies work pri-marily among people with similar risk profiles. Discretionary social assistance targets poorer groups, but is open to patronage and misuse. However, some social assistance designs are less open to misuse than others. Demogrants, i.e. benefits given to people in vulnerable social categories, are easy to administer and difficult to misuse. Whether or not a developing country provides such benefits can be considered an indicator of the willingness of the ruling elite to alleviate hardship among 'unproductive' population groups.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

Global–regional interaction to extend access to social protection for migrant workers: Insights from ASEAN and MERCOSUR

Universal access to social protection for migrant workers is emerging as a problematic issue in the implementation of free movement regimes at a regional level. This article focuses on the concept of regional governance as a possible mechanism to address the unsolved challenges of social security regimes to extend coverage. To this end, the article looks at current legal developments in two regional projects (ASEAN and MERCOSUR) to identify a creative approach to strengthen the development of national floors of social protection. The interest of using these case studies lies in exploring whether the regional integration process can play a major role in the progressive extension of social protection rights to migrant workers by facilitating the adoption of social security agreements.     

China’s social security response to COVID-19: Wider lessons learnt for social security’s contribution to social cohesion and inclusive economic development

China has adopted an array of special social security measures in response to the spread of the COVID-19 virus, to mitigate the downside social and economic impacts caused by the pandemic. Measures include the reduction, exemption and deferral of social security contributions by employers, the extension of benefits coverage for employees, and the provision of more accessible e-services by social insurance agencies. The article points out that a preliminary assessment of those measures would suggest that they have played a key role in supporting social cohesion and in stabilizing the economy. In a critical manner, the article compares the measures adopted in China with those of other countries, and identifies how China could learn from international practice and experience. Finally, and based on recent Chinese experience, the article presents proposals that seek to improve the longer-term contribution made by the Chinese social security system to realize the goals of social cohesion and inclusive economic development. As set out in China’s Social Insurance Law of 2010, the social security system should not only support a fair sharing of benefits of development, but also promote social harmony and stability.     

Social health protection in Cambodia: Challenges of policy design and implementation

The Government of Cambodia is implementing ambitious reform initiatives to improve the country's social health protection system. In January 2018, it was announced that the Health Equity Fund (HEF), which is fully subsidized by a joint government‐donor initiative for the reimbursement of user fees for the poor at public health facilities, is to be expanded to some segments of informal workers belonging to associations, as well as to commune and village chiefs. Since 2017, the National Social Security Fund (NSSF) has provided social health insurance for formal economy workers in enterprises with eight employees or more. In January 2018, it was expanded to civil servants and all employees regardless of the size of the enterprise. However, this article highlights that the new ambitious reforms are not accompanied by careful planning as regards funding, service delivery, human resources and institutional design. This article therefore aims to examine key policy issues and challenges for Cambodia's ambitious reform of its social health protection system in terms of resource generation, population coverage, strategic purchasing and governance.     

Social policy and health: transition countries in a comparative perspective

T. Ferrarini, O. Sjöberg. Social policy and health: transition countries in a comparative perspective Int J Soc Welfare 2010: ??: ??–??© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This article analyses the development and design of unemployment insurance and family policy benefits and their links to health outcomes in Estonia, Poland, the Slovak Republic, Slovenia, the Czech Republic and Hungary from the mid‐1990s. Comparing these six transition countries with long‐standing welfare democracies reveals important similarities and differences in policy and health. Unemployment benefit schemes resemble corporatist schemes in important respects, however, with lower coverage and average benefits. Subjective wellbeing is also comparatively low among both employed and unemployed in the transition countries. Several transition countries have mixed family policy strategies that simultaneously support dual‐earner families and traditional gender roles. One clear exception is Slovenia, which has a highly developed dual‐earner support. Family policy generosity is related to lower rates of poverty, infant mortality and child injuries. The article demonstrates the fruitfulness of institutional analyses of the link between social policy and population health in a broader welfare state context.     

Connecting and engaging with health and social care: Exploring the core components of a telephone and web-mediated family navigation prevention service

Early engagement with health care, mental health care, and social services can promote the well-being of children and families. How practitioners can best support family engagement with these services however remains largely unknown. To address this gap in knowledge, data from a voluntary 12-week telephone and web-mediated family navigation preventive intervention called Navigate Your Way were subject to mixed-methods analysis. Twenty-nine caregivers and five family navigators contributed data to the study. Thematic analysis of weekly navigator check-ins, participant closing interviews, navigator discharge notes, and lab meeting notes was conducted and followed by quantitative analysis of navigator effort across project activities. Results were then mixed to illuminate the essential conditions for supporting family connection to health care, mental health care, and social services. Qualitative analysis identified themes related to empathic engagement and person-centred navigation as central to connecting families to needed services. Quantitative analysis of navigator effort identified participant outreach, weekly check-ins, service identification, and ongoing supervision as essential navigation activities. Together, providing an environment that is supportive, consistent, flexible, person-centred and tailored to families' specific needs are important for connecting to health and social care.     

Geriatric Enrichment in Social Work Education: Lessons Learned from the GeroRich Projects

The Geriatric Enrichment in Social Work Education (GeroRich) initiative was a critical step in addressing the national shortage of social workers interested in gerontological practice. Sixty-seven social work programs participated in the 3-year GeroRich project designed to infuse gerontological content into the BSW and MSW curriculum. This study analyzed the lessons learned by participating institutions about the curriculum enrichment effort. Five themes emerged from the qualitative analysis of GeroRich final reports: (a) obtaining faculty buy-in and faculty development, (b) increasing student interest and engagement, (c) developing community partners, (d) developing interdisciplinary linkages, and (e) facilitating institutional commitment and sustainability. The findings from this study provide valuable information on the implementation of curricular enrichment efforts in gerontology that can benefit social work and other health care disciplines.