The challenges of establishing basic pension insurance for migrant workers in urban China

Since the late 1990s, migrant workers in China have exhibited little enthusiasm to participate in the basic pension insurance schemes that have been promoted by the central and local governments in China. Previous research found that socioeconomic and family factors might have influenced migrant workers' decision to participate in the basic pension schemes. This article explores the impact of institutional factors on migrant workers' willingness to participate in the scheme, such as the work place, the nature of the enterprise, workers' labour contract status, workers' knowledge of the scheme, as well as their personal contribution rate.     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

我国农村社会养老保险存在的问题及对策

我国农村社会养老保险目前正在探求新的制度,研究当前中国农村社会养老保险建设中存在的问题,寻求有针对性的对策,对于进一步完善我国农村养老保险制度具有重要意义。基于此,论文针对我国农村社会养老保险目前存在的问题,提出完善农村社会养老保险的若干对策与思考。     

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.     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

Center‐Based Early Childhood Education and Care in China: Policies,Trends, and Implications

The development of early childhood education and care (ECEC) policies and programs in China has been closely intertwined with social, economic, and demographic changes. This article systematically reviews center‐based ECEC policies and programs in China and presents the major trends and implications for future research and policy. The focus of China’s ECEC policy has shifted from health and custodial care to nurturing and child‐centered education since the economic reforms and the one‐child policy were launched in the late 1970s. Empirical data show that the costs of ECEC services have been continuously increasing. Both the number of children enrolled and the overall enrolment rates have declined during the late 1990s but they have increased slightly since 2001. The ECEC programs vary substantially in every regard by urban or rural residence, type of organization, and region. The quality of center‐based ECEC programs in China is still quite low, indicated by their high child–teacher ratios and low levels of education among principals and teachers relative to developed countries. Children living in rural areas or less developed regions and those from low‐income families suffer from fewer resources and lower quality ECEC as compared to their peers. These problems must be addressed by future policy interventions.     

THE SOCIAL SECURITY CRISIS: AN INTERNATIONAL DILEMMA1

Social security systems throughout the world are in a dilemma. The over-expansion of the sixties has compounded the current recession's unemployment and other problems and created an “ideal” system difficult for the economically depressed countries to alter. Older workers are particularly hard hit during recessions. They are often pressured into retirement, with no financial or career alternatives, in an attempt to free up jobs for younger and hard-to-place workers. Many schemes have been devised to compensate older workers for their losses: high unemployment compensation, partial unemployment benefits and a liberal interpretation of disability insurance and other assistance programmes not specifically designed for the elderly. The author exposes many proposals for altering social security but concludes that most schemes have not yet been implemented. While international economic recovery would surely heal the ailing systems, the author contends there are remedial measures, largely ignored at present, that could be taken to soothe the systems' wounds.     

关于新医疗制度改革的研究综述

在经济发展的基础上,保证人民群众公平享有公共卫生和基本医疗服务,是实现人民共享改革发展成果的重要体现。中国医药卫生体制经过多次改革和发展,取得了很多成就,但也存在一些问题,尤其是国家的经济发展进入新阶段,原有医疗体制有很多制度与经济发展阶段不符。公民的医疗卫生保障需求日益增加,如何在新形势下解决公民的医疗问题,2009年的新医改方案就是一次重要的制度再设计。     

中国养老保障制度发展展望

本文在描述我国城乡养老保障制度框架及主要保障政策的基础上,分析了现行城乡养老保障制度的运行情况。从建立覆盖城乡养老保障制度的角度,可以发现现制度存在的问题,包括城乡社会保障发展失衡、群体差距大、制度缺失、制度碎片化和被人为分割、政府责任不清等。本文提出了建立城乡无保障居民老年补贴制度、完善城镇职工基本养老保险、改革机关事业单位退休养老制度、建立农村养老保险等方面的建议。     

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。     

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.     

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.     

Poland: Social protection and the pension system during the transition

This paper argues that the brunt of the transition-induced increase in Polish social protection expenditures during 1989-93 has been borne by social insurance arrangements, particularly pensions, rather than by social assistance schemes targeted to the poor or more temporary social safety net schemes. This is largely due to ease of access to social insurance and its more attractive benefit structure. Much of the recent efforts to reform social protection arrangements had an ad hoc nature and was driven by the need to alleviate looming financial distress. A major policy challenge is to avoid further burdening the social insurance system, particularly pensions, by problems that should be addressed by basic income support and emergency assistance policies or by general transfers (e.g. family allowances). Current reform needs are illustrated by using the pension system as an example.     

Social security reforms in China: issues and prospects

The phenomenal success of China's market-oriented economic reforms since the 1980s has rendered the traditional employment-based social security system increasingly inadequate and inefficient. For decades, the Chinese government has been trying to develop a more pluralistic, effective and affordable social security system which will be compatible with both a thriving market economy and a flagging socialist political structure. While the emerging system is still struggling with a variety of operational problems, the entry of China into the WTO is looming as a formidable challenge to this social security system. This presentation outlines the recent reforms of the social security system undertaken by the Chinese government, and assesses the effectiveness of the results in meeting the challenge. Here, social security reforms focus on the retirement and unemployment insurance schemes and the social assistance program.     

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.     

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.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.     

China: developmentalism and social security

China began its social security reform when the market-oriented economy was first promoted in the late 1970s. Initiatives have been taken to replace the employer-based labour insurance model with a largely social insurance model. However, it is a mistake to argue that China is pursuing a neo-liberal agenda in its social initiatives. Instead, the state has played a major role in the process. Based on a developmental analysis, it is argued that the direction of change is generally encouraging. The emerging social insurance programme has the following advantages: it widens coverage, facilitates economic development, seeks a minimum entitlement, fosters social integration, and enhances individual participation and responsibility. The creation of an economically and socially viable social insurance programme will support the economic development of the country in the twenty-first century.     

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.     

The Integration of Health and Social Care: The Lessons from Northern Ireland

Mechanisms for the integration of social services with health have come to dominate the debate on providing a more seamless provision of health and social care. Working together at the health and social care interface has been strongly promoted and endorsed in government documents since the late 1990s. Moves towards integration have been treated with suspicion and scepticism in the academic literature, with many authors highlighting the many barriers and challenges presented by this method of working. Yet these proposals do not represent a paradigm shift in culture in all parts of the United Kingdom, as Northern Ireland has had an integrated health and social care system for over thirty years. Based on an empirical study of senior health care professionals in Northern Ireland, this study identifies and discusses the key issues associated with integration. It concludes that the experiences in Northern Ireland have to date been overlooked or misrepresented and could prove extremely valuable in gaining an understanding of the challenges and benefits of integrated arrangements.