Germany's Social Long-term Care Insurance: Design, Implementation and Evaluation

Across all industrialized countries, issues surrounding population ageing have captured the attention of policymakers. Among its manifold ramifications, disability-related poverty and the projected growth in public funding of long-term care demand close attention. Comparative studies have revealed distinct policy approaches to long-term care across different countries, but a shared interest in market-oriented policy design and cost containment. In Germany, legislation on mandatory and universal dependency care insurance came into force recently. The 1994 Dependency Insurance Act responded to limited market insurance against the financial risk of long-term care, deficiencies in servicing long-term care dependants and the fiscal crisis of German communities, which had to provide social assistance to a growing number of destitute care clients. The new social long-term care insurance scheme adopts basic features of existing German social insurance schemes even as it challenges the country's social insurance legacy in terms of cost containment strategies and consumer-directed provision. After three years of operation, the new programme is technically in place and financially healthy. However, critics point to its tight screening procedures, persistent shortages in the supply of formal care, and fraud. Equity issues, quality of care and consumer direction have also drawn critical attention. A variety of scenarios for programme improvement are conceivable. Coverage could be extended and payments offered to family caregivers. A comprehensive "cash and counselling" concept should be developed. Finally, programme efficiency depends on public accountability and quality auditing. Choice should be informed by ongoing research into long-term care and the broader impacts of long-term care policy.     

Changing the culture of social care in Scotland: Has a shift to personalization brought about transformative change?

In April 2014, the Social Care (Self‐directed Support) (Scotland) Act 2013 (SDS Act) was implemented in Scotland. This marked a major shift in how social care is delivered and organized for both users and professionals across the country. Whilst it emerged through the personalization agenda—which has dominated international social care systems over recent years—self‐directed support (SDS) represented a significant shift in thinking for service provision in Scotland. In this article, we review the initial stages of policy implementation. Drawing on two Freedom of Information requests from 2015 and 2016 and a series of interviews with local authority practitioners, we argue that, to date, SDS has yet to produce radical transformative change. We explore the reasons behind this through four key themes. First, we highlight the challenges of promoting the principles of co‐production in policy and suggest that, in reality, this has been compromised through SDS implementation. Second, we suggest that SDS has been caught up in a policy overload and ultimately overshadowed by new legislation for health and social care integration. In looking at the impact of this relationship, our third theme questions the role of new partnership working. Lastly, we argue that the timing of SDS in a period of acute austerity in social care has resulted in disabled people being offered limited choice rather than increased opportunities for independent living.     

India's Mahatma Gandhi National Rural Employment Act: Assessing the quality of access and adequacy of benefits in MGNREGS public works

The extension of social protection to all has become a central policy objective, both nationally and internationally. A considerable number of middle‐ and low‐income countries have undertaken substantial efforts to extend social protection, while the international community reaffirmed its commitment to the extension of social protection through the adoption of the ILO Recommendation concerning National Floors of Social Protection, No. 202 (2012). This article reviews the legal provisions and the implementation of the Indian Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), legislated in 2005, and does so in the light of the more recent provisions of ILO Recommendation No. 202. Since its introduction ten years ago, MGNREGA has provided a source of income to rural workers, increased wage rates, achieved high female participation rates and created durable assets. India's local governance bodies, Panchayati Raj Institutions (PRI), have been empowered and involved in the processes of planning and monitoring. However, despite successes, there have been considerable shortcomings in implementation. This article highlights two central themes: first, the innovative policy framework of the Act, which brings together rights‐based entitlements, demand‐driven employment, and citizen‐centred monitoring. Second, it assesses the accessibility and adequacy of benefits in the implementation of MGNREGA. We conclude that MGNREGA offers potential for South‐South learning, both in terms of policy‐design and implementation.     

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

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

The Smothering Embrace: Competition in the Implementation of Social Policy

One element of recent welfare state reform has been the introduction of market coordination in the implementation of social policy. The authors of this article have conducted a comparative study of social security, health care and housing policy implementation in the Netherlands, focusing on the conditions necessary for an effective mechanism of competition. The most important condition is that clients should be able to switch between providers without difficulty. Evidence shows that the providers in these fields of social policy engage in activities that undermine the potential for future competition. While this is not uncommon in itself, the new markets in social policy appear to be particularly vulnerable to such activities. This can be explained on the basis of two variables: (1) the institutional characteristics of the policy fields as they existed before the introduction of market coordination, and (2) the characteristics of the products that providers distribute. The combination of path dependency and product characteristics strengthens efforts to reduce competition.     

Policing Mental Disorder: Controversies, Myths and Realities

In this article the premises on which Section 136 of the Mental Health Act 1983 have been evaluated traditionally will be outlined and assessed using data from a recent empirical study. In examining the nature of police action in implementing this provision it is shown that police discretion and ability to act autonomously is constrained by the social context within which officers become involved in incidents and the external influences impinging on police decision making. It is suggested that legalism is inadequate both in accounting for the social realities of policing and relevant social policy implications. Instead, a social constructivist approach capable of accounting for wider influences on police action and mental health policy more generally is advocated as the basis on which to evaluate the future use of the provision.     

The impact of India’s food security policy on domestic and international rice market

Food security policy making in India is at crossroads. India has emerged as a leading rice exporter. The Government of India has introduced the National Food Security Act which requires 33.6 million tons of rice per year for its public food distribution system. In this study, we modeled India’s rice market and analyzed policy implications of the long-term impact of India’s food security act on domestic and international rice market. We developed a structural economic demand and supply model for India’s rice market and further added subsidy equations to trace the consequence of National Food Security Act on domestic rice consumption and on the international market. We specifically focus on three different scenarios: subsidy as price effect, subsidy as inelastic income effect, and subsidy as elastic income effect under the broader framework of National Food Security Act. We found that at the end of the projection period (2024–2025), as a result of rice subsidy program, the consumption of rice increases significantly in the case of price effect while the inelastic income effect has no or less impact on production, consumption, and export of rice. Hence, the policy implication of our study is that if the objective of the National Food Security Act is to increase consumption then it needs to be implemented as price effect.     

Redefining “Old Age” and “Dependency” in East Asia: Is “Prospective Aging” A More Helpful Concept?

East Asian societies are currently some of the most rapidly aging in the world. Projections of the traditional old‐age dependency ratios (OADR) present a daunting future of the size of the aged population both in absolute terms and, in the context of low fertility, relative to the future workforce. Recently scholars, especially Sanderson and Scherbov, have argued that OADR is inadequate as a guide to future levels of dependency based, as it is, on past scenarios of “old age” and “dependency” rather than current and future notions. Indeed, in the context of rapidly aging settings in East Asia with developmental welfare states, the OADR has probably never been truly relevant, is profoundly unhelpful and could lead to policy paralysis. As such, Sanderson and Scherbov suggested a new method to measure aging prospectively to take into account both improved life expectancy and health across the life‐course. We introduce these new measurements as a possible new, more radical and optimistic way to think about aging in East Asia. These measurements more accurately demonstrate the “boundaries” to “dependency” and, hence, demonstrate the potential room for social policy interventions to maximize “active aging” for the population currently, perhaps incorrectly, defined as “old” and “dependent”.     

Policies and programmes to end homelessness in Australia: Learning from international practice

Parsell C, Jones A, Head B. Policies and programmes to end homelessness in Australia: Learning from international practice. Many welfare states throughout the industrialised world have recently implemented policies to achieve targeted reductions in homelessness. These policy and welfare initiatives differ across national contexts. They are similar, however, in moving away from social programmes that have essentially ‘managed homelessness’ towards interventions that seek to permanently end homelessness. Australia has recently adopted similar homelessness policy objectives. This article examines the manner in which Australian homelessness policy has been converging with international policy directions. More specifically, the article scrutinises Australian social programmes adopted from the UK and USA as a means to achieve strategic goals of reducing homelessness. It argues that although Australian homelessness policy objectives are converging with international policy, Australian programmes modelled on international successes do not have some of the elements shown elsewhere to be crucial for achieving sustainable reductions in homelessness. This may become central to explaining programme outcomes in future years. Key Practitioner Message: ?Strategies aimed at permanently ending homelessness represent a significant shift to contemporary professional practice;?Homelessness programmes internationally are now characterised by their branding or identification with evidence‐based models;?It is important to critically scrutinise these models, examining their core elements and the manner in which they are appropriated and incorporated across jurisdictions.     

Mothers at the Service of the New Poverty Agenda: Progresa/Oportunidades, Mexico's Conditional Transfer Programme

This article considers some of the changes and continuities in social protection in Latin America through a focus on the ways in which motherhood is positioned as key to the success of the new anti‐poverty programmes that have followed structural reform. It examines a flagship cash transfer programme known as Progresa/Oportunidades (Opportunities) established in Mexico in 1997 and now being widely adopted in the region. Characterized by some commentators as a quintessentially neo‐liberal programme, it is argued that Oportunidades represents a novel combination of earlier maternalist social policy approaches with the conditional, co‐responsibility models associated with the recent approaches to social welfare and poverty relief endorsed by international policy actors. In the first section, the gendered assumptions that have governed Latin American social policy are described; the second outlines social policy provision in Latin America and identifies the key elements of the new approaches to poverty; and the third critically examines the broader implications of the Mexican programme's selective and gendered construction of social need premised, as it is, on re‐traditionalizing gendered roles and responsibilities.     

Family policy and social order – comparing the dynamics of family policy-making in Scandinavia and Confucian Asia

This article compares family policies in two Scandinavian and three Confucian Asian countries. Through a general survey on schemes of child allowance and parental leave, it seeks explaining factors for cross-regime diversity of the welfare systems. In focus are the agents affecting the family policy-making process, including social classes, the state, women and families. In order to assess the roles these agents have played, this study retraces the preconditions of family policy development and its associated socio-cultural backgrounds. Results from such an examination will illustrate how the social order determines the patterns of family policy, which offers a new path to travel to these different cultural 'worlds'. Taking the Confucian Asian states into its frame of reference, the study will take a fresh look at Scandinavian welfare systems, which still have some general implications for the study of the dynamics, model and outcome of family policy in an international context.     

Effects of dependency on compliance rates among elder abuse victims at the New York City Department for the aging, elderly crime victim's unit

A study was conducted at the New York City Department for the Aging Elderly Crime Victim's Unit (ECVU) to examine the relationship between dependency and compliance rates. Dependency was defined by the total score for each case on the Victim Dependency Scale and Abuser Dependency Scale. Compliance was defined as the act of accepting a referral and compliance rates were determined by counting the total number of referrals the victim accepted. Findings indicated that the only factor associated with compliance rates was if the abuser had a mental illness/substance abuse problem. If the abuser did have this problem, the victim was significantly more likely to accept a referral for services as compared to victims whose abusers did not have a mental illness/substance abuse problem (t=-2.774, df=36.899, p<.01). The authors offer explanations as to why this research was important and the implications it has on future research.     

日本新冠疫情的社会影响与政策选择

新冠病毒疫情对日本社会各个方面都产生了严重的影响。疫情防治本身就属于社会政策范畴。总体而言,日本作为东方国家所实施的防疫政策取得较好效果,但同时也存在着一些问题。相对宽松甚至曾经数度放缓的防疫政策使日本错过了疫情治理的最佳时机,因而导致疫情的长期化。实现经济复苏是日本政府关注的重点,规模空前的经济刺激政策与以防疫为主导的社会政策之间既有结合也存在矛盾。日本政治的变化具有长期的社会基础,新冠疫情的暴发与蔓延使其凸显出来。在新的国际格局条件下,日本面临着外交战略方向的重大选择。     

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.     

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.     

The Emperor's new clothes: South Africa's attempted transition to developmental social welfare and social work

This article critically interrogates the depth and quality of change of post‐apartheid welfare policy and social work practice towards a social development paradigm against the background of inequality and poverty in South Africa. It asks several questions: what kind of welfare system has the current welfare dispensation created? How far has it moved from a residual, ameliorative system to an institutional developmental system, in keeping with the developmental welfare paradigm? To what extent can residual provisions be transformed into developmental processes? What conditions are necessary for this to happen? The answers to questions such as these provide the basis for assessing South Africa's new developmental processes. The article highlights the fundamental contradictions in social development policy imperatives, which call for a marriage of economic and social considerations, and the internal contradictions across and within various welfare policies. Further, it argues that the government does not have the political will to bear the costs of the substantive change that the move towards developmental social work requires, choosing instead limited, individually targeted and ameliorative measures, such as increased social security spending. Thus, it suggests that ideological critique, consciousness raising and participation in public policy debates remain crucial for those who seek long‐term solutions to inequality and poverty in South Africa.     

Work Choices: the low productivity road to an underclass

The passage of the Work Choices Act 2005 serves to eliminate one of the last symbols of fairness in Australian society; the judicially‐determined conciliation and arbitration system and wage‐setting machinery. In this paper we examine the flawed conceptual framework, which underpins the Government's view that reducing the rights and protections of workers will produce superior labour market outcomes. We argue that the principal failure of the Work Choices Act is that it ignores the role of macroeconomic policy in directly addressing the efficiency and equity issues that have been said to motivate its provisions. The Act also ignores the different bargaining power of workers and capital and pays no attention to the serious social repercussions that will flow when labour is treated like a commodity. The imperative to minimise labour costs under Work Choices will spur a race to the bottom and the profusion of insecure, low‐paid, poor‐quality work in an economy characterised by allocative and dynamic inefficiency.     

Governing universal health insurance in Korea and Taiwan

This article examines policy responses to the rising costs of healthcare in the Republic of Korea and Taiwan from a governance perspective. It tries to answer why the two countries responded differently to a similar set of challenges facing their National Health Insurance (NHI). While Taiwan – in an attempt to contain costs – introduced a global budgeting system, Korea failed to do so. Governments in both countries attempted to establish a new mode of governance, bringing multiple stakeholders to health policy making in order to build social consensus. But the Korean government, as this article shows, could not resolve its policy deadlock because of a loss of trust between the government and the medical profession, caused by the separation reform of 2001. Even though Taiwan was better able than Korea to address the financial challenges of its NHI, the new mode of health governance is still on shaky ground. This article argues that because neither government now enjoys the exclusive power over health policy that they once did under the developmental state, it is essential to find a way in which different stakeholders can make the necessary compromises that will enable the NHI to run on a sustainable path for the future.     

THE ECONOMIC AND SOCIAL DIMENSIONS OF THE NEW ECONOMY

The concept of the ‘new economy’, though increasingly used by the media, policy makers and scholars, remains elusive. Two main definitions (the popular and specialised) may be identified; and the dimensions of the ensuing debate clarified in terms of three key questions: Is there is something qualitatively different about recent trends in the economy? What are the main economic consequences said to result from this new economy? What are the main social consequences? Of particular importance for social policy is that most models of the new economy suggest that it has led to an increase in inequality and social exclusion for those not positioned to take advantage of its supposed benefits. With most discussion focussed on a narrow use of the term — to do with communications technology — greater attention should be given to a broader definition which examines its consequences for the disadvantaged.