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.     

Mutual benefit societies in Hungary, 1830-1941

In Hungary for most of the nineteenth century mutual benefit societies played a key role in providing various social groups with aid in case of illness, accident, disability or death. The majority were linked to the burgeoning working-class movement and were voluntary associations whose members had no other recourse in times of adversity. Hungary was undergoing transformation in the nineteenth century. Changes in goods production and the craft guilds accelerated the establishment of workers'benefit societies, and so did the lack of a coherent system of social insurance in the new industrial order. They grew in tandem with the expansion of Hungary's economy and the return of constitutional government in 1867, and flourished from the 1870s to the decade preceding the First World War. Austria and Germany provided theoretical justifications and practical models. By the 1890s voluntary mutual benefit societies faced increasing competition from the State. As the economy and social structures evolved, successive governments sponsored their own insurance programmes. By the turn of the century, private companies were also offering life and accident insurance and the appeal of mutual benefit societies to both workers and the middle class diminished. Between the two world wars, they continued to serve a substantial segment of the population.     

The mutual benefit movement in Chile from its origins to the present time (1853-1992)

The mutual benefit movement in Chile first appeared with the beginnings of industrialization and urbanization from the 1830s onwards. The first associations of urban workers emerged in 1853: this was followed by an initial period of expansion of mutual benefit activities until 1890. Almost all the urban trades were represented. During this period the mutual benefit movement was the principal organizing force for popular demands. From the 1890s onwards mutual benefit — linked with the workers'movement — grew rapidly and entered on a process of unification. Encouraging the development of the trade union movement, it took a leading part in determining the shape of the people's movements and maintained this role until 1924: this period marked the high point of mutual benefit activities in Chile. Mutual benefit organizations defended workers'demands and the boundaries between mutual benefit and trade union organizations were quite fluid. But the adoption of the social legislation and the support offered by certain leaders of the mutual benefit movement to the military dictatorship marked the beginning of the movement's decline. Efforts were then made to extend its scope of activities and unify the mutual benefit movement in Chile and in Latin America as a whole. The results of this were limited and the crisis continued after the Second World War. The 1973 coup d'état aggravated the situation still further. Today, with the virtual destruction of social security and its replacement by a system of private insurance schemes, one needs to ask whether the Chilean mutual benefit movement, which at one time was the principal form of popular organization, has a future.     

Creating Stable Racially and Ethnically Diverse Communities in the United States: A Model for the Future

We examine fourteen stable, racially and ethnically diverse communities in nine US cities to understand what produces such communities. These communities in the context of the US experience of increased, multiracial, and multiethnic diversity in the early twenty-first century can serve as a policy model as both the US and European nations look ahead toward more diverse societies. After providing a brief history of US segregation patterns, we provide an analysis of factors related to stable diversity. We found two types of diversity. Diversity-by-direction communities, which are more likely to be black:white communities, consciously worked to preserve diversity through an array of community-based efforts. Diverse-by-circumstance communities, which are more likely to be multiracial, multiethnic communities with significant immigrant populations, have been faced with an unplanned diversity, which they are now working to preserve. Among the characteristics of stable diverse communities are the presence of: social seams linking different groups, community organizations involved in preserving diversity, public discussion of values of what produces 'good' community, and distinctive physical or environmental characteristics that continue to attract new residents.     

Social pensions and policy learning: The case of southern Africa

In the last decade and particularly since the publication of the Millennium Development Goals, social pensions have captured the interest of those concerned with the well-being of older people across that large part of the world where formal, contributions-financed, old-age benefit systems cover only a minority of the population. International organizations have turned their attention to such schemes and some see them as having a valuable role to play. However, information about what they are and how they work, and about their efficacy in meeting the objectives set for them, is still limited. Learning has been taking place not only in the international organizations but also in the region where they are most prominent – southern Africa. Such learning should be encouraged and the International Social Security Association has a part to play in this learning process.     

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.     

发展小城镇落实大战略

发展小城镇是发展社会主义市场经济的需要,针对当前小城镇在发展中存在的问题,要采取积极措施,解放思想,更新观念;科学规划,合理布局;抓住关键,发展经济;改革小城镇的管理体制,为小城镇的发展创造良好的环境;尊重规律,循序渐进,运用市场机制,搞好小城镇建设。     

Youth Cultures,Youth Movements and the Rise of a ‘Counter-Culture’

The rise of a youth culture, youth movement and, more recently, a counter-culture, may be traced to the reaction of student youth in particular against what they consider to be useless academic processing in our societies. Such characteristics as a belief in mutual aid, a spirit of community, and authenticity in interpersonal relationships are advanced to indicate the actual form and style this youthful reaction has assumed. After presenting some reservations concerning the overall worth and effectiveness of such movements within existing societies, the writer optimistically argues that these movements may well result in the rise of a new social order, dramatically different from the present one.     

对小城镇建设的理论思考

在我国城市化过程中心,小城镇的发展具有特殊重要的意义,它是中国城市化道路的现实选择,小城镇的建设要遵循与小城镇的规划建设和规划管理相结合的原则;遵循与农村剩余劳动力转移相结合的原则。小城镇规模与区域自然资源环境容量相适应才能对经济发展产生最佳效益。建设现代化的小城镇,不在于高楼大厦林立,而在于突出自己的风格和特色。     

Social cohesion in rural Australia: Framework for conformity or social justice?

While social cohesion has become a commonly accepted policy goal and framework in many ethnically diverse societies, there is a general concern in some academic literature that it can be a form of governmentality that constructs manageable subjects and communities, represses diversity and distracts attention from the social, political and economic production of inequalities. Drawing on ethnographic fieldwork in two rural Australian towns with ethnically diverse populations, this article engages with these criticisms of social cohesion while simultaneously asserting that social cohesion is viewed by local practitioners as a desirable objective for both strengthening intercultural community and addressing issues of social justice and inequality. We also aim to bring some needed clarity to relevant debates in the literature in distinguishing between social cohesion discourses used for normative and/or homogenising purposes versus frameworks developed in the academic literature with a concern for social justice and equality among diverse populations.     

幸福感城乡差异的元分析

对国内涉及幸福感城乡差异的18项调查研究进行元分析,结果发现,城镇人幸福感比农村人幸福感高,且可以从社会比较和社会适应两方面进行解释。这一结果排除了发表偏倚,具有稳定性。国内对这一问题之所以存在争论,主要是因调查工具的不同造成的,即工具质量越高,越容易得出城镇人幸福感高的结论。     

Analysis of the implementation of a social protection initiative to admit the poorest of the poor to mutual health funds in Burkina Faso

To enable mutual health funds to extend coverage to poor people, the Mutual Health Support Network (Réseau d’appui aux mutuelles de santé – RAMS) in 2012 launched an initiative in collaboration with the Ministry of Social Action and Solidarity (ministère de l’Action sociale et de la Solidarité nationale – MASSN) in Burkina Faso. This article reveals difficulties in the initiative's implementation, which resulted in the continued exclusion of poor people from health services. Poor people were required not only to make co‐payments, but also to accept a limitation of coverage to three episodes of illness per year. Additional challenges to service takeup were the geographical distance of the homes of some beneficiaries covered by a mutual fund agreement from a health centre and the failure by some health workers and managers of pharmacies to recognize the mutual membership card. A formal framework was lacking that brought together all the actors involved in planning and implementing the initiative. Those involved did not all have the same information. Each structure performed the tasks within its scope, according to its own interests, but without consulting the other parties, and there was no platform for discussing implementation difficulties.     

分利秩序与基层治理内卷化——资源输入背景下的乡村治理逻辑

农村税费改革以后,国家资源的不断输入为农村发展和乡村治理带来新的契机。然而,资源输入乡村社会,基层组织却无法有效承接,并遭遇官民不合作的困境。基层组织主要呈现出两种样态：消极作为与难以作为,以及富人和灰黑势力主政后的摆平式“积极”治理。两种治理形态皆导致国家公共资源的耗损,基层组织的权威与合法性进一步下降。在资源不断输送的利益链条中,权力寻租者、地方富人与灰黑社会势力、谋利型的机会主义农民等几个行动主体相赖相生,形成分利秩序,普通民众被排除在外,乡村治理出现内卷化。从根本上说,这是国家在压力型体制与有效治理之间产生的张力,并在推动乡村社会从整体性支配向技术治理转型中产生的结果。这一转向试图建立新的公共规则,却使得乡村治权弱化,缺乏公共规则实践的强制力保证,造成国家、基层组织与农民三者之间的利益与责任的连带制衡关系发生断裂,乡村治理陷入新困境。     

‘You don't want to be a check‐out chick all your life’: The out‐migration of young people from Australia's small rural towns

Globalisation and changes in agriculture have resulted in major social changes in inland Australia. Depopulation of the inland has led many to speculate on the future of rural towns and rural people. This paper will examine population drifts from country towns to cities and from the inland to the coastal regions and, in particular, the out‐migration of young people. In doing this, the paper focuses on several small towns in central New South Wales that have been the subject of intensive study during 2000 and 2001. Drawing on analysis of Australian Bureau of Statistics figures, in‐depth interviews and focus groups with key informants and surveys with young people and their parents in small rural communities the paper will report on the loss of young people and the greater loss of young women from these areas. It is argued that this outmigration of young people is linked to the need to seek higher education and also to the loss of full‐time jobs for young people. The loss of these jobs is the result of changes in agricultural production, labour market restructuring and a withdrawal of public and private sector services. It is further argued that current reliance by governments on market based and community self‐help solutions is not enough to provide a future for rural communities. Even if economic growth occurs this will not solve the problem of loss of young people, and the greater loss of young women, nor will it address the issue of access to education and training. Rather far greater attention to human capital (access to education, training and employment), institutional capital (government and non‐government services and infrastructure) and social capital (strong networks) is needed if Australia's small rural towns are to survive and flourish.     

Is it time to revise the definition of research misconduct?

U.S. federal policy defines research misconduct as fabrication of data, falsification of data, or plagiarism (FFP). In recent years, some have argued or suggested that the definition of research misconduct should also include sexual harassment, sabotage, deceptive use of statistics, and failure to disclose a significant conflict of interest (COI). While the arguments for revising the definition of misconduct used by federal agencies to include misbehaviors other than FFP are not convincing at this point in time, the arguments for revising definitions used by other organizations, such as professional societies, universities, or journals, may be. Since these other organizations play an important role in promoting integrity in science and deterring unethical behavior, they may consider adopting definitions of misconduct that extend beyond FFP. Debates about the definition of research misconduct are a normal and healthy part of broader discussions about integrity in science and how best to promote it. These debates should continue even if the federal definition of misconduct remains unchanged.     

Professionals' attitudes to children's participation in decision-making: dichotomous accounts and doctrinal contests

The attitude of professionals to the involvement of children in decision-making is unclear. This paper discusses a recent research study that utilized qualitative and quantitative methods to explore the views of professionals working in family support and child protection about two different aspects of children's participation in decision-making: the age at which children should make decisions and whether or not they should be involved in child protection conferences. The results showed that social workers tended to favour one of two diametrically opposed viewpoints about the age at which young people should make decisions and then in discussions with colleagues they sought to persuade others to change their perspective. Social workers who believed that young people should not make decisions until much older nevertheless thought that they should be involved in conferences whereas non-social workers did not make this distinction: for them, children who were not old enough to make decisions for themselves should not be involved in conferences. The results are discussed in the light of some of the implications for practice. The paper concludes by outlining how the results informed the design of a training pack commissioned by the Department of Health concerning the involvement of young people.     

White Ethnic Diversity and Community Attachment in Small Iowa Towns

Objectives . This study examines the relationship between white ethnic diversity and community attachment in 99 small Iowa towns. Methods . Our data come from the U.S. Census Bureau and the Rural Development Initiative (RDI) at Iowa State University. The RDI data, which consist of interviews with approximately 110 people in each of the 99 towns, are used to develop a community attachment score for each town. These scores serve as the dependent variable in ordinary least squares regression models to assess the extent to which ethnic diversity is related to attachment. Results . The findings show that towns with high levels of white ethnic diversity tend to have low levels of community attachment. Moreover, residents of diverse towns tend to view their communities with more suspicion and tend to be less involved in community activities than citizens in more homogeneous towns. Conclusions . Looked at narrowly, these results indicate that white ethnic diversity may be detrimental to community building in small Iowa towns. More broadly, the findings provide support for the idea that white ethnic diversity is alive and well in America.     

我国城市农民工医疗保险发展方向与路径选择

我国各地都已建立了农民工医疗保险制度,从城市农民工医疗保险同当地其他社会保险的依附或隶属关系角度可主要分为综合模式、单独模式和混合模式三类.根据世界各国城乡医疗保障一体化的发展趋势,我国农民工医疗保险必将最终融入到城乡医疗保障一体化制度中.但由于我国二元结构短时间内难以改变,农民工医疗保险还将长期存在.目前,限制其发展的亟待解决问题是农民工医疗保险的当期参保和不可随人转移原则.我国农民工医疗保险的改革,应根据不同模式的特点,将单独模式以及其他模式中类似单独模式的部分率先进行异地转移试点,为我国城乡医疗保障、社会保障一体化制度建设提供思路和借鉴.     

社会资本:破解“空心化”农村养老困境的现实选择——以H村为例

农村"空心化"已成为中国社会经济发展过程中中西部地区的一种普遍现象,年轻人的流失突显了农村的养老问题。在年轻人回乡事亲孝亲和农村社会化养老服务在短时间内都难以做到的情况下,加强农村社区社会资本建设,以协助老年人解决日常生活中的困难,成为破解"空心化"农村养老困境的现实选择和可行之路。