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.     

The decomposition of social policy in Sweden

The traditionally strong dominance of the state in social security in Sweden has been replaced by a more mixed structure. Individuals are increasingly covered by a mix of private welfare, employment-based corporate welfare and state programmes. There are several reasons behind this development: shifts in the economic and political conditions, strong tax incentives for the individual to buy private insurance, increasing problems for the public system in covering the loss of income for middle and high income earners, repeated media reports that the public welfare system will go bankrupt in the near future and increasing reports on free-riding and cheating in the area of public insurance. The advantage of the more mixed system may be its similarities to social insurance in some of the European Community Member States. However, from a social policy point of view there are also some dangers. There will be increasing tendencies towards inequality. In particular, the difference in social security conditions between the skilfully employed and marginal groups will be even more marked. The unemployed, the young and people with physical or mental handicaps will be left outside the private and corporate structures. There is also a marked risk that some individuals be reach a level of coverage well above the loss of income, and this will be a disincentive to work. Private and corporate welfare systems are also largely invisible in the sense that individuals may not even know under what conditions they are covered. Another problem is that public attitudes towards the public welfare system will increasingly become more negative and different in various parts of the population. The effect of this may be a vicious circle: public social policy becomes increasingly inefficient and unpopular among the working population and remains only as a marginal system for small marginal groups.     

Social Enterprise – A New Phenomenon in the Field of Economic and Social Welfare?

Drawing upon insights from historical institutionalism, this article critically examines the origins of social enterprise and its emergence into the mainstream policy arena. It begins by relating the social enterprise idea to major non‐state/non‐private institutional traditions, including the European social economy, US non‐profits and the UK charitable sector, and places it within the specific field of economic and social welfare. In so doing, the article contests the idea that social enterprise is a new phenomenon in the social welfare field and proposes instead that the supposed ‘novelty’ of social enterprise as an organizational form and a subject of public policy lies primarily in the nature of the socio‐political and economic context of the 1980s–1990s, during which time it became ‘en vogue’. The process of institutionalization of social enterprise and its ascension into the mainstream policy arena is examined in more detail in the case of England during the time New Labour was in office and beyond, and lessons are drawn from this experience concerning both the role that social enterprise plays or is expected to play as a vehicle to address economic and social needs, and how this is intertwined with both a dominant neo‐liberal discourse, as well as alternative perspectives that emphasize more equalitarian and sustainable development paths. The article concludes with some reflections in relation to the apparent consensus that seems to exist around social enterprise as a legitimate subject of public policy and the resulting social enterprization of public services which is currently taking place in England.     

共治民主：应对气候变化的民主模式初探

应对气候变化是一个特殊的公共领域。为应对气候变化,民族国家和国际政治都已经悄然发生并将继续发生调适性变化,这就是共治民主的形成。在这一人类活动领域,无论聚合民主还是协商民主,抑或一种局限于二者之中的参与民主概念,都不敷使用。共治民主是利益相关各方共同合作或自主实现公共利益的过程;它是共治定向的而非共识定向的;它是合作的,而非博弈的;它是社会的,而非政治的。     

Social work in South Africa at the dawn of the new millennium

The article examines recent developments in social policy and its implications for social work education and practice in South Africa. It traces the changes from the birth of democracy in South Africa to the dawn of the new millennium as these crucial years marked the beginning of a new era in South Africa's welfare history. It examines the challenges to social work and provides an example of the integrated, holistic developmental interventions, which are needed to combat social problems such as crime, AIDS and poverty. It ends with an examination of the implications of developmental welfare policy for social–work education as social workers are called to address mass poverty, unemployment and social deprivation through greater use of diverse social work methods, such as advocacy, community development, empowerment, consultation, networking, action research and policy analysis.     

The evolution of the Georgian social protection system since independence: An unclear future despite recent expansion

In the first decade of transition, the Georgian social protection system experienced a major retrenchment as the government struggled to finance welfare provision in the face of massive economic contraction and the near collapse of public institutions. Since 2004, this trend has been reversed, with the economy returning to a fast growth path and public administration improving considerably. Recent reforms, including the notable introduction of universal public health insurance, are welcome steps towards building a modern welfare state. Major challenges still remain, however, especially in relation to the system's limited effect on widespread poverty. Decelerating growth, the lack of strong pro‐welfare actors, and the absence of positive external pull factors may stall or prevent future growth, but the changing nature of the social contract between the people and government, as well as Georgian politicians' growing recognition of the importance of the welfare system for inclusive growth, leaves ample space for optimism.     

The role of the social innovation and entrepreneurship development fund in fostering social entrepreneurship in Hong Kong: A study on public policy innovation

Creating an enabling environment for social entrepreneurship in tackling complex socio‐economic challenges is at the forefront of government policy agendas globally. Although several policy mechanisms have been proposed to this end, whether and to what extent those policy mechanisms may (re)shape the social entrepreneurship environments have rarely been explored. By examining the Social Innovation and Entrepreneurship Development Fund (SIE Fund), a recent policy project aimed at fostering social innovation in Hong Kong, this article presents a rare empirical exploration to illustrate how public policies can potentially drive social innovation. We explore first the impact of the SIE Fund in fostering innovation among its funded social enterprises, and second, how the SIE Fund may have influenced Hong Kong's social entrepreneurship environment. Results show that the projects under the SIE Fund exhibit characteristics distinct from the social enterprises prior to the inception of the SIE Fund. In addition, evidence of innovations in terms of product, process, marketing, and innovation in developing new or improved social practices were also identified. This study illustrates how specific public policy mechanisms may potentially facilitate the diversification, inclusion, innovation, and expansion of the social entrepreneurship environment. Findings carry substantial policy implications, in particular to neighbouring East Asian societies typically characterized by a strong government, and face similar structural, demographic and socio‐economic challenges that necessitate innovative solutions.     

Demise of the Developmental State? Implications for Social Policy Development in Hong Kong

This paper argues that Hong Kong is now at the crossroads of its journey towards social policy development. While economic development still seems to be the unwavering objective of the Hong Kong government, the demand for democracy and social development can no longer be ignored because of a strong civil society fostered by economic success. The current state of affairs provides a window of opportunity for the Hong Kong government to strengthen its legitimacy through the development of social policy and to promote social harmony through inclusivity in social welfare. The findings from the present empirical survey conducted by the Hong Kong Institute of Asia‐Pacific Studies (HKIAPS) in 2010 demonstrate that Hong Kong people identified social harmony as the main direction for social development, closely followed by economic development, and democracy and freedom. Respondents who chose social harmony as the main goal of social development were more likely to take a step back and find common ground when fighting for their own rights or the rights of society. This paper concludes that these findings reflect the crucial importance of taking social harmony into consideration in the social policy development process.     

Labour Force Participation,Social Inclusion and the Fair Work Act: Current and Carbon‐Constrained Contexts

The notion that employment is a precondition for personal wellbeing and social inclusion is almost sacrosanct in Australian culture. Yet, the working and living conditions of Australia's low paid workers tells a different story. While labour market participation is a cornerstone of the Federal Government's Social Inclusion Agenda, it is recognized that low pay and poor job quality often derail this key objective. Indeed, the difficulty of ‘making work pay’ at the bottom end of the labour market is a social inclusion challenge that has yet to receive the policy or public attention that it warrants. This article considers what the Fair Work Act means for the social inclusion of disadvantaged workers, in the context of wider‐ranging strategies to address low pay. It concludes with some considerations of the challenges that a carbon‐constrained economy is likely to present for labour force participation as a remedy for social exclusion.     

Social Insurance Expansion and Political Regime Dynamics in Europe, 1880–1945*

Objectives. This article analyzes the causal relationship between political regime dynamics and social insurance expansion. I theorize that the social insurance expansion is the result of the ruling elites' strategic decision about regime change to dispel revolutionary motives. The key testable implication is that social insurance expansion is more likely to happen under a democratic regime, which, in turn, is influenced by the threat of social revolution evinced by strike activities. Methods. Using historical data on social insurance coverage from 12 European countries from 1880 to 1945, I test the hypothesis employing a treatment‐effects model that endogenizes democratization. Results. I find a positive association between social insurance expansion and democracy, controlling for other political mechanisms. Furthermore, I find that democratic transition is greatly influenced by the duration and intensity of strikes. Conclusion. This study suggests that social insurance expansion requires a link between a threat of revolution and democratization.     

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.     

Changing society's DNA codes: Democracy and the global movement for community progress measures

This paper examines some critical issues and opportunities for democracy and public policy posed by the growth of the global progress measurement movement. From the democratic perspective, these include: citizen progress measurement as a form of democratic re‐engagement; the re‐examination of democracy and the development of new indicators to define and measure a ‘healthy’ democracy; and the demonstration of clear linkages between healthy regimes, and broader individual and societal wellbeing. In public policy, the global movement challenges two long dominant assumptions: the primacy of continuous economic growth as the key driver of wellbeing; and the ‘inevitability of progress‘. In their place, it offers a more holistic, integrated and nuanced model that recognises the interdependence of economic, social, cultural, environmental and democratic dimensions for genuine wellbeing, progress and sustainability. The paper reviews work in Australia over the past decade at both local community and national levels as examples of these trends, including the development of citizen‐engaged community planning and neighbourhood renewal schemes in which progress and wellbeing indicators play a central role; the development of state‐wide local progress measurement frameworks as part of a commitment to devolved planning and stronger local democracy; and the evolution of national progress measurement systems. The paper concludes with a proposal for a broad community engaged National Development Index (NDI) for Australia.     

‘Any one of us could be among that number’: Comparing the Policy Narratives for Individualized Disability Funding in Australia and England

In this article we compare the introduction of individualized budget policies for people with disabilities in Australia and England. Data is drawn from semi‐structured interviews undertaken in Australia with politicians, policymakers, providers, disability rights groups and care planners, along with analysis of policy documents. This data is compared to the authors’ earlier research from England on the personalization narrative. We argue that the National Disability Insurance Scheme (NDIS) currently being introduced in Australia deploys an insurance storyline, emphasizing risk‐pooling and the minimizing of future liabilities. This contrasts with the dominant storyline in England in which attention has focused on the right to choice and control for a minority of the population. This difference can be explained by the different financial context: the NDIS needed to build public and political support for a large increase in funding for disability services, whereas in England the reforms have been designed as cost‐neutral. Tensions in the English narrative have been about the extent to which personalization reforms empower the individual as a consumer, with purchasing power, or as a citizen with democratic rights. Australia's approach can be characterized as a form of social investment, evoking tensions between the citizenship of people with disabilities now and the future worker‐citizen.     

Social health insurance development in Mongolia: Opportunities and challenges in moving towards Universal Health Coverage

Mongolia achieved high population coverage under mandatory health insurance relatively quickly. This fact was viewed by policy‐ and decision‐makers as a central issue for health financing reform in Mongolia. Health insurance brought many new features for health service planning, provision, funding and resource management. Based on initial achievements, health insurance came to be strategically considered as the vehicle for achieving universal coverage. The article analyses developments in Mongolia's health insurance over the last decade along with the core policy dimensions of Universal Health Coverage. It examines various reform approaches and the numerous amendments to laws that have been implemented during this period and discusses new opportunities as well as challenges. The analytical review and findings discussed suggest that Mongolia has a need for evidence‐based policy decisions and informed political support, with health insurance backed by robust institutional and administrative capacities. More generally, it also emphasizes that health policy goals and objectives can be attained by strengthening and making transparent and publicly‐accountable all health system financing functions and arrangements. The policy analysis, experiences, lessons and proposed strategies presented with regard to Mongolia intend to stimulate wider discussions on health insurance development as well as promote continuing focused research on specific aspects of health insurance and public financing reform.     

Participatory research meets validated outcome measures: Tensions in the co‐production of social care evaluation

Funding for care service research is increasingly subject to the satisfaction of two requirements: public involvement and adoption of validated outcome tools. This study identifies competing paradigms within these requirements and reveals significant challenges faced by researchers who seek to satisfy them. The focus here is on a study co‐produced between academic researchers and people with experience of adult social care services. It examines to what extent research studies can conduct high‐quality public involvement and genuine co‐production of knowledge, whilst attempting to produce quantifiable outcome scores. Findings add to debate around how to incorporate diverse perspectives in research, which may draw on incommensurate accounts of validity and reliability. Findings also highlight constructive attempts by academic and co‐researchers to make the combination of approaches work in the field. These small scale acts of researcher agency indicate some scope to combine the two approaches in future research studies. However, conclusions foreground the importance of broader awareness of how tensions and power imbalances related to this combination of approaches play out in social policy research practice.     

Meeting (or not) at the street level? A literature review on street‐level research in public management,social policy and social work

This literature review analyses the adoption and development of a street‐level perspective in public management, social policy and social work. The last years have seen a prominent revival of a perspective based on Michael Lipsky's street‐level bureaucracy approach in the debates conducted within all three disciplinary fields. Based on 71 key publications in public management, social policy and social work, the review analyses the adoption of the street‐level bureaucracy approach during the period 2005–2015, pointing out the main themes of the debate within, as well as overlaps and differences between, the three disciplines. The findings show the potential of better integrating the different perspectives and taking stock of the articulated debate. Lastly, the review discerns a common viewpoint for further street‐level research, emphasising its importance for the critical analysis and understanding of street‐level work as a vital dimension of responsive and accountable institutions and as a decisive moment to shape positive policy outcomes on the ground. Key Practitioner Message: ? The use of discretion by frontline practitioners and their role as policy actors on the ground has become an important focus of research; ? This literature review shows that the debate has gone far beyond discussing discretion as an all‐or‐nothing issue, pointing out both positive and negative aspects of discretion and developing comprehensive frameworks to explain the use of discretion at the street‐level; ? However, street‐level research has traditionally rather neglected the notion of professionalism. The social work literature brings in the perspective of professionalism; more research efforts are needed to better explore and explain how professionalism matters in relation to challenges and dilemmas of different policy and practice fields.     

New avenues to be opened for social protection in the Arab world: the case of Egypt*

This article looks at social protection in the Arab world. Giving the example of Egypt, it asks why poverty is so widespread and why – despite the country's numerous social protection systems – social risks are a major contributing factor to it. It concludes that reforms are due. The existing systems are well funded but inefficient and more to the benefit of the better‐off than the poor. A reform approach is proposed which builds on both conventional and more innovative strategies: campaigns should be launched to raise public awareness of social risks; social assistance spending should be increased; and the operating public pension schemes should be reformed. At the same time, new avenues have to be opened to meet the specific needs of informal sector workers who have extreme difficulty in being covered by social insurance or social assistance. To this purpose, micro‐insurance is a promising approach for the Arab‐world region.     

Economic crisis and social policy reform in Korea

The economic crisis that broke out in Korea in December 1997 has had a chilling impact on social development in the country. Today unemployment is the highest that Korea has experienced in the past thirty years. This paper aims to examine the impact of the economic crisis on social development and the role of public policy to mitigate the problems caused by the crisis. The economic crisis has hit vulnerable groups harder, increased the proportion of part-time and daily workers, and reversed the trend of steady improvement of income distribution. The economic crisis along with the trend of aging population, globalization, and competition calls for an expanded role of social policy, which the Korean government has neglected for a long time. The main targets of social policy reform in Korea include the expansion of government programs and safety nets for the unemployed and redesigning the national pension and health insurance scheme to provide adequate income security as well as to improve the system sustainability.     

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.     

Comparing unemployment protection and social assistance in 14 European countries. Four worlds of protection for people of working age

Pfeifer, M. Comparing unemployment protection and social assistance in 14 European countries. Four worlds of protection for people of working age This article aims to show which policy responses 14 Western European countries have adopted to deal with rising unemployment levels and increased need for benefits during working age. In contrast to earlier studies, both components of unemployment benefits (UB), i.e. unemployment insurance and unemployment assistance, were taken into account in a social rights indicator that depicts the legal entitlements of the unemployed. In total, there were eight indicators of both UB and social assistance representing expenditure, generosity, problem pressure and benefit entitlements. The following cluster analysis groups countries using these indicators. The resulting typology consisted of four ways of protecting the working‐aged: an extensive safety nets type operating well with functioning labour markets; a liberal protection type dealing with low levels of unemployment; a targeted protection type combined with an insider–outsider divide on the labour market; and lastly, a patchy safety nets type facing high unemployment levels.