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。     

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.     

Health insurance coverage of Hispanic adults: An assessment of subgroup difference and the impact of immigration

This research explores the health insurance coverage of various Hispanic subgroups in comparison to non-Hispanic whites and blacks. The impact of immigration status is also considered as we hypothesize that nativity, duration, and naturalization tap a possible process of structural acculturation that increases access to insurance coverage for Hispanic groups. We find that the immigration variables impact the type of insurance reported. However, race/ethnic disparities continue to exist, with the various Hispanic subgroups more likely to report miscellaneous government health insurance or no health insurance coverage as compared to non-Hispanic whites.     

Transferring from the poor to the rich: Examining regressive redistribution in Chinese social insurance programmes

Social insurance promotes progressive redistribution through risk pooling and cross‐subsidy. However, in China, risks and protection are mismatched, with benefits and protection accruing to the privileged while high‐risk groups are inadequately protected. This article reports on a study of the sources of regressive redistribution in Chinese pension, health and unemployment insurance programmes, and discusses the possible cause of this redistribution paradox. It argues that the government has adopted different strategies for welfare reform towards different socioeconomic groups. For the core groups, such as public employees, reform has been characterised by replacing old programmes with new (i.e., a replacement strategy). For marginal groups, the government has handed off its responsibilities to individuals and the market (a retrenchment strategy). This political pecking order of welfare reform is the cause of distorted distributional outcomes. As social policy programmes continue to spread in developing countries, China's case illustrates that they may reinforce existing disparities rather than realise progressive redistribution, risk management and social inclusion.     

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.     

Healthcare financing reform and the new single payer system in the Republic of Korea: Social solidarity or efficiency?

In July 2000, national health insurance in the Republic of Korea was transformed into a single insurer system. This major reform in healthcare financing resulted from the merger of more than 350 health insurance societies. Inequity in healthcare financing and the chronic financial situation of the health insurance societies for self–employed workers in rural areas have been the driving forces leading to the unified health insurance system. The unique institutional context together with political change opened the window of policy change, and various stakeholders such as politicians, rural self–employed workers, trade unions and civic groups were involved in the healthcare reform process. Fair income assessment of the self–employed and the role of the single insurer as a prudent purchaser of medical care will be vital for the new system to achieve its intended goal and improve social solidarity and efficiency of healthcare.     

族群与教育不平等:我国西部少数民族教育获得的一项实证研究

摘 要：本文通过梳理国内外有关族群（民族）分层的文献,认为有必要把“民族”纳入到中国的市场转型和社会分层理论框架之中,并从教育获得的角度对这一问题进行实证分析。影响中国少数民族教育获得的因素主要包括：城乡地域区隔、职业结构（阶层）、文化差异和国家政治进程（政策变迁）。基于对2004年中国西部抽样调查数据分析,作者发现：（1）基础教育阶段入学的族群差异主要由城乡差别和阶层不平等造成,族群不平等已不显著;（2）少数民族子女高中升学概率依然显著低于汉族,其原因部分在于城乡、地域和阶层因素,部分在于少数民族和汉族的文化差异（如语言环境）等因素;（3）与汉族教育不平等的代际传递模式不同,少数民族教育不平等的代际传承以资源转化模式为主,从而影响了不同族群在教育扩展中的获益程度。总体而言,虽然中国西部少数民族的教育获得仍显著落后于汉族,但其教育不平等更多地来自城乡和阶层之间的差异。     

An Analysis of Selected Pension and Health Care Initiatives for Informal Sector Workers in India

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.     

Rural population and social security in Brazil: An analysis with emphasis on constitutional changes

This paper analyses the situation of the Brazilian rural population with respect to social insurance and social assistance at two points in time: 1988 and 1998. The 1988 Constitution defined new rules with regard to eligibility conditions and benefit values for the rural population. But it was only in July 1991, with Law 8213, that these changes were implemented. We compare — by gender and individual age — activity rates and probability of receiving benefits, before and after the changes in legislation. We also compare, at these two points in time, family structure and the importance of the income of older people in the family budget. The analysis makes clear the positive impact brought by the legislation on the coverage and per capita family income of those families with older members in rural Brazil, bringing about some degree of poverty alleviation, as well as bridging the gender gap with respect to access to benefits. In contrast to what occurs in other Latin American countries, nowadays the Brazilian rural population has almost universal access to social security benefits, not only at family level but also in individual terms.     

Caregiving Load and Respite Service Use: A Comparison between Older Caregivers and Younger Caregivers

Study aims were to explore differences in predictors of respite care use between older (aged 65+) and younger caregivers (aged 18–64 years), and associations between caregiving load and respite care use using multivariate logistic regression analysis and unpaid caregiver (n= 10,500) data from the 2009 California Health Interview Survey. Caregiving load comprised number of care recipients, weekly hours in caregiving, and caregiving duration. Variables with a significant association with respite care for older caregivers were female gender, income, and health insurance. For younger caregivers, respite care use associations were with ethnicity, caregiving relationship, education, and availability of substitute help.     

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.     

Determinants of Household Insurance Coverage Among Low‐Income Families from Boston,Chicago, and San Antonio: Evidence from the Three‐City Study*

Objectives. In this article we examine correlates of health insurance coverage for low‐income households. Methods. Using data from the Welfare, Children, and Families Project (1999–2001), a sample of 2,402 low‐income families from Boston, Chicago, and San Antonio, we estimate two logistic regressions, one that predicts health insurance coverage for one focal child in each household and another that assesses the odds that all children in the household have coverage. Results. The children of poorly‐educated, immigrant, and Mexican‐origin parents are at an elevated risk of lacking insurance. These characteristics also increase the risk of incomplete household coverage. Mexican‐origin children and households are at particularly high risk of lacking complete coverage, a fact partially reflecting their residential concentration in states with high uninsurance rates, such as Texas. Conclusions. Serious holes in the health‐care safety net affect poor Americans differently based on their state of residence, race, ethnicity, and household structure.     

农民工社会认同的决定因素研究：基于上海的实证分析

本文首次从国际移民的涵化理论视角对农民工的社会认同方式及决定因素进行探讨,通过对上海市农民工抽样调查数据的实证分析发现,农民工作为国家内部城乡移民的重要组成部分,其社会认同存在以户籍为基础的制度性约束和以资源匮乏为特征的能动性限制。农民工社会认同主要受文化态度、社会交往、经济成功和社会环境四类变量的影响,农民工的个体人口统计特征也会影响城市认同的意愿。当地语言的熟练程度、与当地人交朋友的意愿（而非与外省市的农民工交朋友）、类似群体的收入地位水平、感知到的社会歧视程度和参与保险的程度都成为重要的决定因素。因此,公共政策的制定与执行应该要有助于农民工的心理层面的社会认同的转变,尤其是从“外地人”向“本地人”的认知转型。     

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.     

The Associations between income,informal social networks,and health among older adults in South Korea: A multi‐group analysis based on the level of age‐friendly environments

The aim of the present study was to empirically investigate the role of age‐friendly environments (AFE) on the associations between income, informal social networks, and health among South Korean older adults. We used data from the “2017 Age Integration Survey” collected nationally and ultimately analyzed 615 older adults over 50 years of age. Structural equation modeling and multi‐group analysis were used to test the hypothesis. Specifically, two groups of perceived levels of AFE (top 25%, bottom 25%) were compared in order to examine the moderating effects. The results indicated that poor income and scarce informal social networks each had a significantly adverse impact on health. However, the effect of income on health was no longer significant for older adults living in environments that were more age‐friendly. In both groups, the presence of fewer informal social networks adversely impacted health, although the sizes of the effects decreased when the level of AFE perceived by older adults was improved. Finally, several implications of the study findings were discussed.     

Extending social security coverage to the rural sector in China

In late 2009 China launched an innovative, voluntary programme that by 2011 had extended pension coverage to 326.4 million people in the rural sector, including contributors and beneficiaries. It requires one contribution per year and provides a flat‐rate benefit and a contributions‐related benefit through a contributory individual account, with a government guarantee that the benefit will continue for life. The programme encourages participation of persons who do not pay income taxes, and thus have no tax incentive to participate, by providing substantial government subsidies. As a further incentive, old‐age benefits are provided to older parents when all their adult children participate in the contributory programme.     

Social security for China's rural aged: a proposal based on a universal non‐contributory pension

Yang Y, Williamson JB, Shen C. Social security for China's rural aged: a proposal based on a universal non‐contributory pension Int J Soc Welfare 2010: 19: 236–245 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. China's relative lack of social security coverage for rural elders exacerbates the already severe rural–urban economic disparity, slows the rate of rural poverty reduction, and raises social justice concerns. Our analysis draws on evidence from a number of sources including interviews with experts on China, Chinese government documents, Chinese newspaper accounts, and other sources from other countries. Based on our analysis of what has been tried in other countries and the current situation in rural China, we offer some suggestions for Chinese policy makers. We suggest that, for rural China, a universal non‐contributory old‐age pension deserves serious consideration, and refer to our proposed model as a Rural Old‐Age Social Pension. It will reduce the level of poverty in rural areas and the degree of income inequality between rural and urban areas while simultaneously promoting social and political stability.     

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.     

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.