Social investment effects of public education,health care,and welfare service expenditures on economic growth

The purpose of this study is to theoretically and empirically examine whether public spending in education, health care, and welfare service operates as a fruitful investment in welfare states, which has been implied in the literature of social investment arguments. Based on comprehensive review of existing literature, this study suggested a tripartite mechanism of social investment effect of such spending, that is “enhancement of human capital,” “support for labor force participation,” and “job creation.” To find the empirical evidence, a pooled time‐series cross‐section analysis was conducted with the data of 15 advanced welfare states from 1980 to 2015 using estimation technique of fixed‐effect model. The results confirmed that public spending in education, health care, and welfare service had a positive medium‐term as well as long‐term effect on economic performance, while cash‐type welfare spending had an obscure or no visible effect on economy. Government consumption that is a proxy and control variable of size of the welfare state showed a positive effect on real GDP in the medium term but a negative effect in the long run. In conclusion, this study suggests that reinforcing social services should be recognized and dealt with as essence of social investment strategy.     

Young people leaving care in Sweden

The transition from a placement in care to an independent life can be a problematic phase for young people. In Sweden, special care‐leaving services are almost non‐existent. What then happens to young people when they leave a placement in out‐of‐home care? This paper draws on the results of a study in which 16 young care leavers between the ages of 18 and 22 years were interviewed. Telephone interviews were also performed with the young care leavers' parents, social workers, foster carers and institutional staff. The aim of the study was to investigate how young care leavers perceive the transition from care to an independent life. The Swedish welfare model, the prolonged transition to adulthood and the family‐oriented welfare discourse have been used as analytical perspectives. The results show that young care leavers have a pronounced need for social, emotional, practical and financial support. Whilst such support is occasionally provided by foster carers and residential staff, it is seldom given by social services or biological parents. This group is at risk of facing severe problems in the transitional phase from care to independent life, a fact that is not acknowledged by the Swedish welfare system.     

Solidarity put to the test. Health and social care in the UK

As welfare states experience challenges from ideological and funding sources, the position of the United Kingdom represents an important case study. Apparently under severe attack for its perceived failures to deliver efficiency, effectiveness and social justice, there remains a continued high level of public support for `nationalised' health and social care. The paper explores the nature of the fissures in the systems and the data which indicates enduring solidarity.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

Defining responsibility for care: approaches to the care of older people in six European countries

This article examines the social care of older people in six contrasting European countries. Family, institutional and community care are compared, focusing on vulnerability, empowerment and the gatekeeping of resources. The article considers the position of older people in each care system by presenting individual case studies. The six countries include the family-oriented systems of Ireland, Italy and Greece, and the individual-oriented systems of Denmark, Norway and England. To improve the care of older people in any of these welfare cultures, resources need to be developed that work with existing sources of care but extend the rights of older people, at least to assessment and an equitable matching of needs to the care services available. Overall, the different levels of provision of organised social care services are a major aspect of inequality within and between the countries. Whilst there is little prospect for any major policy transfer across national boundaries, there is potential for selective cross-national learning with regard to particular service developments.     

The impact of the use of the social welfare services or social security benefits on attitudes to social welfare policies

Muuri A. The impact of the use of the social welfare services or social security benefits on attitudes to social welfare policies
Int J Soc Welfare 2010: 19: 182–193 © 2009 The Author(s), Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. This article investigates the attitudes of citizens and clients to social welfare services and social security benefits. The data come from a Finnish national survey conducted at the end of 2006. First, the article overviews the previous welfare‐state studies relating especially to the theoretical perspectives of self‐interest and legitimacy. The empirical analysis indicates (i) that a different operation of self‐interest can only weakly explain the differences in attitudes between services and benefits; (ii) that there is general support for Finnish social welfare services and social security benefits, which, however, is mixed with growing criticism among women and pensioners who are supposed to benefit most from the welfare policies; and (iii) that such determinants of attitude as gender, use and, to some extent, lifecycle have become as important as class‐related factors such as income and education.     

Human Motivation and Professional Practice: of Knights, Knaves and Social Workers

Efforts to improve the efficiency and responsiveness of public services by harnessing the self‐interest of professionals in state agencies have been widely debated in the recent literature on welfare state reform. In the context of social services, one way in which British policy‐makers have sought to effect such changes has been through the “new community care” of the 1990 NHS and Community Care Act. Key to this is the concept of care management, in which the identification of needs and the provision of services are separated, purportedly with a view to improving advocacy, choice and quality for service users. This paper uses data from a wide‐ranging qualitative study of access to social care for older people to examine the success of the policy in these terms, with specific reference to its attempts to harness the rational self‐interest of professionals. While care management removes one potential conflict of interests by separating commissioning and provision, the responsibility of social care professionals to comply with organizational priorities conflicts with their role of advocacy for their clients, a tension rendered all the more problematic by the perceived inadequacy of funding. Moreover, the bureaucracy of the care management process itself further negates the approach's supposedly client‐centred ethos.     

Empirical Analysis of Fiscal Soundness and Public Social Expenditure: A Lesson for the Future Direction of the Korean Welfare State

The aim of this paper is to investigate the relations between fiscal soundness and public social expenditure in advanced welfare states so as to reconsider the conventional wisdom that welfare expenditure aggravates national finances. Through this, I propose the clues of building the sustainable Korean welfare state. I focus on the interdependent relationship between fiscal soundness and public social expenditure based on fiscal sociology. Considering this interaction, I form two sets of simultaneous equations models and employ a special statistical method, three‐stage least squares (3SLS). The results regarding the causal relationship between fiscal soundness and public social spending indicate that, if public welfare spending is increased, fiscal health is damaged. However, as many comparative social policy researchers have pointed out, outcomes of welfare states differ from country to country according to the composition of public welfare spending. Specifically, some welfare states with priority given to social services such as vocational training or childcare services have maintained the stability of public finance. By extension, we can say that public social expenditures have a positive influence on fiscal soundness based on the composition of social expenditures. Finally, it is possible to create financially sustainable welfare states.     

Public Satisfaction with the Health System and Popular Support for State Involvement in an East Asian Welfare Regime: Health Policy Legitimacy of Hong Kong

The legitimacy of social policies has gained increasing attention in the past decade, against the backdrop of fiscal austerity and retrenchment in many nations. Policy legitimacy encompasses public preferences for the underlying principles of policies and the actual outcomes as perceived by citizens. Scholarly knowledge concerning the legitimacy of health policy – a major element of modern social policy architecture – is, unfortunately, limited. This article seeks to extend the scholarly debates on health policy legitimacy from the West to Hong Kong, a member of the East Asian welfare state cluster. A bi‐dimensional definition of health policy legitimacy – encompassing both public satisfaction with the health system and the normative expectation as to the extent of state involvement in health care – is adopted. Based on analysis of data collected from a telephone survey of adult Hong Kong citizens between late 2014 and early 2015, the findings of this study demonstrate a fairly high level of satisfaction with the territory's health system, but popular support for government responsibility presents a clear residual characteristic. The study also tests the self‐interest thesis and the ideology thesis – major theoretical frameworks for explaining social policy legitimacy – in the Hong Kong context. Egalitarian ideology and trust in government are closely related to both public satisfaction with the system and popular support for governmental provision of care. However, the self‐interest thesis receives partial support. The findings are interpreted in the context of Hong Kong's health system arrangements, while implications for the territory's ongoing health policy reform are discussed.     

From Official Supervision to Self‐monitoring: Privatizing Supervision of Private Social Care Services in Finland

In October 2011, a new Act on Private Social Care Services came into force in Finland. The Act included a provision on a ‘self‐monitoring plan’. According to the provision, providers of private social care services are required to draw up a self‐monitoring plan and to follow its realization. The plan must be kept publicly on view so that clients and their relatives can also keep an eye on the realization of self‐monitoring. In this article, self‐monitoring is first explained and then briefly analyzed against the background of a wider theoretical discussion on accountability. It is argued that the introduction of client involvement in the supervision of private social care services represents a new mechanism of accountability that is typical of the Post‐Keynesian welfare state. Because public authorities are no longer able to supervise the growing number of private social care service providers, the responsibility has been partly shifted to service providers themselves as well as to clients. However, it is argued that the idea of self‐monitoring lends itself poorly to ‘delegated’ private social care services, i.e. to services that are outsourced to private service suppliers. Supervision of private social care service providers should not be too eagerly delegated to service providers themselves, or to clients, because we are here dealing with the constitutional right to adequate social care services. Client involvement also involves numerous practical problems, as shown at the end of the article.     

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.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

Fairness, Equality and Legitimacy: A Qualitative Comparative Study of Germany and the UK

The pressures of globalization and shifts towards post‐industrialism are producing policies that increasingly emphasize the common themes of activation and of individual responsibility for outcomes. Such approaches suggest normative principles of equality of opportunity rather than of outcome, and of individual rather than collective responsibility for the outcomes achieved. Does this imply a shift towards a common normative framework for European welfare states, with implications for future policy developments? This article reports a recent qualitative study examining ideas about fairness and social provision in the very different regimes of Germany and the UK. The analysis shows that while respondents in both countries value equality of opportunity as a normative principle, those in Germany are much more likely to argue that an equal opportunity approach requires government to guarantee equal access to basic services. They are also more likely to express concerns about market freedoms which allow those who can afford it better access to health care and education. Real differences in welfare values remain, loosely following differences of regime type, despite the greater emphasis on activation and individual responsibility across European welfare states.     

Public support for the social rights and social obligations of the unemployed: Two sides of the same coin?

In light of the ever‐growing shift towards activation in European welfare states, the present article examines the relationship between citizens’ welfare generosity (i.e., support for social rights) and welfare conditionality (i.e., support for social obligations) with regard to the unemployed. Using data from the 2014 Belgian National Elections Study, we found that generosity and conditionality appear to be two sides of the same coin. The two factors are negatively correlated, and most of their respective attitudinal drivers are quite similar in strength, yet opposite in direction. In addition to self‐interest and conventionally recognised ideational beliefs, such as egalitarianism and individualism, beliefs about welfare deservingness – an explanatory factor that has remained understudied in the field – are particularly influential in shaping people’s welfare preferences. A stronger emphasis on criteria of deservingness such as control, attitude and reciprocity considerably lowers support for social rights and strengthens support for social duties.     

‘Southern‐style’ National Health Services? Recent Reforms and Trends in Spain and Greece

This article analyses recent changes in the Greek and Spanish national health services. The aim is to assess how the period of austerity and further recovery during the 1990s and early 2000s impacted on them in terms of equity and efficiency. This is of interest because of the closeness in time between the universalizing reform laws and the arrival of the conditions for economic convergence established in the Maastricht Treaty. The analysis is also attractive because it deals with the transformation of already mature health insurance systems into national health services, a transformation that is novel in European welfare history. The article addresses the questions of whether austerity has hindered full implementation of the reform laws enacted in the early to mid‐1980s, examining reform trajectories and financing and expenditure trends. Furthermore, it considers the impact on access, understood in terms of population coverage, the array of services provided, waiting lists, and territorial inequalities. Finally, it discusses the introduction of new managerial formulas and attempts at enhancing efficiency. The concluding section states that divergent trajectories have occurred, thus rendering the definition of a ‘Southern model of health care’ difficult. It also provides explanations of the trajectories followed in both national cases and informs on prospects for the future.     

Hybridization instead of Clustering: Transformation Processes of Welfare Policies in Central and Eastern Europe

Welfare state theories tend to use concepts of clustering for defining the affiliation of national social security systems to overarching worlds of welfare. A closer look at the transformation processes of welfare policies in Central and Eastern Europe shows a great variability among those countries in approximating their welfare states to Western European standards. In the design of their pension systems, their health care provision and their unemployment protection, Central and Eastern European Countries (CEEC) follow different reform paths. Welfare clusters in Western Europe are used as reference models, but no single example applies to all sectors of social security. Thus, a generalizing picture of welfare provision cannot be drawn for Central and Eastern Europe. Instead of constituting a new individual type of welfare arrangement, a hybridization process is observable.     

Do public services influence patterns of informal care? Informal networks and public home care in three Swedish municipalities

Whether an individual receives home care services depends on two factors: the functional disability of the care recipient and the caregiver's gender, when the living arrangements of the care recipient are controlled. Data from this longitudinal study of social networks and home care organization in 3 municipalities in Sweden show that care recipients with a severe disability received more home care services than others. In cases where the main caregiver lives together with the care recipient, the public services are adjusted to the family situation and are independent of the functional disability of the care recipient. Care recipients who live with the primary caregiver receive less formal help than do care recipients who live alone. When the primary caregiver does not live together with the care recipient, the public services are adjusted to the functional disability of the care recipient and are independent of the primary caregiver's gender. Care recipients supported by a male helper received more formal help than care recipients supported by a female helper. Those supported by a female helper received more informal help. Various models of relationships, supplementation and complementation between informal care and public services are discussed. The dependence on public home services is high. Assistance with basic activities of daily living is the first area requiring complementary contributions from the public services. A special type of kin independene was found, related to the function of public services in a modern and gender-equal society. The results provoke a discussion on research design as well as comments on welfare policy and gender equality in the transformation of the welfare state.     

Care leavers: A British affair

Individuals in and leaving care within the UK experience numerous dilemmas that include a lack of supportive housing and potential homelessness, lower educational attainment and occupational status, and greater likelihood of moving into poverty. These adverse situations—all of which are interrelated—shape their present and future health status. Models of these processes usually focus on individual behaviours/characteristics, the consolidation of positive identities through the development of supportive networks, and specific social policies germane to this group. Although informative, these models neglect many key contextual factors that shape these outcomes. In this paper, we present a model of care‐leaving that incorporates developments in the political economy of health literature to show how differing welfare state arrangements shape health by mediating the distribution of economic and social resources over the life course for populations in general and for those in and leaving care specifically. The key recommendation suggested by this model is to focus upon developing public policies to address the vulnerable situations care leavers experience associated with skewed income distributions, lack of housing affordability, weak employment standards, and lack of access to higher education typical of liberal welfare states such as the UK.     

Caregiver‐endorsed strategies to improving sexual health outcomes among foster youth

Foster youth are at an increased risk of unintended pregnancies and sexually transmitted infections (STIs) compared with peers. We conducted 11 semistructured focus groups with 86 foster and kinship caregivers in three child welfare jurisdictions to understand their strategies for monitoring and communicating with youth in foster care around sexual health topics, with the overall goal of developing a training for caregivers to reduce STI and unintended pregnancies among youth in foster care. We used thematic analysis to analyse the data. Three main themes emerged: (1) strategies to communicate with youth about sexual health (trust‐building, open/direct communication, tailoring information to each individual youth, creative conversation‐starters, and self‐education), (2) strategies for monitoring youth (e.g., tailoring monitoring to youth development/characteristics, clearly communicating rules, co‐development of rules, spending time with youth/friends/friends' parents, using technology, using a social support system), and (3) other strategies to promote positive youth development (advocating for youth, engaging youth in goal‐setting). Trainings that provide caregivers with (1) information on sexual health and normal adolescent development and (2) strategies and skills to help caregivers engage in open, evidence‐informed communication, and monitor youth in a tailored, developmentally‐informed manner are likely to improve reproductive health and other outcomes among youth in foster care.     

Public Attitudes towards Income Redistribution: Evidence from Hong Kong

The drivers of public support for redistributive policy have stimulated academic debate around the world. The majority of studies use cross‐country surveys conducted in the Organisation for Economic Co‐operation and Development countries to contribute to the debate on whether self‐interest or social values have more influence on public attitudes towards redistribution. Drawing on a phone survey conducted in 2013, this study advances the discussion by investigating public attitudes towards redistribution and social policy changes against the backdrop of buoyant government revenues in Hong Kong. The Hong Kong welfare model, best seen as a parallel to the liberal welfare state, is selective and residual. Contrary to the usual assumption, the social values hypothesis, viewing poverty as societal problems instead of individual reasons, has been supported in the Hong Kong context. It lends support to greater redistribution in a residual welfare state. The policy implications of the findings are also discussed.