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.     

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.     

Welfare State Changes and Outcomes – The Cases of Portugal and Denmark from a Comparative Perspective

It is well known that welfare states ensure a certain level of social protection affecting levels of well‐being and the extent of inequalities in society. Changes within crucial domains of social policy, such as education, health, or social protection, have, therefore, a major effect upon individuals' opportunities. In this article I compare the effects of these changes in two countries from the mid‐1980s to the financial crisis of 2008. Portugal that was a latecomer in welfare state development and Denmark was at the forefront of de‐commodification and universalization of social rights. The conclusion of this article is that income inequality has been steadily increasing in Danish society; while in Portugal, despite improvements in many social domains (healthcare, poverty alleviation, unemployment protection), problems of inequality remain deeply embedded in the country's social and institutional structures.     

Public Opinion against Markets? Attitudes towards Market Distribution of Social Services – A Comparison of 17 Countries

This article studies how citizens view the appropriateness of market criteria for allocating services commonly associated with social citizenship rights and welfare state responsibility. The article focuses specifically on a potential role for the market in the provision of social services. The relationship between welfare policy institutions, socio‐economic class and attitudes is explored by comparing attitudes across 17 countries of the Organisation for Economic Co‐operation and Development, using multilevel modelling and data from the 2009 International Social Survey Programme. Results show that public support for market distribution of services is relatively weak in most countries, a result suggesting that public opinion is unlikely to pose a driving force within ongoing processes of welfare marketization. Still, attitudes are found to vary a lot across countries in tandem with between‐country variation in welfare policy design. First, aggregate public support for market distribution of services is stronger in countries with more private spending on services. Second, class differences in attitudes are larger in countries with more extensive state‐led delivery of services. Together, these results point to the operation of normative feedback‐effects flowing from existing welfare policy arrangements. The theoretical arguments and the empirical results presented in this article suggest that future research exploring the relationship between welfare policy and public opinion from a country‐comparative perspective is well advised to place greater focus on the market institutions that, to varying extents in different countries, act as complements to the state in the administration of social welfare.     

Welfare regime change – or lack of change – in unemployment compensation

Drawing on theoretical accounts of institutional change, this study explored the politics of welfare regime transformation in regard to Turkey's unemployment compensation system. By using the institutionalist approach, the study shows that the process of welfare regime change was one of “institutional layering” of unemployment insurance (UI) over severance pay. Also, the study demonstrates that the economic bureaucracy played a key role in pushing the establishment of UI (state‐centric approach) in contrast to the class‐based organizations that focused their struggles on the severance pay scheme (power‐resource perspective). However, the economic bureaucracy preferred a rudimentary UI design, which prevented UI from undermining the vested interests behind the severance pay scheme. Furthermore, subsequent attempts at the reformation of the severance pay scheme were not successful because the social welfare bureaucracy lacked the capacity to develop a policy alternative to resolve the stalemate between the societal actors. Lastly, the study used the successful severance pay reform experiences of South Korea and Austria to locate the Turkish case within a broader comparative framework.     

Comparing Formal Unemployment Compensation Systems in 15 OECD Countries

This study contributes to the welfare regime literature by analyzing unemployment compensation programmes – unemployment insurance (UI)/assistance (UA) programmes and redundancy pay schemes – of welfare state/occupational welfare regimes. It covers 15 countries of the Organisation for Economic Co‐operation and Development (OECD) selected from Southern European, Liberal, Continental‐corporatist and Social Democratic country clusters. In contrast to the common argument that Southern European countries have underdeveloped formal unemployment compensation systems, this study argues that they (especially in Spain, Portugal, and to some extent Italy) are comparable in strength to those in Continental‐corporatist countries if occupational welfare programmes – notably redundancy pay – are considered alongside welfare state programmes for unemployment protection. The study also outlines the characteristics of redundancy pay schemes in the four country clusters and shows how different redundancy pay schemes are linked to UI/UA schemes in these clusters.     

Long-term Care Policies in Italy, Austria and France: Variations in Cash-for-Care Schemes

Cash benefit provisions have been at the core of many recent reforms in the long-term care sector in Europe. The respective schemes, however, vary widely in terms of the definition of entitlements, the level of benefits, and the ways in which benefits can be used by recipients. This article investigates cash-for-care schemes in three European social insurance countries. It asks whether the diversity of these schemes indicates different paths or just differences in the pace with which the respective policies address the risk of dependency. A characterization of the three schemes and a discussion of the implications for care work arrangements lead to the conclusion that the context and timing of long-term care reform processes are in fact quite variegated. All three countries have histories of cash schemes and of applying the cash approach to support – and to some extent relieve – traditionally strong family obligations. Differences predominate in terms of linking cash to employment, although some convergence is apparent in the effects on qualifications, working conditions and wages in care work.     

Multi‐pillared social insurance systems: The post‐reform picture in Chile,Uruguay and Brazil

This article focuses on an analysis of social insurance models and reforms in Chile, Uruguay and Brazil. Noting that these three countries are following different reform trajectories, the article explores trends in the restructuring of each of these insurance systems across the course of successive reforms. In the systems, different trends are supporting a closer link between contributions and benefits, according growing importance to private individual accounts and favouring the expansion of the role played by social assistance. These trends all suggest a move towards various forms of multi‐pillared social insurance, but with uncertain results in terms of redistribution and the dynamics of the fundamental objectives of social insurance.     

Mandatory occupational welfare: Severance pay as an unemployment compensation instrument

This study focuses on the conceptual and empirical development of severance pay (SP)/redundancy pay schemes established through centralized collective agreements (in Nordic countries) and legislation for unemployment compensation. It argues that these “mandatory” occupational welfare benefits have been neglected in social policy debates due to the ambiguity in their conceptualization, overemphasis on their cost implications, and the nonrecognition of their redistributive effects. The study offers quantitative indicators to analyse SPsapos; redistributive structure (coverage, generosity, and benefit equality) during the Global Recession in Canada, the United Kingdom, Australia, Ireland, France, Germany, Austria, Spain, Portugal, Denmark, and Sweden. The findings demonstrate that SP schemes possess distinctive elements in Southern European, Continental European, Anglo-Saxon, and Nordic clusters. The indicators are also used to analyse the interplay between these schemes and unemployment insurance/assistance in these clusters.     

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.     

Pension reforms in Chile and social security principles, 1981–2015

Chile pioneered in Latin America not only the introduction of social security pensions, but the structural reform that privatized them and a process of “re‐reform” implementing key improvements. A Presidential Commission in Chile, appointed in 2014 to evaluate reform progress and remaining problems in the pension system, released its report in September 2015. In light of the Commission's findings, the article assesses Chile's compliance with International Labour Organization social security guiding principles: social dialogue, universal coverage, equal treatment, social solidarity, gender equity, adequacy of benefits, efficiency and affordable administrative cost, social participation in management, state role and supervision, and financial sustainability. The exercise follows three stages: the structural reform (1981–2008), the re‐reform (2008–2015), and the Presidential Commission proposals (2015)     

Complexities in Assessing Unemployment Benefits and Policies

Employed workers cannot access unemployment insurance as a matter of choice. Benefit periods and benefit amounts vary between groups in the population. Unemployment benefit recipients have not only rights to benefits but also obligations to meet in order to maintain eligibility. The existence of functional equivalent benefit schemes contributes to benefit transition and substitution. All these aspects are of crucial importance both for the economic well-being of families with unemployed members and for policymaking. This article illustrates some of these complex institutional aspects through an analysis of benefits for unemployment in a number of northern European countries in 1996 and by reference to recent Danish experiences.     

Downscaling,Upgrading or Linking? Ways to Realize Micro‐Insurance

Micro‐insurance is seen by many as a promising tool to improve the social protection of low‐income earners. This assumption is supported by the positive experience of existing micro‐insurance schemes. At the same time, however, many schemes have failed to organize sustainable insurance arrangements that are affordable for the poor and near‐poor. The question is thus which institutions are best able to arrange for micro‐insurance. Formal institutions such as public agencies or commercial companies are usually too distant in social and spatial terms from the target group of micro‐insurance and face severe difficulties in downscaling. Informal institutions, however, such as self‐help groups or grassroots NGOs, usually lack the know‐how, experience and capacities to design and manage insurance arrangements. They need powerful partners to upgrade. An alternative would be that formal and informal institutions cooperate in providing micro‐insurance. This article argues that such a linking approach is superior to both the downscaling and upgrading approach.     

Changes in work and social protection: France, Germany and Europe

This article adopts a dual approach to the examination of unemployment insurance reforms in France and Germany. On one hand it looks back at the historical link between waged work and social protection which is characteristic of both systems; on the other hand it considers the impact of the European Employment Strategy on national reforms. The historical retrospective reveals the eminently political nature of social protection and its intimate relationship with a vision of society based on a nation of wage‐earners. That vision is now being called into question but the kind of alternative political project needed to breathe life into the idea of Social Europe has yet to emerge.     

Design limitations of long-term care insurance schemes: A comparative study of the situation in Spain

Social and demographic changes are gradually transforming the way Western societies cope with old‐age dependency, in particular the provision of long‐term care (LTC). In response to the need for formal care services and financing instruments, this study examines a range of both private and public insurance tools. As a general rule, LTC insurance is markedly underdeveloped. Furthermore, in southern European countries, the role of the public sector in LTC is unclear compared with its role in other, related welfare areas such as healthcare. The study examines the financing alternatives for LTC insurance, taking as its benchmark the Spanish LTC financing reform. It briefly examines some existing, publicly funded LTC financing tools and explores the potential role of private LTC insurance, arguing that it has an active part to play alongside compulsory mainstream insurance schemes and self‐insurance alternatives. As in other European countries, Spanish social attitudes show a preference for some kind of general entitlement to publicly funded schemes, although this preference is subject to significant regional heterogeneity.     

Economic openness and welfare state attitudes: A multilevel study across 67 countries

This article extends previous studies investigating economic globalisation and the welfare state by examining individual attitudes, ranging from a preference for individual responsibility (economic individualism) to public demand for government intervention (social equality), across a large number of countries. It formulates different hypotheses about the direct and moderating effects of economic openness on these attitudes. The multilevel analysis, investigating data from 99,663 citizens of 67 countries, leads to the following two conclusions. First, economic openness is associated with a stronger preference for economic individualism and less demand for government intervention. Second, groups benefiting from globalisation and right‐wing voters have a stronger preference for economic individualism if the economic openness of their country is higher. Key Practitioner Message: ● The results show that some vulnerable groups demand more social protection in economically more open countries.     

Recent developments in China's social security reforms

China is one of the few developing countries which have managed to establish a comprehensive social security system encompassing social insurance (for pension, medical care, unemployment, employment injury and maternity), social assistance and a housing provident fund. The past two decades have witnessed a continuous process of reform in the Chinese social security system. This article highlights the latest developments in each of the schemes and offers some insights into the problems confronting the system and the prospects for the reform.     

Left to Market and Family – Again? Ideas and the Development of the Rural Pension Policy in China

The rural pension policy in China is characterized by a high degree of instability. In the past 15 years since the introduction of pilot schemes in some regions, the state has been unable to establish a stable institutional framework for rural old‐age security. This article seeks to integrate the theoretical insights from a growing body of international literature on the role of ideas in social policy reform in order to shed new light on the study of Chinese rural pension policy. I argue that the rise of the rural pension scheme and its eventual failure to make consistent progress towards a comprehensive system is directly related to conflicting ideas among bureaucrats with respect to what sort of welfare provision the rural elderly actually need. The fluctuations in this policy realm vividly illustrate the predominance of the policy idea that peasants could still rely on their land and family, supplemented by private commercial insurance, in their old age. Given this alleged self‐reliance on the part of rural residents, the state is very reluctant to set up a comprehensive rural pension scheme. As a result, the old‐age security of the peasants in rural China is standing on very thin ice, and the prospect for more active state involvement in the near future remains dim.     

Linking macro‐level mechanisms to street‐level accountability practices. A cross‐national case study of street‐level accountability of social workers in government funded homeless shelters

Available studies on the accountability relation between social work and the government are mainly conducted in Anglo‐Saxion countries. This limits the generalizability of these findings to other countries. Moreover, these studies hardly descent to the street‐level, making the perceptions and actions of social workers barely visible. To address this gap, this article explores how three elements of governance interact with street‐level accountability of social workers in homeless care in three country cases (the Netherlands, Belgium and Germany). The data (N26) was gathered by means of a mixed method design (interviews, focus groups and document analysis). By combining a street‐level bureaucracy research approach with a relational definition of accountability, we opened up the black box of what happens in these organizations and bridged the gap between macro‐level mechanisms and street‐level accountability. Our study adds three important insights to street‐level research of accountability in social work. First, elements of governance cannot be studied in isolation. Mechanisms should always be explained in relation to the context in which they are embedded. Second, the social workers in our cases do not perceive their accountability to the government as a professional obligation. They see it as a strategic mechanism to secure funding. Third, interaction is an important condition for the engagement of the social workers in their accountability relation with the government. More research is needed to develop a multi‐level theory that identifies which mechanisms play a role in the accountability relation between the government and social workers.     

Regulation of Personal Social Services – The Israeli Experience

The current article explores the aspects of regulatory policy in the field of personal social services. In Israel, the government sets standards, and finances and oversees personal social services, while the services themselves are provided primarily by non‐governmental organizations. Based on a qualitative study we examined two questions. First, what characterizes the implementation of regulatory mechanisms in the field of personal social services in Israel? Second, how can we explain the outcomes of regulation in the personal social services in Israel? In a unique approach, we used the institutional analysis and development (IAD) framework to explore the regulatory practices implemented in community residences and hostels for people with intellectual disabilities and in after school programmes. The findings revealed that although there were implementation gaps in both cases, the IAD might improve our understanding of the nature and magnitude of these gaps. Furthermore, the insights gained may have implications for policymakers in their development of regulatory policy.