Mark Time: India's March to Universal Health Care Coverage

This article evaluates the efforts underway in India to achieve universal health care coverage and the conditions that fostered its contemporary evolution. It finds that India’s health system is characterized by private provision and financing, horizontal and vertical fragmentation, and weak governance arrangements. The article argues that these defining characteristics, which have solidified over time, account for poor health outcomes and make the system impervious to reforms as they deny the government levers to intervene and shape outcomes in the sector. While the government's recent efforts of increased public funding of national programmes have helped to reduce out of pocket spending, these are unlikely to work in the long run unless the government addresses the sources of the problems. The article argues that building health care governance, strengthening regulatory architecture, and stewardship over the system, in conjunction with increased public spending, are essential if the health care system is to provide affordable care to the entire population.     

Obamacare and the Politics of Universal Health Insurance Coverage in the United States

In the USA, universal coverage has long been a key objective of liberal reformers. Yet, despite the enactment of the Patient Protection and Affordable Care Act (PPACA) (commonly known as ‘Obamacare’) in 2010, the USA is not set to provide health care coverage to all, even if and when that reform is fully implemented. This article explores this issue by asking the following question: Why was a clear commitment to universal coverage, the norm in other industrialized countries, excluded as a core objective of the PPACA and how has post‐enactment politics at both the federal and the state level further shaped coverage issues? The analysis traces the issue of universal coverage prior to the debate over the PPACA, during the 2008 presidential race, and during consideration of the bill. The article then looks at the post‐enactment politics of coverage, with a particular focus on how states have responded to the planned use of the Medicaid programme to expand access to care. The article concludes by discussing how an explanation of the limits of the PPACA, in terms of both its commitment to universal coverage and, more importantly, the failure to provide comprehensive health insurance to all, requires an understanding of complex institutional and policy dynamics.     

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.     

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.     

历史个体与普遍历史:历史主义脉络中的社会变迁

发端于18世纪的德国历史主义思想脉络中,包含着一种从历史个体到历史个体的普遍历史解释模式。这种独特的社会变迁思想是在同启蒙思想的对话中确立起来的。起先包裹在天意历史论的目的论外衣中,后来历史主义的发展逐步脱去了这层外衣,在解释社会学传统中演变成了一种经验科学意义上的独特社会变迁思想。随着社会理论对韦伯的去历史化,蕴含在解释社会学中的这种社会变迁思想逐渐被淹没了。有鉴于此,本文将在赫尔德以来的历史主义脉络节点中梳理这种社会变迁思想的形成。     

Social Policy in a Cold Climate: Health and Social Welfare in Russia

The Russian Federation faces multiple challenges for its health and welfare systems and for the development of social policy responses. This article provides a review of some of the key challenges for social policy in Russia and assesses the adequacy of the responses to date. The author surveys recent developments in health and social welfare and makes recommendations on priorities for Russia's policy‐makers and international funders. A range of public health challenges including drug and alcohol misuse, health in prisons and mental health is discussed; HIV/AIDS is singled out for particular attention. While Russia is increasingly attracting the attention of social scientists in the West, there is uncertainty about models and concepts suitable for the analysis of this complex society. Although empirical trends are largely discussed in this article, it is argued that theoretical development is required and some suggestions are made about concepts of the ‘middle range’ to assist in future analyses. Intermediate theories, such as those relating to the management of personal welfare, and development of resilience in a formerly collectivized context, are identified as having explanatory potential for this task.     

呼吁·反思·监督—论社会工作者之于山西煤炭政策

山西煤炭工业在拉动经济快速增长的同时，带来了严重的环境污染，包括大气污染、土壤污染和水污染。防治煤炭污染，必须依靠煤炭政策。社会工作在影响山西煤炭政策方面应扮演呼吁者、反思者和监督者的角色。而要有效扮演这三种角色。必须具备一定的主观要件与客观要件。     

Household assets and health in China: evidence and policy implications

China's health care reform of the 1990s has not yielded much success. The market‐oriented health system has resulted in declines in fairness of health services and efficiency of investment in the health sector. Further health care reform will be required. Among many options, asset‐based policy has demonstrated some potential in domestic policy development. To provide evidence to inform health policy development in China, this study focuses on the effects of household assets on health in China. Specifically, the current study examines how household assets may affect health status and how assets differ from income in predicting health status. Using a random sample of Chinese elderly, we find that asset holding in the form of household durables and household utilities has both direct and indirect effects on health status. Household assets directly affect access to medical care and indirectly affect health by influencing health behaviour and psychological condition. In other words, in addition to economic effects, household assets appear to have behavioural and psychological effects on health. Interestingly, these effects appear to be associated with assets, but not with income. Implications for asset building policy are suggested as a complement to existing health care models.

中国自20世纪90年代开始的卫生保健改革还没有取得很大成功。市场主导的医疗系统使卫生部门提供的健康服务无论在公平性和效率都有所下降。进一步的医疗保健改革是需要的。在众多的选择当中,以资产为基础的政策已显示出一定的潜力。为向中国的卫生政策发展提供证据,这项研究的重点是家庭资产在中国对健康的影响。具体来说,目前的研究探讨家庭资产如何影响健康状况,以及资产如何不同于收入来预测健康状况。作者用随机抽样的方法研究中国的老年人,发现家庭耐用消费品和家庭水电费都直接和间接影响健康状况。家庭资产直接影响到能否获得医疗照顾和间接影响有关影响健康的行为和心理状态。换言之,除了经济影响,家庭资产似乎对行为和心理健康有所影响。有趣的是,这些影响似乎是与资产相关,而并非收入。作者建议以资产建设政策补充现有的医疗保健模式。     

Social Insurance and Older Adults in China: Effect of Education and Household Income on Coverage Following the 2009 Health Reform

Abstract

Education and income have been considered two primary determinants to affect individuals’ health outcomes. China initiated a comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothesized that older adults’ years of education and income are determinants of participation in each social insurance scheme following the 2009 health reform. Multilevel logistic regression models were used with a nationally representative sample (n?=?5,274) to investigate the education and income disparities in each social insurance scheme for older adults, with random effects among provinces at the national level. The analyses show that years of education was not associated with enrollment in three social insurances, with the exception of the association between 11?years of formal education or above and the rural coverage. Participants with higher levels of household income had greater odds of having urban social insurances, but had lower odds of having the rural scheme. Further research should continue to investigate the disparities of enrollment of each social insurance. Chinese policy makers should consider these social factors carefully to reach a true universal coverage.     

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.     

Extending pension coverage in Cambodia: The governance and investment challenges of the Social Security Investment Fund

Rapid economic growth, declining fertility and changes in family structures have encouraged the Kingdom of Cambodia to reform its old-age pension system. The Government of Cambodia reached an important milestone in 2019, when the Law on Social Security was promulgated. The Law includes provisions for a compulsory defined benefit pension scheme, establishing a sound framework for extending compulsory pension coverage beyond the public sector to formal private-sector workers. As a future step, the compulsory pension scheme should be extended to informal workers. To accompany the reform, the investment policy for the pension scheme’s reserve funds, including the supervisory regime and investment strategy, will be essential for the modernization of the Cambodian social security system. In this regard, Cambodia has successfully sought policy advice. However, the country should continue to seek further advice, and to act on this. Otherwise, the necessary and increasingly pressing policy ambitions of Cambodia to develop an adequate and sustainable social protection system may not be fully realized.     

Health care in post-crisis South Europe: Inequalities in access and reform trajectories

The European debt crisis stimulated debate about the future of national health systems. The objective of this article is to contribute to this debate by examining any changes in the scope and content of universal coverage and underlying pattern of solidarity in South Europe. Access to health care provides the vantage point for our analysis. Inequalities in access are scrutinized along a number of dimensions by using data from various sources. Our main conclusions clearly show that the public health care systems in Italy and, particularly, in Spain weathered the crisis pretty well and retained their universalistic features. Nonetheless, rising supplemental private coverage (of an “occupational-mutualist” type) adversely impacts access, but it is unclear how this will unfold in the near future. Tackling fragmentation through expansion and equalization of coverage, though for a comparatively “lean” basket of provisions, has been the focus of reforms in Portugal and Greece. This keeps private spending high and sustains inequalities, whereas any prospects for a stronger variant of universalism remain an open question.     

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.     

Challenges in Multidisciplinary Systematic Reviewing: A Study on Social Exclusion and Mental Health Policy

In the clinical sciences, systematic reviews have proved useful in the aggregation of diverse sources of evidence. They identify, characterize and summate evidence, but these methodologies have not always proved suitable for the social sciences. We discuss some of the practical problems faced by researchers undertaking reviews of complex and cross‐disciplinary topics, using the example of mental health and social exclusion. The barriers to carrying out social science and cross‐disciplinary reviews are reported and some proposals for overcoming these barriers are made, not all of them tried and tested, and some of them controversial. Using a mapping approach, a wide‐ranging search of both clinical and social science databases was undertaken and a large volume of references was identified and characterized. Population sampling techniques were used to manage these references. The challenges encountered include: inconsistent definitions of social phenomena, differing use of key concepts across research fields and practical problems relating to database compatibility and computer processing power. The challenges and opportunities for social scientists or multidisciplinary research teams carrying out reviews are discussed. Literature mapping and systematic reviews are useful tools but methods need to be tailored to optimize their usefulness in the social sciences.     

经济危机时期英国的移民报道及其对中国的启示——从广州媒体报道非洲黑人说起

2009年7月15日广州黑人冲击派出所,以及随后网上对《东方天使》的参赛者“黑女孩”娄婧的一些讨论,使得黑人群体受到全国媒体乃至世界媒体的关注,境外媒体称“中国首次爆发了有关种族歧视的不同寻常的公开讨论”,“中国人对黑人抱有天真的种族主义”。与此同时,移民大国——英国国内关于移民的讨论也达到了白热化的程度,移民报道在文化与政治领域的重要性得到了前所未有的关注。通过分析经济危机时期英国媒体的移民报道策略、成因和危害,并与中国媒体的黑人报道做简单比较,以期为正在走向世界的中国传媒以启示。     

Children Starting to be Looked After by Local Authorities in England: An Analysis of Inter-authority Variation and Case-centred Decision Making

This paper presents findings from a study of children lookedafter by 24 local authorities in England. The study combinedanalysis of key statistical data with a questionnaire surveycompleted by the social workers for a sub-sample of the children.This paper focuses on children who started a period of beinglooked after in the participating authorities during the 6 monthsfrom October 2000 to March 2001. The study found considerablevariation between the authorities in their rates of childrenstarting to be looked after, and the paper explores reasonsfor these differences. It also highlights the variety of legalroutes and placement options used for children entering thelooked after system, and proposes a matrix that summarizes thevarious combinations that the authorities were found to be using.The matrix can assist social workers and their managers in identifyingthe most appropriate option for individual children.     

Correcting misconceptions about the development of social work in China: a response to Hutchings and Taylor

Hutchings and Taylor, in their article entitled ‘Defining the profession? Exploring an international definition of social work in the China context’[International Journal of Social Welfare 16: 381–389], no doubt had good intentions in offering their account of the development of social work in China, as the opening and concluding sections of the article show. Within the text, however, their critique of contemporary social work in China is, in my opinion, unfair in relation to, among other things, (i) the undemocratic nature of the Chinese political system, which they say hinders the development of social work in China; (ii) the ideology of the Communist Party, the government, and traditional Chinese culture, which they say are at odds with Western social work's value system and methodology; thus concluding that (iii) it is doubtful whether social work development in China could integrate with that of the international community. In this response, I comment on (i) the information base of the authors; (ii) the disconnection between their conceptualisation and historical facts; and (iii) their use of the international definition of social work.     

New Directions in child protection and family support in Western Australia: a policy initiative to re-focus child welfare practice

There is now considerable evidence from numerous countries that statutory child welfare agencies are being overwhelmed by a massive increase in child protection referrals which require investigation, while there has been a growing failure to develop preventive family support services. This paper describes the changes introduced in Western Australia to address this situation in what has come to be called New Directions in Child Protection and Family Support . The results demonstrate that the changes have led to a significant restructuring of the way the Department of Family and Children's Services there responds to concerns expressed about children. It is argued that this has had an impact on the proportion of child maltreatment cases which are substantiated and the way responses are prioritized and allocated, and has provided the Department with a more explicit and clearer focus for its work in a period of increasing demand and rapid change.     

Equipping child protection practitioners to intervene to protect children from cumulative harm: legislation and policy in Victoria,Australia

Many children are repeatedly reported to statutory child protection services, but do not receive the protection they need. Many such children are suffering chronic maltreatment, which is likely to result in cumulative harm. Chronic maltreatment encompasses emotional abuse and chronic neglect. As a result, children can experience a range of cognitive, emotional, and behavioural problems that are more serious than those associated with other abuse types. This paper focuses on the Victorian statutory child protection system, and considers why cumulative harm is not receiving the attention the legislation intends. Under the Victorian legislation cumulative harm must be proven on grounds of emotional abuse and/or neglect. However, it is difficult for child protection practitioners to place before the court the necessary evidence to establish these grounds. The paper concludes that the legal definitions of emotional abuse and neglect should not require evidence of a link between the abusive actions of the parent and the poor outcomes for the child. The evidentiary focus should be on the actions of the parent. Furthermore, legislation should focus on abusive parental behaviours that are likely to result in cumulative harm, which are more concrete and measureable than emotional abuse and neglect, such as intimate partner violence and parental illicit drug use.     

Changes in marital status and links to self-rated health: A study of temporal relationships

This study examines whether self-rated health (SRH) changes predict marital status changes or vice versa, and tests whether changes in trust mediate the relationship between marital transition and SRH change. A logistic regression model and a mediation analysis method are used separately to analyze the longitudinal data on 2,042 respondents from the Panel Study of Family Dynamics (PSFD) in Taiwan. The survey achieves response rates above 70%. The findings show that none of health status at either time point predict the three types of marital transitions including never married to married, married to divorced/separated, and married to widowed. Bonding trust plays a more important role than generalized trust in mediating the adverse effect of remaining widowed status on health change within a context of Confucian culture. Those who maintain a widowed state have a lower likelihood of sustaining high levels of bonding trust, which in turn leads to poor SRH. Hence, the findings provide more support for a social causation hypothesis rather than a health selection hypothesis.