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.     

Family policy,economic development and infant mortality: a longitudinal comparative analysis

Ferrarini T, Norström T. Family policy, economic development and infant mortality: a longitudinal comparative analysis Int J Soc Welfare 2010: ??: ??–??© 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. In the present study, the impact of family policy legislation and economic development on infant mortality was estimated. Time series analyses indicate that economic growth decreased infant mortality in the earlier part of the 20th century, while the postwar period showed a zero or even a reversed correlation between economic development and child health. The results from fixed effects modelling of data for 18 welfare democracies for the period 1970–2000 are in line with the hypothesis that the more generous the earnings‐related parental leave benefits, the lower the infant mortality.     

Varieties of liberalism: A comparative analysis of family policy and poverty outcomes across the 50 United States

The United States is generally recognised as an exemplar of liberal policy regime types. However, given evidence of state-level divergence in social policy, this article investigates to what extent such variation is present and relevant in state-level family policy. To this end, we pose a primary and secondary research question. Our primary question is whether varieties of liberalism exist across the 50 states in the United States. Our secondary question is whether these varieties of liberalism correspond to variety in social indicators of families' economic well-being. To answer our primary question, we first construct a family policy index that scores the relative generosity and coverage of state-administered social programmes that contribute to the (de)commodification and (de)familialisation of households with children. We then perform a cluster analysis to group states by shared decommodifying and defamilialising features. To answer our secondary question, we investigate how our family-policy clusters are associated with social indicators of families' financial security. Our findings suggest that varieties of liberalism do, indeed, exist within the United States. With the exception of Vermont, which stands out with respect to its comparatively generous family policies, we classify states into two groups: those with ‘soft’ liberal family policy in states featuring relatively generous and accessible policies and ‘hard’ liberal family policy in states achieving little of either. We find that these differences help explain state-level heterogeneity in levels of economic security among households with children, particularly single-mother households.     

Extending social security in developing countries: a review of three main strategies

The article discusses strategies to extend social security cover-age in developing and newly industrialised countries. The three major options are to extend social insurance coverage , to rely on mutuals or micro-insurance or to bring in social assistance in one form or another. Social insurance usually covers small population segments. Insiders are seldom willing to extend coverage to poorer groups, as poorer groups are usually higher-risk groups. Micro-insurance and mutual societies work pri-marily among people with similar risk profiles. Discretionary social assistance targets poorer groups, but is open to patronage and misuse. However, some social assistance designs are less open to misuse than others. Demogrants, i.e. benefits given to people in vulnerable social categories, are easy to administer and difficult to misuse. Whether or not a developing country provides such benefits can be considered an indicator of the willingness of the ruling elite to alleviate hardship among 'unproductive' population groups.     

How social networks affect policy implementation: An analysis of street-level bureaucrats' performance regarding a health policy

Policy implementation is an interactive process between citizens and street-level bureaucrats. Although the literature has already addressed different factors that influence discretion, there is still a gap in understanding if and how bureaucrats' relational profiles affect policy implementation. This article analyses bureaucrats' interactions and the relational environments in which they exercise their discretion. The hypothesis is that bureaucrats' different relational profiles specify policy implementation at the street level. We study bureaucrats in a Brazilian health care programme involving community workers that requires regular visits to beneficiary families' homes. The research departs from ethnography and network analyses with workers from three very different contexts. We analyse bureaucrats' practices, the discursive styles mobilized in their interactions, and their personal networks. The results show that organizational factors are central to explain variations in practices, and their relational profiles highly influence the discursive styles used by bureaucrats in their interactions with citizens. The article concludes that relational elements can affect the exercise of discretion and influence interactions at the street level and should be incorporated more systematically in the implementation literature.     

Welfare policies for older people in transition? Emerging trends and comparative perspectives

The article examines how the three Scandinavian countries are responding to the seemingly growing gap between demands and resources. Various strategies and approaches are identified and evaluated, and their relevance and potential are discussed in a comparative context across time and between countries. What about the recent changes in the Scandinavian welfare policies on aging? Do they merely represent minor adaptations in order to protect and sustain “the Scandinavian model”, or are they early signs of major changes in progress?     

Family policy and women's employment outcomes in 45 high-income countries: A systematic qualitative review of 238 comparative and national studies

The article reviews the available quantitative evidence on the relationship between explicit family policy and women's employment outcomes in 45 high-income countries between 1980 and 2016. At the methodological level, we gathered 238 papers through a four-stage systematic qualitative review. We included articles published in English in international journals or by leading research institutes. Despite the accrued importance of the field, comparative works and national case studies do not sufficiently engage one another for methodological and disciplinary reasons. Our contribution is to integrate the findings from both streams of the literature in two ways. First, we chart systematically the debate describing its evolution over four decades, the disciplines involved (demography, economics, politics, social policy, sociology, and interdisciplinary work), and the geographical and policy breadth of the empirical contributions. Second, we provide a rich guide for scholars in the field by exploring how national case studies fit (or not) the broad trends captured in comparative research and discussing key and controversial debates in the field. In conclusion, we point out also important gaps in the literature and propose new avenues for future research. An exhaustive set of tables provides information on each comparative and national case study and on the databases and variables employed in the literature.     

A framework for comparing social protection in developing and developed countries: The example of child benefits

Abstract   The article outlines a conceptual and theoretical framework for improved comparative analysis of publicly provided social protection in developing countries, drawing on the research tradition of the study of longstanding welfare democracies. An important element of the proposed institutional approach is the establishment of comparable qualitative and quantitative indicators for social protection. The empirical example of child benefits indicates that differences between developed and developing countries should not be exaggerated, and that the prevalence of child benefits in sub-Saharan African and Latin American countries today resembles the inter-war period (1919-1938) situation in developed regions.     

Family leave policy and child mortality: Evidence from 19 OECD countries from 1969 to 2010

This study examined the effects of family leave policy on five age‐specific child mortality rates across 19 Organization for Economic Co‐operation and Development countries from 1969 to 2010. I used the dataset developed by Ruhm and Tanaka and extended it with data from various institutions, including the Max Planck Institute for Demographic Research. I controlled for six relevant variables including GDP per capita and health expenditures, three child health indicators, as well as three social expenditure measures for families. I included in all models country and year fixed effects as well as country‐time trend interactions. Throughout all model specifications, the results indicated that job‐protected paid leave significantly reduces infant mortality (death at less than 1 year of age) and postneonatal mortality (death between 1 month and 1 year of age). Other leave (unpaid or nonjob protected) had no significant effects on any of the outcome indicators.     

The Swiss social insurance system: Social security and grass‐roots democracy

The foundations of Switzerland's social insurance system can be traced to 1890 when a public referendum voted the inclusion of an article into the Federal Constitution that gave the executive the task of creating a sickness and accident insurance scheme. Currently, as in other European countries, the Swiss social insurance system is facing challenges as a result of rising health costs and demographic shifts, which are placing a growing burden on both public finances and private households. To reach policy decisions to address these challenges, the Swiss system is distinguishable from those of its European neighbours because of a continuing tradition of political decision‐making based on grass‐roots democracy: through referenda, the Swiss people remain directly responsible for the development of the national social insurance system. Importantly, not only might this unique feature of Swiss democracy lead the Swiss people more readily to accept and identify with their social insurance system but it may offer a sound democratic base upon which to build a consensual approach to address the policy challenges that lie ahead.     

Social policy and poverty in post-totalitarian Europe

This article attempts to compare the social policy models of the west with social policies in post-totalitarian central and eastern Europe. It is argued that historical roots as well as recent developments make post-Communist social policy similar to the two major models in the west: the institutional redistributive model and the industrial achievement or performance model. The present problems of mass unemployment and growing poverty cannot be solved without a major reform of social policy, including state intervention and control. The residual social safety net and a strong market orientation are unlikely to be able to reduce poverty and unemployment. However, it is also argued that the strong role of the state and organized labour in both of these European welfare systems creates an obstacle to the future of social policy in the countries of central and eastern Europe. The state is viewed with great scepticism and organized mass social movements are weak in most of these countries. It will take time to develop such agents that can support the development of state social policy, and it may not even be accepted that the route of interventionist state welfare characteristic of western Europe is desirable.     

Extending health care coverage: Potential linkages between statutory social security and community-based social protection

Abstract   The extension of social health protection in developing countries is widely recognized as a priority. Various financing and institutional methods can be used in pursuing this objective, but none of them can achieve universal coverage in the short term. Based on an analysis of the respective strengths and weaknesses of social health insurance and community-based health care schemes, this article demonstrates the high potential of coverage extension strategies that use a pluralistic institutional approach to establish linkages and exploit complementarities optimally. A typology of potential linkages among different methods is presented and their value added illustrated using country examples.     

Welfare state regimes and family policy: a longitudinal analysis

The primary aim of the article is to access the extent to which welfare state regimes support distinct family policies across OECD (Organisation for Economic Co‐operation and Development) countries and over time. Focusing in particular on the work of Esping‐Andersen we address the following questions: (i) What is the relation between de‐commodification and de‐familialisation? (ii) Are there distinct welfare state regimes that support different levels of family policy? (iii) To what extent have levels of support for family policy differed over the last decades toward divergence or convergence among OECD welfare states? Using data from the OECD Social Expenditure database (1980–2001), we find that the degree of de‐familialisation through welfare state regimes parallels the de‐commodification scores. However, the findings indicate a degree of instability in the relationship between levels of support for family policy and welfare state regimes over the last decades. We conclude by discussing how the findings speak to the changing character of welfare regimes and the implications of a longitudinal perspective.     

The economic consequences of divorce in six OECD countries

This article uses longitudinal data to estimate the short‐ and medium‐term economic effects of divorce in the USA, the UK, Switzerland, Korea, Germany and Australia during the first decade of the 21st century. Based on the data collected during the 2000s, in all of the countries studied, divorce had, on average, negative effects on the equivalised household incomes of women. However, the extent and duration of the negative effects of divorce differed markedly between countries. In all of the countries, the effects of divorce on the equivalised household income of men were smaller than for women. Although, using the available data, it is not possible to definitely explain the differences between countries, the analysis presented in this article has demonstrated that the average economic effects of divorce, particularly for women, are heavily influenced by the social security system, the labour market, family models and the family law system of each country. While the social security system and institutional arrangements such as child support and spousal maintenance do influence women's post‐divorce economic outcomes, what is most important in explaining cross‐country differences is women's labour market earnings and the extent to which re‐partnering occurs.     

Social Policy in Harsh Times. Social Security Development in Denmark, Finland, Norway and Sweden during the 1980s and 1990s

For the past two decades, Nordic social policy has been subject to a range of serious challenges, among which economic problems and critiques by neo-classical economists have been most prominent. This article raises the question whether Nordic social policy has significantly changed during this period of challenges. Based on an empirical analysis of social expenditure data and three central social security programs, this article provides evidence that changes in Nordic social policy over this period have, in fact, been relatively minor. Indeed, the four welfare states of Denmark, Finland, Norway and Sweden have shown remarkable resilience considering the harsh challenges that they have been exposed to since the early 1980s.     

Social pensions and policy learning: The case of southern Africa

In the last decade and particularly since the publication of the Millennium Development Goals, social pensions have captured the interest of those concerned with the well-being of older people across that large part of the world where formal, contributions-financed, old-age benefit systems cover only a minority of the population. International organizations have turned their attention to such schemes and some see them as having a valuable role to play. However, information about what they are and how they work, and about their efficacy in meeting the objectives set for them, is still limited. Learning has been taking place not only in the international organizations but also in the region where they are most prominent – southern Africa. Such learning should be encouraged and the International Social Security Association has a part to play in this learning process.     

Globalisation, memory and welfare regimes in transition: towards an anthropology of transnational policy transfers

Processes of transnational policy transfers are of immense importance in understanding new forms of the reproduction of relations and discourses of power, and of memory and forgetfulness, within particular social welfare regimes. Transnational advice and policy transfers appear particularly unsuited to the need to address the complexities of the ways in which welfare subjects interact with welfare regimes which seek to organise their lives, a theme which touches complex issues of culture, identity and resistance, at the interface of local, national, regional and global social relations. Utilising ethnographic material from post–Yugoslav countries, particularly Bosnia–Herzegovina, this article addresses international consultancy, transnational policy advice, and project and programme documents as a specific 'genre' with its own language and power, including the power of silence. The article is based on an explicit erosion of the border between 'research' and 'consultancy'. Theoretically and empirically, a literature on 'global social policy' has paid too little attention to an emerging 'cultural' perspective on welfare which focuses much more on the social relations of welfare; the role of biographies, subjectivities and memories; and the need for forms of reflexivity and attention to the minutiae of everyday life constructed within, and itself constructive of, 'welfare' as a lived experience. Rendering the practice of policy–making as a subject for ethnographic or anthropological research may be the basis for a new action research, and for policy agendas for a democratic welfare, envisioning forms of access, voice, and empowerment, which much current transnational policy advice militates against.     

Social workers' attitudes towards the unemployed in the Nordic countries

Kallio J, Blomberg H, Kroll C. Social workers' attitudes towards the unemployed in the Nordic countries In recent decades, municipal social workers have become the implementers of new types of social policy measures aimed at activating the unemployed. These policies put a greater emphasis on the individual's own responsibility for being unemployed. Little is known, however, about how social workers view the unemployed – one factor that might influence how policies are in fact implemented. Therefore, our purpose was to analyse Nordic social workers' attitudes towards the unemployed and their determinants: Do social workers' attitudes correspond with a more individualistic view on unemployment? We utilised the data from surveys of professional social workers in four Nordic countries. Our analyses showed that individualistic attitudes towards the unemployed appeared to be rather rare among Nordic social workers. However, attitudinal differences were found between and within countries.     

Social enterprise policy design: Constructing social enterprise in the UK and Korea

Taking the elusive definition of social enterprise as its starting point, this study seeks to understand the impact of government policies on the development of social enterprises in the national contexts of the UK and South Korea. The social construction of target populations is utilised as a theoretical framework in order to identify which factors influence government policy. A comparison of the two countries over a 14‐year period from 1997 to 2010 reveals that, despite very different contexts, governments in both countries have taken an instrumental approach to social enterprise. This tendency is more pronounced in Korea however, where government has limited the input of stakeholders and used an approval system to control access to the social enterprise name. The study concludes by recommending a more value‐oriented approach to social enterprise.