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.     

浅议我国社会救助制度的几个现实困境

社会救助是社会保障体系的重要组成部分,它与民生、社会稳定密切相关。转型时期,中国的社会救助的改革取得了很大的成绩,覆盖城乡的社会救助体系已基本建立,但在社会救助政策的实践过程中仍然存在一些问题,这些问题能否解决关系到我国的社会救助制度能否进一步发展、完善,关系到广大人民能否分享我国经济社会的改革发展成果。本文主要从我国社会救助思想的理论基础和思想渊源出发,探讨了我国社会救助实施过程中几个现实问题,并针对这些问题提出了政策建议。     

Redefining Welfare: Australian Social Policy and Practice

The present paper outlines and analyzes Australia's welfare reform policies as they have been implemented over the past decade. While there have been numerous social policy initiatives over this period, welfare reform provides an interesting site for analysis and review. This suite of policies and programs is of particular importance from several standpoints. First, its target groups – those needing income security assistance, including the unemployed, people with disabilities, and single parents – are historically and traditionally of concern to social work and social welfare. Second, welfare reform policies have had significant impact on social welfare agencies, and the social workers and welfare workers employed in them. Finally, welfare reform has had a wider impact on inequality in Australia and our attitudes to those in need. This paper first provides a brief overview of the context of Australian social policy and welfare, its origins and current situation. It then outlines the key operational elements of welfare reform and how it has been implemented. The third section of the paper offers a critical analysis of these policies and programs and finally poses some questions and issues requiring further discussion and research.     

英国医疗卫生体系问题与医疗卫生政策改革研究

健康是人们福利的重要组成部分,因此医疗卫生政策和体系是社会政策的重要领域。该项研究从贫穷、低收入和健康之间的关联中评估人们对医疗保健的需要;指出英国存在全科医生、医院医生及公共卫生医生是医疗卫生服务提供的主体;英国在医疗卫生政策改革方面的内容包括:(1)对英国全民医疗体系(NHS)多渠道的财政支持,(2)提高服务质量的机构管理改革,(3)实施提高服务质量的安全、有效、病人中心、及时、效率、和平的原则;英国存在的强大政治集团及其利益影响着改革;政府需要在减少医疗服务中不平等和提供及时有效的服务方面努力。     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

From Social Insurance to Social Assistance

In attempting to establish a social security system that would function to smooth the transition from a planned to market economy, the government of China has, for most of the time in the past decades, focused its efforts on setting up social insurance programs in the urban areas. Along with the emergence of urban poverty since the mid 1990s, the emphasis of the government has shifted to means-tested social assistance programs as the major means to combat poverty and maintain social stability. However, with the absence of more equitable social and economic policies that can protect people against the many risks associated with a market economy, the role of social assistance is very limited.     

论社会公正及政府对策

维护和实现社会公正是中国社会主义制度的本质要求,也是构建社会主义和谐社会的价值基础。伴随着现代化进程以及市场经济进程,我国在社会公正方面取得了一些进展。但就总体而言,社会公正的具体状况却不容乐观。因此,各级政府必须强化公正政策的公正导向,切实保障公民的基本权利,建立公正的利益表达机制、建构公正的社会矛盾调节机制。     

The New Social Policy in Britain

This paper starts from the proposition that approaches to crime and penal policy in contemporary Britain are of a piece with approaches to social policy across a number of fronts. "The New Social Policy" is examined in terms of "the stakeholder idea", its implications for how people are meant to behave, and the distance between this and socio-economic realities. The paper then explores various sectors of stakeholder social policy in their new order of importance—employment and training, education, health care, social care, housing, social security—before commenting on policies in respect of crime and crime prevention, in the light of the foregoing observations and with particular reference to the "lock-'em-up" tendency. The paper concludes that stakeholdership is no recipe for crime prevention.     

对美欧学者关于邻里效应研究的述评

文章回顾、评论了美欧学者对于邻里效应作用机制和研究方法的归纳、邻里效应研究方法面临的挑战以及具体的经验研究和实践。文章指出,邻里效应有助于减少社会差别、促进社会平等,这在理论和实践上都能得到说明。如果要采取某种混合居住的政策以帮助社会下层并降低住房不平等以及总的社会不平等程度,那么现行住房政策将不得不做出改进。具体说来,可以考虑采取渐进式的改革：配合户籍制度改革,逐步把少数常年在城市打工、表现良好的农民工纳入经济适用房和廉租房等制度的照顾范围以内。同时本文希望抛砖引玉,激发社会学界乃至于社会科学界住房和城市问题研究者更多关注于邻里效应和社会不平等研究。     

Decision time: Cost estimations and policy implications to advance Universal Health Coverage in Cambodia

Cambodia aims to expand social health protection to move toward Universal Health Coverage. We developed a modeling tool to facilitate the simple, interactive estimation of cost and coverage for three policy alternatives, enabling decision-makers to simultaneously adjust for scenario options currently under consideration. Assuming the adoption of all scenario options, the projected cost of expanding social health protection to all is US$42 million, to vulnerable individuals is US$32.1 million, and to uncovered 1st–3rd wealth quintile people is US$30.4 million. These policy alternatives are projected to increase population coverage to 100%, 89.1%, and 92.5% by 2025, respectively. The results have multiple policy implications. First, given the similar costs and coverage estimates for the targeted approaches, and other considerations, expansion to the 1st–3rd wealth quintiles is recommended. Second, the model quantifies the potential impacts for policy changes relating to each scenario option. The inclusion of dependents under the contributory schemes significantly shifts costs; reversing the policy of non-payment for priority public health services increases public health facility revenue; and, alignment of reimbursement rates leverages demand-side financing which can increase value for money. Finally, the cost estimates provide a basis for economic planning. Revenue raising options include increasing the contribution ceiling for the private employees’ scheme and the progressive adoption of strategic purchasing.     

Housing disparities, caregiving, and their impact for older Puerto Ricans

The needs of older persons in historically oppressed racial and ethnic populations remain "invisible" in the public arena (Wallace & Villa, 1999). Understanding the ethnocultural factors that shape their housing needs is essential to effective, equitable policy formation and program planning. This article examines the impact of housing disparities, health status, and cultural patterns of caregiving in relation to older Puerto Ricans on the U.S. mainland. Following a literature review of the socio-economic, living arrangement, and cultural profiles of older Puerto Ricans, policy recommendations to advance adequate housing options for this population are provided. The article concludes with a discussion of Section 202 housing policies and how they can be adapted to the current and emerging population of older Puerto Ricans.     

Advocacy Coalitions and Health Politics in Korea

This article analyses the political dynamics underlying health care reform in Korea after the Asian economic crisis. The reform was a significant volte‐face in respect of the social policy paradigm, which now aims to enhance equity in National Health Insurance. The article pays special attention to the evolution of the advocacy coalition for equity in health policy and how it developed the two attributes required for successful policy change: institutional strength and the elaboration of policy rationale for reform. This process was not a simple linear development but a combination of setbacks and advances. The article also takes into consideration the structural conditions that set the policy environment over the course of the advocacy coalition's evolution since the 1960s. In short, the policy reform of 2000 was not a simple policy change in response to the economic crisis, but rather the outcome of the long‐term evolution of the advocacy coalition for equity in health policy.     

Social Security in Hungary: A Balance Sheet after Twelve Years

The social and political transformation in Hungary contributed to the development of a democratic political system and to the establishment of the rule of law and a market economy. The process was accompanied by a series of economic and social problems. The paper first reviews the social policy orientation of the three free consecutive governments elected since the transition. None of them has had a clear political profile: they have constituted mixed and unclear welfare regimes. None of them has sketched a clear welfare policy except perhaps the current government. In its case central redistribution is consistently biased in favour of the middle and upper strata at the expense of the poor. Instead of a consensual plan defining priorities, decisions and reforms in the last ten years have been motivated by political interests, at hoc ideas, and authoritarian rulings. The paper next shows what reform meant in the case of the different instruments and various fields of social policy, namely unemployment, health, pensions, family benefits and social assistance. It concludes that while both the inherited and the newly created systems had contributed to alleviate the shocks of the transition, yet there never was enough political will to give sufficient or adequate help to those needing it. As a consequence of the "reforms" public expenditures have been significantly reduced. The welfare gap between East and West has thereby grown. The consequence is that the country has become gravely divided, and that poverty is greater and deeper than it might have been under a different set of policies.     

Equity and ‘No Fee’ Schools in South Africa: Challenges and Prospects

Despite almost 20 years of democratic governance in South Africa, there is growing evidence that equitable access to quality education remains elusive for the majority of its children. In 2007, the Department of Education declared 40 per cent of schools in the country to be ‘no fee’ schools and, by 2011, 60 per cent of all schools had been designated as such. This article examines the introduction and the effects to date of the no fee schools policy, and assesses the progress of South Africa's undoubtedly pro‐poor education policies towards promoting equality in education and, above all, achieving equity of access to resource allocation. It discusses the main challenges and issues relating to the implementation of the no fee policy at provincial and school levels while also considering the efficacy of existing equitable funding instruments, and concludes with suggestions for how more effective and equitable access to quality education can be realized.     

Beyond continuity? Italian social assistance policies between institutional opportunities and agency

Madama I. Beyond continuity? Italian social assistance policies between institutional opportunities and agency The article addresses recent developments of social assistance policies in Italy with two interpretative aims. The first regards the approval of the long‐awaited framework law in 2000 and deals with the factors that made a path‐shifting national reform possible in a policy sector which had evolved through successive accretions and gradual revisions. The second regards the effectiveness of the reform, providing an assessment of the (scant) achievements subsequent to its adoption. The reform process was investigated through a model that combines factors of historical neo‐institutionalist derivation and agency dynamics, the latter of which is intended to overcome the structuralist bias of purely neo‐institutionalist explanations. The article draws two conclusions. The first concerns the resilience of Italy's backwardness in this policy field. The second, a theoretical consideration, is that if institutions function as constraint generators as well as opportunity generators for actors, agency dynamics are crucial in order to fully understand the timing and specific contents of institutional change.     

The Reform of Health Policy in China – Left Behind in the Race to Industrialize?

A major programme of health reform was announced in 2009. China is growing fast, and is beginning to engage with the international social policy community to discuss and review the consequences of rapid industrialization. As a specific part of social policy, health policy shares some of the characteristics of a policy area driven by the consequences of industrialization, but it also has its own particular features. This article reviews the general relationship between state and citizens in the health field by way of an introduction before focussing more specifically on Chinese patterns of health inequalities, and the pressures for reform. The 2009 reform of health policy and its dynamics are then presented, and the article concludes that there has been a deterioration in Chinese health policy, which threatens to undermine the benefits of economic growth for Chinese people.     

Poverty, Housing Niches, and Health in the United States

Drawing on psychological, health, and social science literature, a housing niche model is developed that focuses on (a) housing markets and other societal processes that constrain residential choice, (b) effects of residential environments on health and access to human and social capital, and (c) family dynamic effects on health and the intergenerational consequences of particular housing niches for future health and housing choices. The model requires the examination of cumulative risks, mediating and moderating processes, and the use of multilevel statistical models. The health consequences of existing housing policies are explored and future directions for research and policy suggested .     

Poland: Social protection and the pension system during the transition

This paper argues that the brunt of the transition-induced increase in Polish social protection expenditures during 1989-93 has been borne by social insurance arrangements, particularly pensions, rather than by social assistance schemes targeted to the poor or more temporary social safety net schemes. This is largely due to ease of access to social insurance and its more attractive benefit structure. Much of the recent efforts to reform social protection arrangements had an ad hoc nature and was driven by the need to alleviate looming financial distress. A major policy challenge is to avoid further burdening the social insurance system, particularly pensions, by problems that should be addressed by basic income support and emergency assistance policies or by general transfers (e.g. family allowances). Current reform needs are illustrated by using the pension system as an example.     

经济法视角下住宅房地产价格调控研究

我国自实行城镇住房制度改革后,房地产业飞速发展,在推动经济发展的同时,也导致我国部分地区出现了住宅房地产价格过高、上涨过快等问题.住宅房问题事关国计民生,国家政府运用经济的、法律的、行政的手段在调控房地产价格时,始终应当坚持权力法制、秩序稳定、社会公平的原则.在住宅房地产价格调控时,要修改和完善《价格法》,完善土地调控法律制度,完善住房保障法律体系,制定专门法规调整我国住宅房地产,逐步扩大经济适用房等保障性住房惠及的范围,完善相关调控主体法律责任.     

Contested Housing Landscapes? Social Inclusion,Deinstitutionalisation and Housing Policy in Australia

Deinstitutionalisation is represented as a major step toward social inclusion through the resettlement of disabled people residing in segregated large‐scale institutions into community‐based homes. By promoting the right to live in ordinary community residential settings, deinstitutionalisation fundamentally changes both the support services and housing arrangements of former institutional residents. In Australia, as in many western countries, debates on community care have tended to focus on the location and nature of non‐housing supports for people leaving dependent care. This focus, however, overlooks the fact that deinstitutionalisation involves a radical rehousing of people in care. This paper explores the character and implications of deinstitutionalisation in Australia as a rehousing process. It is based on a recent national research project that has examined the housing futures of people with intellectual disabilities who have been, or will be, deinstitutionalised. The paper considers the increasingly divergent socio‐political perspectives that have emerged in recent discussions about social inclusion, institutional reform and independent living and their implications for housing and community care policies.