Development of Social Health Insurance in Mongolia: Successes, Challenges and Lessons

This paper examines the process of developing social health insurance in Mongolia, and its successes, challenges and lessons. The government of Mongolia introduced social health insurance in 1994, which is compulsory for all public and private sector employees and low-income and vulnerable population groups. The scheme also provided voluntary insurance for unemployed people of working age. About 95 per cent of the population was covered by health insurance within the first two years thanks to a high level of government subsidy for vulnerable population groups. The insurance benefit initially covered nearly all inpatient services except the treatment of some specified chronic and infectious diseases, which were directly funded by the government. The scheme not only had many successes but also faced challenges in maintaining universal coverage. The new financing arrangement has provided little financial incentive for healthcare providers to contain health expenditure, contributing to rapid health cost inflation. In addition to reforming the payment system for providers, there has been an increasing need to expand benefits into ambulatory care. The development of compulsory health insurance in Mongolia shows that a prepaid health insurance mechanism based on risk sharing and fund pooling is feasible in low-income countries given political commitment and government financial support for vulnerable population groups.     

When Social Health Insurance Goes Wrong: Lessons from Argentina and Mexico

Social health insurance (SHI) has gained popularity in recent years as a health‐care funding mechanism for developing countries in Latin America and beyond. This is reflected in a number of high‐profile conferences sponsored by international agencies, and a profusion of externally funded reform projects. This article assesses the potential of SHI to provide a sound model of health‐care financing, drawing on the experiences of Argentina and Mexico. It uses four criteria to assess the performance of SHI: coverage, equity, effectiveness and sustainability. The article begins by outlining key principles of SHI and comparing it to other models of health‐care financing. It then gives a comparative overview of four SHI programmes in Argentina and Mexico, before analysing their performance in greater detail. The article finishes by extracting lessons from this comparative analysis, both for the countries studied and for global debates on SHI.     

Social Health Insurance: Key Factors Affecting the Transition Towards Universal Coverage

Several low- and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand the factors that affect the transition from incomplete to universal coverage. This paper analyses the experience of eight countries in the implementation of social health insurance. It highlights the importance of the socioeconomic and political context, particularly in relation to the level of income, structure of the economy, distribution of the population, ability to administer and level of solidarity within the country, but also stresses the important stewardship role government can play in facilitating the transition to universal coverage via social health insurance.     

Social Insurance and the Contributory Principle: A Paradox in Contemporary British Social Policy

At the outset of the twenty-first century, the situation of British National Insurance is one of paradox. Due to socioeconomic changes and successive government policies over the past three decades, the contributory principle, which was a cornerstone of social security reconstruction after World War II, has been in remarkable decline. At the same time contributions to the National Insurance Fund increased significantly and continues to represent a substantial form of total social security revenue. The contributory principle has a broad public appeal, but National Insurance does not figure prominently in public debates and the system is poorly understood. Recent policies have added to the ambiguity as to how far the contributory principle confers social rights, and have further eroded its rationale. The article states that this situation is not matched by developments in other European countries. Despite substantial reforms and heated debates marked by controversy, the prospect for social insurance and the contributory principle appears considerably better than in the UK. One major explanation is, the article argues, the distinctive notion of social insurance in Britain and particularly the lack of "wage-replacement" transfers. Elsewhere in Europe, earnings-related transfers sustain a very different incentive structure, institutional involvement and wider public participation in matters of social insurance.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

国民健康:中国当今不容忽视的社会问题

世界卫生组织(WHO)在其宪章中对健康作出如下定义:“健康不仅仅是没有疾病或不虚弱,而是身体的、精神的健康和社会 适应良好的总称。由此可见,随着社会的进步,健康将日益受到人们的重视,同时人们也将对健康提出更高的要求和标准。从上述定义中,我们得知健康由三个方面的     

National Health Insurance: An Alternate Medical Viewpoint

Increasing medical technology, expertise and community expectations of health care are leading to an alarming escalation of health costs throughout the world. Many health planners are expressing doubts as to whether quality of health care can be maintained in the present circumstances. It is maintained that the Australian Government's proposal of National Health Insurance is an interim measure, intended to grant hospital and medical expenditure assistance to the entire community, at minimum cost. There is little evidence that the scheme threatens the medical market place, as it is seen at the moment, and a plea is made for productive and constructive discussion of the scheme by the medical profession.     

Issues in Complementary Health Insurance in Belgium

This article attempts to assess the increasing role of complementary social insurance in healthcare in Belgium. As different players attempt to fill in the lacunae of the statutory social security scheme, the demarcation of their sphere of action and of their mutual relationship is becoming problematic. It is therefore interesting to see the evolution of solidarity and selectivity. The analysis of both categories and products in complementary health insurance indicates the limitations and the bottlenecks in coming years for the social security scheme on the one hand and complementary social insurance on the other.     

阜新矿区社会保障扬爱心风帆建和谐家园

阜新矿区是一个具有百年开采历史的老矿区,阜新市是国家惟一资源型城市经济转型试点城市。阜新矿区的部分企业实施了国家政策性破产,随着这项工作的开展,阜新市矿区社会保障管理中心应运而生。“中心”担负着矿区破产企业5万多离退休、工伤残等人员的管理服务,以及上万人的养老保险续保和劳动代理工作。社保工作是一项紧连着天地人的大工程,是社会治安的“稳定器”,和谐社会的“安全阀”,更是党和政府与人民群众的“连心桥”。面对这项关系社会经济发展与和谐稳定的事业,中心班子用科学发展观创新思想、创新机制,用热情、耐心、诚意、精心地…     

Tackling Inequalities in Physical Health: A New Objective for Social Work

Correspondence to Eileen McLeod, Department of Social Policy and Social Work, University of Warwick, Coventry, CV4 7AL, UK. Summary We argue that tackling the impact of social inequality on physicalhealth should become a central objective of social work andintrinsic to the development of anti-oppressive practice. Thisis on three grounds. First, the suffering embodied in inequalityin physical health should be a cause of concern to social workers,as a pervasive social problem. Secondly, awareness of socialwork's complicity in contributing to such a problem, throughits historical role in implementing state policies, needs toinform assessment of social work outcomes. Nevertheless, thirdly,social work—not confined to health care settings—whichredresses social disadvantage and tackles its consequences forphysical well-being can contribute to greater equity in health.Indicative examples of such practice are provided in relationto health maintenance, living with ill health and terminal illness.Finally, consideration is given to the current wider politicalcontext in which social work addressing health inequalitiesis embedded and to the need for complementary organizational,professional and political initiatives to buttress its development.     

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.     

Social Policy from Olson to Ostrom: A Case Study of Dutch Disability Insurance

Social policy development and reform in corporatist welfare states often follows a pattern of subsequent collectivization and de‐collectivization. This has to do, the article argues, with the social problems these phases address. Early social policy development forms a response to Olson‐type collective action problems that organized actors (labour and employers' organizations) in the field experience: state‐obliged benefits solve free rider problems, while bipartite administration allows labour and employers' organizations to organize their constituencies. This solution to Olson‐type collective action problems, however, also constitutes an Ostrom‐type collective action problem. Such a system functions as a common pool resource. Individual benefit take‐up is experienced as free and the costs of benefit take‐up are collectivized in the common pool. The article illustrates this pattern with reference to Dutch disability insurance.     

The Smothering Embrace: Competition in the Implementation of Social Policy

One element of recent welfare state reform has been the introduction of market coordination in the implementation of social policy. The authors of this article have conducted a comparative study of social security, health care and housing policy implementation in the Netherlands, focusing on the conditions necessary for an effective mechanism of competition. The most important condition is that clients should be able to switch between providers without difficulty. Evidence shows that the providers in these fields of social policy engage in activities that undermine the potential for future competition. While this is not uncommon in itself, the new markets in social policy appear to be particularly vulnerable to such activities. This can be explained on the basis of two variables: (1) the institutional characteristics of the policy fields as they existed before the introduction of market coordination, and (2) the characteristics of the products that providers distribute. The combination of path dependency and product characteristics strengthens efforts to reduce competition.     

Risk Adjustment for Health Insurance: Theory and Implications

This paper explores the potential for welfare-improving public risk adjustment in health insurance markets characterized by adverse selection. The optimal risk adjustment system is derived in a theoretical model under a range of assumptions regarding government information and market equilibrium. Special attention is focused on the interaction between risk adjustment and the private transfers that can occur in markets characterized by adverse selection. Risk adjustment has the potential to improve both equity and efficiency; however, it can also have the effect of crowding out private transfers.     

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.     

The State Children's Health Insurance Program: Participation and Substitution

We examine the effects of SCHIP enactment by focusing on two policy concerns: take-up and crowd-out. The literature has examined how income eligibility expansions affect the type of children's insurance coverage. However, states jointly implemented various policy instruments. The results in previous works do not control for this variety. We analyze how changes in several SCHIP factors affected decisions regarding health insurance coverage. Our analysis indicates that the estimates in the literature may have combined the effects of various policy factors. In distinguishing individual policy factors, our results provide useful information for designing effective public health insurance programs.     

农村商业健康保险的定位及发展模式

商业健康保险是农村医疗保障体系的有机组成部分。它在满足农村居民个性化的风险保障需求以及提供专业化的经办管理服务方面能发挥积极作用。在农村医疗保障体系中,公共医疗保险居基础性地位,商业健康保险则居补充性地位,两者应协调发展,共同构建我国农村多层次医疗保障体系。现阶段,我国农村商业健康保险发展模式包括补充型发展模式、替代型发展模式以及第三方管理模式三种类型,其未来发展模式包括医保合作模式、第三方管理模式,以及最终打造成以健康保障为中心、集医疗服务提供与经办管理服务为一体的农村商业健康保险产业链发展模式。