Health care as a social security benefit: Institutional approaches to extending coverage

Reaching universal health‐care coverage requires an appropriate mix of compulsory contributory social insurance schemes, with mechanisms to include the informal‐economy population, and tax‐based social assistance for those whose incomes preclude their own contributions. This article urges a reversal of the trend that favours the separate development of social health insurance by separate health authorities and makes the case for the extension of health‐care coverage using existing formal‐sector social security schemes, not least because they have the necessary political backing and institutional structures. The article reviews reasons for the slow pace of coverage extension to date, and stresses the added value of incorporating health care as a social security benefit while also acknowledging the importance of retaining linkages between statutory and well‐regulated community‐based or micro health‐insurance schemes.     

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.     

Semi‐conditional cash transfers in the form of family allowances for children and adolescents in the informal economy in Argentina

In 2009, Argentina introduced a new transfer programme for children and adolescents younger than age 18 (Universal Child Allowance) that extended coverage under the contributory programme for family allowances to include families in the informal economy and families of unemployed persons. This article describes this innovative programme, compares it with similar programmes in Latin America and analyses its impact on coverage and its possible effects on the welfare of the population. The results indicate that the extension of access to this type of benefit has reduced considerably the coverage gap for the poor and indigent and supports efforts to consolidate the operations of different and poorly coordinated transfer programmes.     

The "X component" in Shanghai's social security reforms

In 2003, the Shanghai Bureau of Labour and Social Security launched the zhenbao (town insurance) programme, now widely known as 25 plus X. This scheme is regarded as an important experiment in social security reform and has been lauded for extending social security to areas where previously only segments of the population had mandatory coverage. Using data from 103,000 individuals enrolled in 25 plus X, we examine the extent to which the scheme represents an extension in social security coverage. Our analysis suggests that while it does represent an extension of benefits for some, for many it represents a considerable dilution in benefits.     

The performance of social security contributory and tax‐financed pensions in Central America,and the effects of the global crisis

Over the last 30 years, Latin America has pioneered structural pension reforms. This article focuses on a representative regional sample of seven Central American countries with diverse levels of development (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama) studying contributory and tax‐financed pensions as well as recent pension reforms. It comparatively assesses system performance regarding five social security principles: unity; universal coverage; adequacy of benefits; equal treatment, solidarity and gender equality; and financial sustainability. It also evaluates the impact of the world crisis on these pension systems, highlighting the differences between public and private pensions, and extracts lessons and suggests policies for the future.     

(A‐)typical and (in‐)secure? Social protection and “non‐standard” forms of employment in Europe

Atypical forms of employment (part‐time work, mini‐jobs, fixed‐term contracts and solo self‐employment) have gained in importance overall in recent years in many European countries. They are often part of an irregular career pattern and carry a high risk of unemployment. In a 6‐country comparison (Germany, the United Kingdom, the Netherlands, Italy, Denmark and Poland) we consider whether and in what way national social protection laws cover the various forms of non‐standard employment and the specific risks these entail. Significant variations were found in coverage standards and practices between countries as well as substantial variability within countries in their responses to different types of non‐standard employment. A need for further and improved coordination of both social legislation and tax law is identified.     

Extension of social insurance coverage to informal economy workers in China: An administrative and institutional perspective

This article reviews administrative issues in the context of decentralized social protection in China. In particular, what are the main obstacles to expanding social insurance coverage for workers in the informal economy? Over the last two decades, China has achieved remarkable progress toward universal social protection when this target was set as a national policy priority. However, the social insurance enrolment of informal economy workers still lags significantly behind. This article reviews the application of the International Labour Organization’s definition of informality in the Chinese context and overviews existing pension and health insurances in China. This article discusses the impact of China’s inter‐governmental fiscal relations and decentralized social protection in the multilevel government system. The article highlights that under a system of decentralized managed social insurance many informal economy workers choose to opt out of the system because of low benefits and high compliance costs. This result in deficits in social insurance coverage amongst informal economy workers.     

Including informal economy workers in contributory social protection: Current challenges in Latin America

Owing to a favourable economic situation and to national labour market and social protection policy reforms, Latin America has witnessed significant progress in social protection coverage. Some countries, however, have seen weaker progress, with stagnant coverage levels. Several factors underlie the extension of pensions and health care coverage and the formalization of the labour market: substantial improvements in the quality of employment, more flexible eligibility criteria for contributory coverage, and the strengthening of the supervisory and regulatory roles of the State. This article first addresses the link between social protection and informality in Latin America to show the relationship between informal labour markets, the lack of social protection and the scale of unpaid contributions. Also highlighted is regional progress in extending social protection as a result of labour market formalization. Countries in the region have used various policies to encourage formalization and these have also helped to reduce wage inequalities, since formalization has had especially beneficial effects on low‐income sectors. Finally, we discuss dichotomous views on social protection financing in the region that tend to place contributory and non‐contributory financing in opposition to one another but do so in favour of the latter, tend to support proposals for limited coverage, and which do not challenge the stratification of access to social protection. The move towards a convergence of benefits is deemed essential: strategies to universalize social protection in the region should not focus exclusively on increasing resources, but must address institutional change as a crucial part of the locus of innovation.     

The recent evolution of social security coverage in Brazil

Abstract   This article describes and assesses indicators of social security coverage in Brazil over the period 1992 to 2006 for employed workers and the elderly. While the coverage of retired workers has shown some degree of stability over the past years, that of employed workers changed significantly over the period, showing clear signs of deterioration between 1992 and 2002, and of recovery since then. Fewer self-employed persons in agriculture in rural areas (Special Insured Persons, workers with specific social security schemes) accounts for most of the deterioration. The economic recovery and an increase in new registered jobs accounts for most of the improvement in coverage between 2003 and 2006. Administrative and institutional factors also played a relevant role, especially in promoting the inclusion of domestic and self-employed workers as social security contributors.     

社会保障立法与社会保障制度建设

我国在计划经济体制向社会主义市场经济体制转换过程中建立的社会保障制度,目前尚存在内容不健全、法制化程度低、实施机制脆弱的不足.比较国外较为成熟的传统型、福利型、储蓄型三种社会保障制度模式,我们可以从中吸取经验,受到启发,进而建立具有中国特色的、保障面宽、保障程度适中的社会保障制度.为此目的,我们必须加强社会保障立法,既要健全社会保障法律体系,又要严格社会保障执行的法律监督.     

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.     

Participation of seniors in the Argentinian labour market: An option value model*

The aim of this article is to define the factors which determine seniors' decisions to continue to participate in the labour market in Argentina. An option value model is developed. This model is used to produce estimates based on micro‐data drawn from household surveys. These indicate the relative importance of the impact of conditions governing eligibility for benefits on decisions to remain actively employed. Work history is found to be the main factor in such decisions. Inadequacy of social security benefits and accumulated human capital also create incentives for economic participation in old age. On the basis of these findings, compensatory policy adjustments, to improve coverage, increase benefit levels and improve employment conditions for seniors, are proposed.     

Working life and retirement pensions in Spain: The simulated impact of a parametric reform

This article aims to offer an ex ante evaluation of the impact of a parametric reform of the Spanish pension system that would involve increasing the reference period used to calculate benefits, an approach proposed many times by various actors in the socio‐economic field. Such gradual change may be categorized as a non‐structural reform of the pension system. This contrasts with reforms of a structural nature that have been very popular in Latin America and elsewhere, involving the creation of defined contribution individual account schemes. As regards the parametric reform proposed in this article, the main findings indicate that it would have a small but negative impact on pension income for pensioners and would reduce income distribution.     

构建适应市场经济的中国社会保障制度

社会保障制度作为市场经济运行的"安全阀"和"减震器",担负着保证社会成员的基本生活水平、保持社会稳定、协调公平与效率的使命。鉴于目前城乡社会保障的巨大反差、保障范围覆盖不全、保障基金利用效率低下的实际,构建适应市场经济的中国社会保障制度,应建立和发展多元化、多层次的社会保障体系;拓宽社会保障覆盖面,采用新的社会保障筹资比例和筹资方式;大力推进社会保障的法制建设,调节财富,以建立中国的社会保障安全网;解决好城市化进程中新型城镇人口和农村的社会保障问题。     

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.     

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.     

Global–regional interaction to extend access to social protection for migrant workers: Insights from ASEAN and MERCOSUR

Universal access to social protection for migrant workers is emerging as a problematic issue in the implementation of free movement regimes at a regional level. This article focuses on the concept of regional governance as a possible mechanism to address the unsolved challenges of social security regimes to extend coverage. To this end, the article looks at current legal developments in two regional projects (ASEAN and MERCOSUR) to identify a creative approach to strengthen the development of national floors of social protection. The interest of using these case studies lies in exploring whether the regional integration process can play a major role in the progressive extension of social protection rights to migrant workers by facilitating the adoption of social security agreements.     

China’s social security response to COVID-19: Wider lessons learnt for social security’s contribution to social cohesion and inclusive economic development

China has adopted an array of special social security measures in response to the spread of the COVID-19 virus, to mitigate the downside social and economic impacts caused by the pandemic. Measures include the reduction, exemption and deferral of social security contributions by employers, the extension of benefits coverage for employees, and the provision of more accessible e-services by social insurance agencies. The article points out that a preliminary assessment of those measures would suggest that they have played a key role in supporting social cohesion and in stabilizing the economy. In a critical manner, the article compares the measures adopted in China with those of other countries, and identifies how China could learn from international practice and experience. Finally, and based on recent Chinese experience, the article presents proposals that seek to improve the longer-term contribution made by the Chinese social security system to realize the goals of social cohesion and inclusive economic development. As set out in China’s Social Insurance Law of 2010, the social security system should not only support a fair sharing of benefits of development, but also promote social harmony and stability.     

The Achilles' heel of scale service design in social security administration: The case of the United Kingdom's Universal Credit

This article takes a critical view of the United Kingdom government's design for the delivery of the Universal Credit (UC) benefit reforms. It is argued that the UC is destined to fail because of the policy's extension into specifying the means (“digital by default”) of delivery for such services. The authors argue that an unseen but ubiquitous set of “scale” management assumptions has been allowed to infiltrate the means by which the government intends to enact its headline policy objective to “make work pay”. Following Seddon's “Vanguard Method”, a practical example of how a better service was designed in a local authority housing benefits service is then examined. Results from this service include being able to deal with up to 50 per cent more demand, with fewer resources, in half the official target time. Finally, the article will conclude with a call for more evidence‐based policy.     

The challenge of pension reform in Georgia: Non‐contributory pensions and elderly poverty

Georgia's national social security system offers almost universal non‐contributory basic pension coverage. The basic pension has, to date, proved effective in dealing with old‐age poverty. But Georgia's fiscal constraints and ageing population also highlight the importance of improving the pension system, in order to ensure its sustainability. This article presents policy reform choices, which suggest that, in Georgia, pension reform might include increasing the statutory retirement ages and reducing the generosity of benefits through means testing. The case of the Georgian non‐contributory basic pension might hold value for some low‐ and middle‐income countries that are considering the implementation of, or expanding coverage under, a non‐contributory pension programme.