Narratives of Promise,Narratives of Caution: A Review of the Literature on Social Impact Bonds

Social Impact Bonds (SIBs) are a new mechanism for delivering public services. This article reviews the emerging SIB literature in high‐income settings. It identifies three distinct narratives: a public sector reform narrative; a financial sector reform narrative; and a cautionary narrative. These are analyzed relative to three themes: public versus private values; outcomes contracting; and risk allocation. The first two narratives are complementary and offer a ‘win‐win’ portrayal of SIBs. The third narrative challenges this dominant commentary by highlighting potential risks. There is limited empirical evidence on active SIBs to support these narratives. SIBs may have the potential to align public and private interests while improving outcomes for people affected by entrenched social problems, but this is yet to be established and appears less probable than the third more cautionary narrative. More empirical research is needed to consider the potential risks, drawbacks, benefits and alternatives of SIBs in different settings.     

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.     

Risk and its Management in Post-Financial Crisis Hong Kong

In the 1970s and up until the financial crisis occurred in the late 1990s, Hong Kong prospered in a relatively stable social, economic and political context. Since the financial crisis, however, its population has been increasingly exposed to risk: there has been job uncertainty and decreasing capacity for self‐reliance, leading to a growing reliance on public welfare and on families at a time when both are under pressure. The old welfare policies, unable to cope with the new risks, have been replaced by neo‐liberal reforms, redistributing the roles and responsibilities of the individual and the state, with a greater burden falling on the former. Individuals are required to be prudent to manage risk. While these reforms have relieved some of the burden on the state, both new social risk groups and ‘net taxpayers’ considered themselves to have borne disproportional costs. Society is facing serious problems resulting from ineffective old welfare policies, new social risks due to new policies, and the political upheavals arising from increased social conflicts and weakened social cohesion and solidarity. A further complication is that there is no acceptable platform or agent to negotiate a compromise between the polarized groups. This article argues that reliance on publicly funded risk coping strategies or on neo‐liberal risk prevention and mitigation strategies is not a desirable and sustainable policy. A commonly accepted political platform is required to negotiate a compromise which emphasizes shared and balanced roles and responsibilities, and a well‐conceived combination of risk prevention, mitigation and coping strategies.     

Extending coverage under the Argentinian pension system: Distribution of access and prospects for universal coverage

One of the main challenges facing social policy in Latin American is to guarantee social security coverage for the entire population in the presence of a large informal sector. In Argentina, a regional pioneer in terms of the development of its pension system, more than one third of those of retirement age were without benefits in 2005. Since then, considerable progress has been made in extending coverage thanks to the introduction of a programme that has reduced contribution requirements and allocated benefits to a large number of seniors previously excluded from the system. This article analyzes the impact of this process in Argentina on the level and distribution of coverage, identifies changes in socio‐demographic factors which affect inclusion/exclusion in the social security system, and discusses remaining obstacles to the provision of universal coverage in the medium and long term.     

But is it ‘Fair'? The UK Coalition Government, ‘Fairness’ and the ‘Reform’ of Public Sector Pensions

The article analyses arguments for reform of public sector pension schemes by the UK Coalition government on the grounds that existing provision is ‘unfair’. Three dimensions of ‘fairness’ are discussed. That between public and private sector provision; between the costs to public sector employees and other taxpayers; and between members of public sector schemes. The article argues that there are serious weaknesses in the Coalition position on each of these dimensions of ‘fairness’. It suggests that these weaknesses are rooted in the discussion of public sector pensions in isolation from the overall pattern of occupational pension provision in the UK and that a more satisfactory analysis requires reference to principles of distributive justice.     

Postmodernization: A Phase We're Going Through? Management in Social Care

This paper considers the challenges facing managers of socialcare services in public sector organizations in the UK. Sometheorists might argue that these challenges are the manifestationof a new postmodern era. It is argued here, however, that societyis not fully postmodern: indeed modernity continues with someof its features (such as a concern with rationality and reason)heightened and intensified. Social trends associated with thistransitional phase of postmodernization have been highlightedin the literature and here they form the framework for discussingsocial care management today.     

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.     

The disability self‐direction movement: Considering the benefits and challenges for an Australian response

The following article provides a snapshot of the current self‐direction movement within the disability sector across the industrialised world, with particular emphasis on the Australian context. As a global movement, self‐direction has been in progress for several decades through a variety of implemented responses. Despite implementation variation, all self‐direction models aim to facilitate individual control and decision making in care and support services. We describe self‐direction, its various models and programs, and explore its benefits and challenges. We conclude by making broad recommendations for decision makers involved in self‐direction. In particular, we offer a hierarchical decision tree that can be used to inform policy decisions at a systems – government policy – and organisational level.     

Collective empowerment: A comparative study of community work in Mumbai and Stockholm

Mumbai and Stockholm are worlds apart in terms of public services, infrastructures and standard of living. However, both cities have known common problems of social exclusion and marginalisation related to neo‐liberal globalisation. Social workers are facing similar challenges regarding collective empowerment as a strategy for community work. This comparative study explored how collective empowerment is undertaken by community workers. The research participants were 13 informants from community‐work organisations in the two settings. Semi‐structured interviews were used and were analysed with the help of Atlas‐ti 6.2 (ATLAS.ti Scientific Software Development GmbH D‐10623 Berlin Germany). Social work in Mumbai is in a context of extreme poverty and mainly within the informal sector, whereas in Stockholm most social work is done in relation to a public welfare model. In Stockholm, interventions are aimed towards strengthening social networks, without direct aim at social change. In Mumbai, community workers organise people for collective empowerment to strengthen marginalised groups and achieve social change.     

Longevity insurance annuities: China adopts a benefit innovation from the past

Longevity insurance annuities are deferred annuities that begin payment at advanced older ages, such as at age 80. Such annuities would benefit some older retirees who have drawn down their savings, but the private sector has problems in providing them. Originally, social insurance old‐age benefits programmes in some countries were structured as longevity insurance programmes, with 50 per cent or less of those entering the workforce surviving to receive the benefits. Over time, however, as life expectancy has improved, the benefits these programmes provide have slowly transformed into benefits that most people entering the workforce ultimately receive. This article argues that the reintroduction of longevity insurance benefits as part of social insurance old‐age benefit programmes could be an important policy innovation, in particular because this benefit is generally not provided by the private sector. China has introduced longevity insurance benefits as part of its social insurance system, offering a model for other countries, particularly those providing modest social insurance old‐age benefits.     

The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s

During the 1990s, the Swedish welfare state was declared by some to be in a “crisis”, due to both financial strain and loss of political support. Others have argued that the spending cuts and reforms undertaken during this period did slow down the previous increase in social spending, but left the system basically intact. The main argument put forward in this article is that the Swedish welfare state has been and is still undergoing a transforming process whereby it risks losing one of its main characteristics, namely the belief in and institutional support for social egalitarianism. During the 1990s, the public welfare service sector opened up to competing private actors. As a result, the share of private provision grew, both within the health‐care and primary education systems as well as within social service provision. This resulted in a socially segregating dynamic, prompted by the introduction of “consumer choice”. As will be shown in the article, the gradual privatization and market‐orientation of the welfare services undermine previous Swedish notions of a “people's home”, where uniform, high‐quality services are provided by the state to all citizens, regardless of income, social background or cultural orientation.     

Economic Determinants of Voting in an Era of Union Decline*

Objective. The objective of this article is to test competing hypotheses regarding union vote effects by economic sector. Overlooked in existing research on political participation and the labor movement is de‐unionization's sectoral dimension: declining union rolls is a private‐sector phenomenon. The sectoral dimension of union decline carries important political consequences if the influence of unions on voter turnout varies by sector. Method. Using Current Population Survey (CPS) November Voting and Registration Supplements for all national elections between 1984 and 2006, I estimate union vote effects for public‐ and private‐sector employees. Results. The results of the analyses reveal that while union members continue to vote at higher rates than otherwise similar nonmembers, the union effect is nearly three times as large for private‐sector members: private‐sector unionists have a predicted probability of voting 6.7 points higher than nonmembers, while public‐sector members have a predicted probability of voting only 2.4 points higher than nonmembers. Conclusions. Given the small fraction of private‐sector workers now in labor unions, recent fluctuations in the unionization rate have little aggregate affect on turnout. Given that private‐sector union members tend to be less educated and earn less than their public‐sector counterparts, the near disappearance of private‐sector unions from the economic landscape removes an important institutional buffer against political inequality in the United States.     

Developing a Community-Based Social Service Program for the Elderly

This article describes the development and implementation of a community-based social service program for the elderly. The problems encountered as a new professional unit within the municipality are analyzed and the role of the social worker in resolving those problems is described. The local community is the primary focus of change and strategies of intervention include reaching out and involving members from all levels of the community in the social service program, from members of the client group to individuals with political influence in the governmental system. Planning considerations for social work practice are posed including the relationship of the private, nonprofit sector to the public sector, the demands for service and difficulties establishing program stability.     

The democratic challenges and potential of localism: insights from deliberative democracy

This article considers the democratic challenges and potential of localism by drawing on insights from the theory and practice of deliberative democracy. On a conceptual level, the ideas embedded in localism and deliberative democracy share much in common, particularly the democratic goal of engaging citizens in decisions that affect them. Despite such commonalities, however, there has been limited conversation between relevant literatures. The article considers four democratic challenges facing localism and offers a response from a systems perspective of deliberative democracy. It argues that, for localism to realise its democratic potential, new participatory spaces are required and the design of these spaces matters. Beyond structured participatory forums, local democracy also needs an active and vibrant public sphere that promotes multiple forms of democratic expression. This requires taking seriously the democratic contributions of local associations and social movements. Finally, the article argues that, to fulfil its democratic potential, localism needs to encourage greater democratic and political connectivity between participatory forums and the broader public sphere.     

Benefit ‘Myths’? The Accuracy and Inaccuracy of Public Beliefs about the Benefits System

There is a widespread assumption by academics and commentators that negative public attitudes to the benefits system are due to ‘myths’ held by the British public. However, there is little research on whether the public believe these ‘myths’, nor critical scrutiny of benefit ‘truths’. This article therefore investigates what British people believe about the benefits system, and the extent to which these beliefs can be regarded as correct. To do this, we use 46 measures from 18 datasets (including British Social Attitudes, the European Social Survey, Eurobarometer, and surveys by YouGov and Ipsos MORI made available for academic study for the first time), and compare these perceptions to true figures obtained from a variety of sources. We find that – against expectations – there are some areas where the public are (on average) relatively accurate (e.g. the share of the population who currently claim out‐of‐work benefits). Yet overall, our evidence shows that the British public have low levels of understanding of the benefits system, primarily in ways that seem likely to undermine public support. People wildly overestimate unemployment benefits compared to pensions, the value of unemployment benefits, and misperceive trends in claims. While it is difficult to know the true level of benefit fraud exactly, the public overestimate fraud compared to any reasonable figure. We conclude by discussing the implications for both understanding and changing attitudes towards benefits.     

Healthcare in India: Changing the Financing Strategy

The way in which healthcare is financed is critical for equity in access to healthcare. At present the proportion of public resources committed to healthcare in India is one of the lowest in the world, with less than one‐fifth of health expenditure being publicly financed. India has large‐scale poverty and yet the main source of financing healthcare is out‐of‐pocket expenditure. This is a cause of the huge inequities we see in access to healthcare. The article argues for strengthening public investment and expenditure in the health sector and suggests possible options for doing this. It also calls for a reform of the existing healthcare system by restructuring it to create a universal access mechanism which also factors in the private health sector. The article concludes that it is important to over‐emphasize the fact that health is a public or social good and so cannot be left to the vagaries of the market.     

Cell phones,electronic delivery systems and social cash transfers: Recent evidence and experiences from Africa

Electronic delivery systems for social cash transfer programmes offer advantages to programme implementers and benefit recipients in terms of enhanced cost efficiency and flexibility. The rapid penetration of cell phone infrastructure, combined with a growing interest from banks to extend financial services, is likely to make the electronic delivery of cash transfers an increasingly viable option. Taking into account the broader benefits for cash transfer recipients arising from improved access to financial services infrastructure, this article elaborates recent evidence and experiences from Kenya, Malawi, Namibia and Swaziland. The article concludes with an assessment of the opportunities and challenges for scaling‐up electronic delivery systems.     

Second‐pillar pensions in Central and Eastern Europe: Payment constraints and exit options

During 1998–2007, a majority of Central and Eastern European (CEE) governments enacted laws obligating workers to save for retirement in privately managed individual accounts. The governments funded these accounts with a portion of public pension revenues, thus creating or increasing deficits in public systems. After the onset of the global financial and economic crisis (2008), most CEE governments reduced these funding diversions and scaled back the accounts. Now, a decade after the crisis, this article examines the benefits that the accounts are beginning to pay retiring workers. In general, these benefits are shown to be disadvantageous compared with public pensions. Some pay lump sums in lieu of regular monthly benefits, most fail to adjust pensions regularly for inflation, and some pay women less than men with equal account balances. In several countries, pensioners with individual accounts receive lower benefits than those without them. To enable retiring workers to avoid these disadvantages, several CEE governments have allowed them to refund their account balances and receive full public pensions. Yet while this strategy diffuses worker dissatisfaction, it also places strains on public pension finance. To assist second‐pillar account holders without weakening public pensions, governments should consider making private pension savings voluntary and financing these schemes independently of public pensions – i.e. by worker and employer contributions and, possibly, direct state support.     

I'm OK, You're (Not) OK: The Private Welfare State in the United States

The American welfare state has been premised on the mixture of substantial private, tax‐subsidized benefits rather than on more universalistic public benefits. That pattern is in some ways being undermined as private pension plans are increasingly going bankrupt and firms reduce the benefits they provide employees. On the other hand, however, the current Bush administration is attempting to enhance the private sector role by allowing individuals to invest at least a part of their social insurance contributions into private savings plans. These changes may in the end increase the role of the public sector as a regulator and underwriter at the same time that attempts are made to minimize public sector involvement.     

National pension systems and mass opinion: a case study of confidence, satisfaction and political attitudes in Norway

It is commonly assumed that popular support for national pension systems depends on widespread satisfaction with projected benefit levels among the working age population, and in particular that public support for the system will be jeopardised if the taxpayers do not feel confident about eventually receiving the promised benefits. On the basis of Norwegian survey data, two sets of questions are addressed in the article: (1) Is there a widespread lack of confidence in and satisfaction with the Norwegian National Insurance pension scheme? and (2) Is there an association between confidence and satisfaction and people's political attitudes towards the National Insurance pension scheme? Although we do not find any signs of a dramatic erosion of confidence towards the system, we do find that overall satisfaction with projected benefits is low among the working age population. Contrary to what one might expect, however, confidence and satisfaction from the point of view of individual interests appear not to be associated with a political preference for privatisation.