First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
The article sets out key elements of the policy agenda for enhanced integration between health and social care for older people in high-income countries and demonstrates its wider relevance to low- and middle-income countries (LMICs). The article then explores the context for this agenda in Brazil, including growing demand for long-term care (LTC) and current institutional arrangements. It goes on to discuss a case study project of partnering for LTC between local social assistance and health agencies in the Brazilian city of Belo Horizonte. It identifies challenges and potential benefits of this partnership model, offering policy insights for LTC policy in Brazil and other countries.
First published in April 1948 as the Bulletin of the International Social Security Association, this year marks the 75th anniversary of what, since January 1967, we have all come to know as the International Social Security Review. To mark this important anniversary, this special double issue, “The human right to long-term care for the elderly: Extending the role of social security programmes”, talks to current debates on social security coverage extension in a context of population ageing. There is a case to be made for revising the international social security standards to formally recognize long-term care for the elderly, possibly as a distinct branch of social security. At the heart of this discussion, the questions to be addressed by all countries are the roles that social security systems can and should play in helping to meet the long-term medical and social care needs of elders.
With the acceleration of population ageing, healthy ageing is becoming an imperative for all. Social protection systems have an important role to play in this endeavour. Through a life cycle approach, social protection systems can support i) the prevention of disability in old age (i.e. by addressing the social determinants of health and rehabilitation), ii) effective access to long-term care without hardship for those who need it, and iii) decent work in the care economy. To do so will require adopting a gender-transformative approach. Indeed, women are disproportionately represented among both older persons and long-term care providers in their diversity. Further, to adequately contribute to healthy ageing and effective access to long-term care without hardship as a rights-based entitlement, social protection systems will need to build strong coordination between health care, social care and other social policies. This article highlights the key entry points for social protection systems to contribute to the United Nations Decade of Healthy Ageing, building on the rights-based approach of human rights and international social security standards.
The family is the dominant player in India’s current long-term care (LTC) system. Yet informal family-based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non-familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross-state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC.
In this article, we provide an overview of the current long-term care (LTC) landscape across low- and middle-income countries (LMICs), based on an analysis and synthesis of literature review findings. We begin with a brief assessment of LTC needs on the demand side, followed by a supply side assessment of the available mix of formal LTC services vis-à-vis informal care provision. Next, we describe and discuss the role of government policies in LTC provision and governance. We conclude by discussing and offering practical LTC policy considerations for LMICs, drawing on experiences, best practices and lessons learned from high-income countries.
Care for the elderly is one of the most important socioeconomic issues arising from the ageing of the population. Given the declining workforce in the care and health sectors, difficulties exist already in fully meeting care needs. Moreover, deinstitutionalization, which involves a transition from institutional to community-based care, requires an increase in human resources in the care and health sectors. The article addresses long-term care systems for the elderly and the conditions affecting the possibility for the Visegrád countries (Czechia, Hungary, Poland and Slovakia) to transition from a post-socialist model (familialism by default/unsupported familialization) to a European care model based on deinstitutionalization. A further aim of the article is to show some differences in the provision of long-term care for the elderly that are observed in Central Europe, and to underline that their specific characteristics should be taken into account when planning and designing public policies and guidelines for social policy at the European Union level.
Older people and their care workers have been disproportionately affected by the COVID-19 pandemic. Many OECD Member countries have taken measures to contain the spread of the infection and improve the care workforce. Yet the health crisis is highlighting and exacerbating pre-existing structural problems in the long-term care (LTC) sector. In many OECD Member countries, recruiting enough workers in LTC remains a challenge and care workers experience difficult working conditions. Skills mismatch and poor integration with the rest of health care lie at the root of preventable hospital admissions even in normal times. Such challenges are likely to become ever more acute if no further action is taken given the speed of population ageing. Policies to improve recruitment and which also address retention through training, improvements in coordination and productivity, leveraging the effect of digital technologies, are needed.
This article investigates challenges of ageing for long-term care. The analysis proceeds in three steps. In the first step, we estimate the prospective care demand for 30 developed countries based on projected ageing and disabilities among the elderly. In the second step, we outline challenges for care systems with respect to shortages of care workers, increasing skill requirements for care workers, barriers to universal and equitable access to care, and cost containment subject to adequate care quality. In the third step, we identify solutions for these challenges by comparing the care systems of Germany, Israel, Japan, the Netherlands, and the Republic of Korea.
In 2008, Great Britain overhauled its disability benefit programme by introducing a new disability determination process called the Work Capability Assessment and a new earnings replacement programme called Employment and Support Allowance. This article examines the British reforms from the perspective of the United States, which may consider changes to its disability benefit programme, the Social Security Disability Insurance programme, in the near future. The article provides an overview of the steps leading to the reform in Great Britain, details how the new programme operates, reviews research on its initial implementation and effects, and identifies lessons for the potential reform of the disability benefit programme in the United States.
This article addresses the reforms introduced in Latin American pension systems that had the aim of increasing coverage beyond formal-sector workers. For this purpose, fourteen representative regional experiences are analysed using a taxonomy based on features of the cases examined in terms of design, implementation and results. The findings show that, although the reforms share the goal of expanding coverage, there are significant differences deriving from the context in which they were originally designed, their goals, and the capacity available to implement them. The results are not homogeneous, and it is possible to identify some aspects in which policy decisions can lead to better or worse results.
This article reviews the recent literature on existing mechanisms that allow for the portability of social security entitlements for migrant workers and finds that North–North migrants have the best access to portability. There is limited coordination between origin and destination countries regarding the portability of social entitlements of South–North migrants. These migrants are dealing with discourses and policies that treat them as second class citizens, even as they are providing much-needed labour to their host countries. South–South migrants are seeing new regional mechanisms addressing portability. However, many of the impacts of these mechanisms are not yet known. Other knowledge gaps on portability relate to internal and South–South migration, the role of gender and other social identities, migrants' occupations as well as their legal immigration status.
One of the biggest challenges currently facing European society is the dramatically high level of youth unemployment. Commonly, political solutions and strategies can be found in those countries that have been able to keep youth unemployment low in spite of the financial and economic crises. Austria is such a case. On the basis of European Union member state data, the article gives a multifactorial explanation of youth unemployment and asks whether these factors can explain relatively low youth unemployment in Austria. With the country's "youth safety net" presented in detail, it is shown that active labour market policy reduces youth unemployment in Austria. The article also points out the limitations of cross-country comparisons of youth unemployment rates and proposes the use of a greater number of indicators. Finally, the article argues for economic policies to stimulate demand, which have to be based on a political and social commitment to full employment.
Protecting maternity at work has been one of the primary concerns of the International Labour Organization since its foundation in 1919. Along with fundamental human rights treaties, the adoption of the Maternity Protection Convention, 2000 (No. 183) and, more recently, the ILO Recommendation concerning National Floors of Social Protection, 2012 (No. 202), have marked the universalization of the right to maternity protection and call for its extension to all women in line with the principle of equal opportunity and treatment between women and men. In the framework of these historical developments, this article presents evidence of how national legislative provisions on paid maternity leave have improved in the light of the principles of international labour standards, although a large majority of women workers are still not adequately protected in case of maternity. The article then addresses patterns of exclusion from maternity protection in law and practice, and concludes by discussing some social protection programmes that have the potential to extend maternity protection coverage and support to meet the care needs of the most vulnerable and which do so with a gender transformative focus.