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 this article the adequacy of social insurance benefits is addressed from the perspective of eight fundamental goals of social insurance. With respect to these goals, the legislated level of the benefit and other conditions represent tools to achieve adequate levels of benefits vis-à-vis contributory effort. The goals address income risks of various sorts: (i) income compensation; (ii) securing a decent standard of living; (iii) universality, implying simplicity and a high takeup of social rights; (iv) reducing income risk deriving from physical incapacity; (v) safeguarding insurability by balancing the expected payoff to the insured and the value of the contributions paid over the lifetime; (vi) intergenerational equity; (vii) containing work and savings disincentives; and (viii) risk reduction (prevention). A simple model serves to clarify what is needed to achieve benefit adequacy together with insurability and contribution adequacy. An example of income support in working age, based on Israeli data, illustrates the use of specific instruments to achieve a decent standard of living while containing economic disincentives. The example stresses the importance of synchronizing efforts with institutions outside the social insurance system.
The 2014 Research Conference of the International Social Security Association (ISSA), which offered a platform for discussion and analysis among social security administrators and academia, addressed issues concerning the adequacy and sustainability of social security. Core issues discussed were the definition and measurement of adequacy and the contribution of social security systems to social and economic development. Also addressed were "megatrends", including demographic ageing and climate change, and their impacts on social security systems. As an objective, the conference sought to evaluate the implications of these issues for social security administrations and, on the basis of national good practice and new research findings, to identify measures permitting future adaptation and innovation.
The BRICS countries have made important progress in extending social security coverage. However, much remains to be achieved to realize the goal of comprehensive universal social security protection. Using policy experiences from the BRICS, the article explores the possibility of drawing from existing models of social security provision to design effective policy interventions for universalizing social security. Main principles of a framework for bridging the coverage gap are identified. These principles are then placed in complimentary and supplementary relationships to develop a framework for policy interventions to bridge the social security coverage gap and achieve universal social security.
The rapid rise in unemployment since 2008 caused by the global financial crisis has created renewed interest in the effects of well-designed unemployment benefit systems on the speed at which labour markets recover and job creation resumes. On the basis of a newly-created database on labour market flows, this article makes use of a micro-founded macroeconomic model to estimate different effects of active and passive labour market spending on employment growth and the state of public finances. It demonstrates, in particular, that for the average G20 country, spending on unemployment benefits yields employment gains both in the short term and long term that are superior to those observed for active labour market policies. Moreover, rather than tightening their budgets prematurely, G20 countries would have fared much better in accepting further deterioration in public finances stemming from higher spending on social transfers in order to stimulate faster employment growth, which would have led to a more rapid recovery in the state of public finances as well.
This article offers a framework for the comparison and benchmarking of administrative expenditures of mandatory pension schemes as part of national social security provisions. It presents results of a quantitative analysis that builds on a framework developed around the extensive body of literature on both public and private pension programmes surveyed as part of this analysis. Our dataset includes over 100 observations and a broad set of explanatory variables. We developed and compared a number of standardized cost indices discussing their advantages and limitations. We also discuss major cost components and their shares in total programme costs. The regression analysis explains over 90 per cent of variation in administrative expenditures. It confirms some of the hypotheses expressed in the earlier studies and presents new evidence of driving factors for costs. We developed three different specifications for statistical analysis. The first set looks at the impact of design of a programme on total costs. The second group of specifications assesses differences in costs of managing pension liabilities between the public and private mandatory pension schemes. Finally, on the basis of the third model we generate benchmarks for staffing levels and for the total administrative expenditures, providing guidance for policy analysis and recommendations. Notably, the spread between low and high benchmark estimates for programmes of the same size and operating in the same economic environment can be four-fold and is driven by parameters of design and operation (for example, asset management function, in-house collection, or operation of special supplementary schemes). Therefore, inferences about the level of administrative expenditures should always be done keeping in mind the institutional context for each programme.