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.
This article evaluates the implementation of the Child Grant, one of the major social protection interventions in Nepal, and identifies bottlenecks that limit its ultimate effectiveness. On the whole, while delivery works for many beneficiaries, we found inconsistencies between the way the policy is laid out on paper, and the way it is actually implemented. Targeting efficiency is high, despite the wealth targeting criterion not being applied in practice. Owing to informal awareness-raising campaigns, beneficiaries’ knowledge on registration, eligibility and entitlement is patchy. Payment levels vary and tend to be infrequent. These implementation bottlenecks limit the Grant’s effectiveness and temper some of its impact potential.
Chile pioneered in Latin America not only the introduction of social security pensions, but the structural reform that privatized them and a process of “re-reform” implementing key improvements. A Presidential Commission in Chile, appointed in 2014 to evaluate reform progress and remaining problems in the pension system, released its report in September 2015. In light of the Commission’s findings, the article assesses Chile’s compliance with International Labour Organization social security guiding principles: social dialogue, universal coverage, equal treatment, social solidarity, gender equity, adequacy of benefits, efficiency and affordable administrative cost, social participation in management, state role and supervision, and financial sustainability. The exercise follows three stages: the structural reform (1981–2008), the re-reform (2008–2015), and the Presidential Commission proposals (2015)
With social security provisions in Kenya remaining under-reported in the more recent literature, this overview covers recent reforms in key areas of the country’s social security system. In the health sector and in old-age pension provision social security is still mainly workerist (biased toward those in formal employment), and attempts to expand coverage have had limited effect only – cash transfer programmes, for instance, have been expanded but in practice they do not universally cover the entitled categories. Thus, although the Kenyan social security system now has a considerable pro-poor social assistance component it remains biased toward those in formal employment, to the benefit of the highest income quintile.
In the context of the reform of defined benefit pension systems under population ageing, we focus on the introduction of automatic adjustment mechanisms linked to life expectancy. Our goal is to establish a relationship between changes in the key parameters of the pension system and changes in life expectancy, applying the principle of intergenerational actuarial neutrality. For a defined benefit pension scheme, we first obtain the fundamental adjustment equation and then, for particular cases, we derive different designs of automatic adjustment mechanisms depending on the involved parameter. We include a numerical application only for illustrative purposes.
This article analyses the health care system reform process in Europe based on the concept of privatization. This notion is understood from two perspectives. First, privatization may concern the health care financing or the provision of health services. Second, privatization can be “imposed” on individuals or be “internalized” and then introduced by individuals (patients and doctors). So we emphasize the diversity that privatization can assume. We classify privatization mechanisms used by different countries and identify which of the perspectives presented are more common in 14 European Union countries since the 1980s. The article shows that even if privatization processes are widespread, they assume different patterns in each country.