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.
As part of international efforts framed by the Sustainable Development Goals (SDGs) to extend sustainable and adequate social security coverage, social security systems are increasingly looking to deliver holistic policy responses that meet the different needs of people across the life course. To achieve these objectives globally, not only must the design and goals of social security programmes be recalibrated but significant investments in the health workforce are required. Yet, a fundamental challenge is the current and projected mismatch between the global supply, demand, and need for health workers. A number of critical issues require attention: the need for more and better investments in the health workforce; recognition that the health workforce is not gender neutral and that policies that appropriately recognize, value, and reward women’s work in health are of utmost importance; and that political will at the highest level and action across sectors is necessary to allow the required changes.
The development of social security policies and programmes raises the need for their coordination to enhance effectiveness as well as to prevent the fragmentation of social policies, programmes and services. Although there are expected benefits, implementing coordinated programmes poses significant technical challenges, which increase the complexities and costs of projects and hinder the achievement of such initiatives. Some of the main difficulties are related to system and information integration (Interoperability) as well as the ability to enforce data security and privacy regulations. To help meet such challenges, the International Social Security Association (ISSA) has developed Guidelines on Information and Communication Technology to support the integrated ICT-based implementation of social programmes. This article reviews existing scenarios, discusses the benefits and challenges of coordinated approaches, and offers models to show how to implement such types of systems while applying the ISSA Guidelines.
The concept of integrated services is a common feature of current social policy discussions. It is often argued that social support systems have not evolved to cope with the complexity of individuals’ needs. This is deemed true for a variety of interrelated difficulties that cut across traditional welfare programmes and life course lines. This article examines the efforts of integrated services to bridge policy areas such as social policy, labour market policy and health care services for four different vulnerable groups at major stages of the life course: childhood, youth, adulthood and old age. Analytically, the article adopts a framework developed by Valentijn et al. (2013) that allows systematic comparisons. Using mainly high-income economy examples, the article connects key features of a certain policy area with key elements of integrated services. Key features of a policy area direct attention to the function of the policy area, and these are expressed through the framework of “person-focused” and “population-focused” services. Key elements of integrated services in turn emphasize levels of integration (macro, meso, micro level). Central questions addressed are the character of integration efforts for vulnerable groups at different stages of the life cycle and how variations therein can be understood. As a complement, sociological explanations of individual vulnerability, which are separated by causes of vulnerability into basic, conditional and triggering factors, are also used. A main finding is that the life course perspective as such does not explain variation in integration efforts; rather, it is the institutional features of the specific policy areas. These constrain or promote the potential for greater integration.
The concept of nudge theory, from the fields of behavioural science, political theory and behavioural economics, has sparked government initiatives yielding significant public value. A nudge is a method for predictably altering behaviour without restricting consumer choice options or significantly changing incentives. Nudges work by leveraging default human behaviour such as the tendency to take the path of least resistance when exercising choice. Government agencies have run many successful trials with simple textual nudges designed to positively influence behaviours such as tax compliance, voter registration and student attrition. This article develops the concept of the digital nudge in social security administration. The digital nudge leverages predictive analytics technology within a digital government framework to support a social investment policy approach. Based on a literature review of nudges within a digital government context, the article identifies examples of innovation within social security administration where nudges are contributing to better social outcomes. At the same time, concerns regarding ethics and privacy are identified as nudges are applied at the individual rather than the population level. The use of data and personal information to drive the nudge process has to be managed in such a way that individual rights are protected. This requirement has to be reconciled with the broader interests of society in achieving affordable outcomes, the parameters of which are determined through the political process.
Social security systems around the world evolved at different times, at different speeds, for often very different needs. But now each country faces a universal truth: their social security organizations must be truly adaptive, ready to deliver a new type of service at a time of constant technological and social change. Each social security system is approaching this daunting task in their own way – a grand social experiment in how agencies can provide a proactive, personalized service that meets their citizens’ ever-changing needs. The results are simply unknown. This article intends to start the debate on what is and is not working, and indeed on how agencies should measure their progress in moving away from the traditional transactional model. The challenges they face are immense. Populations are ageing and social security budgets are shrinking. Meanwhile, the pace of digital change is matched only by the soaring rate of customer expectations. But the opportunities are of similar scale. Advanced technology, automation and new partnerships between public-sector agencies promise a much smarter, more insight-driven service for all. Technology is only one side of this equation. As part of rethinking their entire mission, social security agencies will need new workers with new sets of skills, and for their existing workers to adapt and embrace their changing roles. None of this will be straightforward. Whatever the original purpose of the social security organization, it has now changed irrevocably. But with the right combination of talent and technology, agencies can aspire to a new model: one that is flexible enough to withstand economic and social shock and resilient enough for the challenges that lie ahead.
The article summarizes four corridor studies on bilateral social security agreements (BSSAs) between four European Union (EU) members that were undertaken to assess their working and the establishment of benefit portability. BSSAs between migrant-sending and migrant-receiving countries are seen as the most important instrument to establish portability of social security benefits for internationally mobile workers. Yet, only about 23 per cent of international migrants profit from BSSAs and their functioning has been little analyzed and even less assessed. The four corridors studied (Austria-Turkey, Germany-Turkey, Belgium-Morocco, and France-Morocco) were selected to allow for comparison of both similarities and differences in experiences. The evaluation of these corridors’ BSSAs was undertaken against a methodological framework and three selected criteria: fairness for individuals, fiscal fairness for countries, and bureaucratic effectiveness for countries and migrant workers. The results for pension portability suggest that the investigated BSSAs work and overall deliver reasonably well on individual fairness. The results on fiscal fairness are clouded by conceptual and empirical gaps. Bureaucratic effectiveness would profit from information and communication technology-based exchanges on both corridors once available.
This 2016 special issue addresses the topic of excellence in social security administration. For the International Social Security Association, “excellence” is most usually associated with ensuring that the technical processes and administrative procedures that underpin the delivery of social security benefits and services are high-performing, well-governed and sustainable. But it also refers to the covered population’s perceptions of the quality and adequacy of the services and benefits provided. The academic literature on “social security” is immense, but the larger part of this published research addresses questions of social security theory and policy. The critical, analytical literature on social security administration, including that which marries theoretical analysis with the empirical evidence of administrative performance, is thus smaller. A major aim of this special issue is to make a contribution to redressing this imbalance. This is done not only to support and stimulate research that draws equally on empirical evidence and the theoretical literature, but in a very practical sense to better take into account and provide responses to the increasingly complex operational challenges facing social security administrations.