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.
Studies on the social protection of platform workers in Spain have focused on the bike couriers (or “riders”) who deliver meals to customers’ homes and whose services are used by some of the best-known platforms on the country’s social and economic scene. Most of these workers are covered by the social security scheme for self-employed workers. However, a Supreme Court ruling issued on 25 September 2020 reclassified the relationship between Glovo and its couriers as a contract of employment. This decision has changed the outlook for platforms and prompted the Spanish Government to regulate platform work in Spain. Nonetheless, the government ruling is limited to couriers, whereas, in reality, the issue is much broader. In this article, we look at the current reality of Spain’s platform workers vis-à-vis the social security system and the latest court rulings.
In the Netherlands, the social security rights of platform workers have still not been formally defined. At present, the level of social security protection accorded to all workers is derived directly from the labour law qualification. In the continuing absence in the Netherlands of specific legislation for platform workers, specifically as regards labour law and social security law, the existing legislation is steering. This means that the platform worker is either included using the status of employee with the corresponding extensive protection package, or the status of self-employed with limited social protection. For the majority of platform workers, this second option is applied to date. Nevertheless, recent developments point to possible improvements in the social security position of platform workers in the Netherlands.
This article compares social security coverage for the self-employed and for employees on digital platforms in Switzerland. It sheds light on the particularities that have acted to slow down the evolution of Swiss social legislation to the new emerging forms of work, and summarizes the solutions provided by case law. These solutions are still being fine-tuned, but lean towards the reclassification of contracts as salaried work. Finally, despite the hesitance of the Swiss authorities to take political steps to encourage these new forms of work, which offer significant economic potential, and while also seeking to prevent the risk of precarity in work, we discuss the options available.
In a changing world of work, platform workers struggle to gain adequate protection, and effective access to the benefits provided by the social security system form a part of this. Social security benefits in Romania are particular in that access is based on a person having a professional income, regardless of the legal status of the worker (subordinate or self-employed). As a rule, all workers are covered in the event of illness and changing family circumstances as well as for pensions. In contrast, coverage for self-employed workers for unemployment benefits, workplace injury and occupational disease benefits, paid leave in the event of illness, protection against the risks related to pregnancy or to care for a sick child is voluntary. Given the diffusion of platform work, the article addresses the specific situation of platform workers in Romania, formally covered by the social security system, but who face obstacles related to eligibility criteria, administrative formalities, the risk of the automatic termination of work and intermittent work patterns.
Platform work confronts traditional social security law in two dimensions. First, it makes the distinction between dependent and independent work uncertain and unclear, as the borderlines between these blur. This is a profound challenge for social security law, because the criteria of dependent and independent work have to be precise. In the determination of work as dependent or independent, German law illustrates that a shift has taken place in determining employment status, moving from external and objective criteria to the contracting parties’ decision, which is to be executed under private law, but also respected under social security law. Second, platform work is heavily intertwined with digital communication, which has established a global environment for communication. Thereby, platform work can also facilitate international trade by making transnational work more accessible and efficient. Therefore, it seems necessary to examine the implications of platform work in international law. International law makes possible the choice of law, executed by the contracting parties. As a consequence, the protection of employees by social security law is related to the private law arrangements between the service provider and the service recipient. Gaps in social security protection of service providers are widespread. In many countries, awareness of the social protection deficits of platform workers has grown and responses to improve the social status of platform workers have come under scrutiny. Analysis reveals that there is a joint responsibility of the service provider and the service recipient to be bound to social security coverage under the same national legislation. Nevertheless, from an international law perspective, it is shown that reforms are confronted with restrictions under international law.
Are online platform “workers” in Denmark effectively and adequately protected against social and labour market risks? This article discusses this fundamental issue in the context of the Danish labour market, which is known for having high levels of job insecurity but a rather generous social security system. The article finds that the Danish statutory social security system provides a necessary cushion against risk, but also identifies gaps in protection, which brings into question the system’s effective coverage and the adequacy of benefits.
This article highlights the debate on social security regimes applicable to platform workers in Italy. As social security regimes differ according to the type of employment or self-employment relationship, Italian case law dealing with platform workers’ employment status will be illustrated. Italian legislation, case law and collective bargaining on health and safety at work will then be presented, clarifying the coverage to which platform workers are entitled in the event of accidents at work and occupational diseases, with a focus on the COVID-19 pandemic impact. In turn, the two main Italian minimum income schemes and the related scholarly debate will be outlined, as well as their impact on the ability of digital labour platforms to avoid their responsibilities as regards workers’ rights, including access to adequate social protection.
This special issue of the International Social Security Review addresses the important topic of social protection for digital platform workers in Europe. The special issue highlights the risk that social protection systems may be largely undermined by a decline in social solidarity in favour of individualism, the partial or full privatization of social security, and a reduction in protection levels, all as a result of the emergence of digital platforms and the support they receive from legislators in most countries.
Addressing the social protection of platform workers, the French legislator in 2016 and then in 2019 made moves to incorporate these workers into the general social security regime with regard to certain covered risks (work injury and occupational diseases), and to improve adequacy (enabling possible access to complementary coverage). However, these moves rest on radically opposed perspectives. Rather than reasserting the legal responsibility of the employer vis-à-vis workers’ health and safety, we see responsibility placed with the platform, but only on a voluntary basis under the aegis of corporate social responsibility. This risks fragmenting social benefits, to be determined by each platform, thus weakening the practices of mutual protection and risk pooling among enterprises and workers that lie at the heart of social security. In doing so, the legislator has broken the link that had as its historic objective the goal of social inclusion and has encouraged in different ways the privatization, or a re-commodification, of social security in the commercial interest of private insurance companies. Moreover, this has been done using the Trojan Horse of the French labour code. This approach is in contrast to the converging position of international organizations, such as the European Union, International Labour Organization or the Organisation for Economic Co-operation and Development, recommending that States establish a right to social protection for all atypical workers and non-salaried workers. Instead of identifying the common challenges that face workers who work for platforms, and offering responses specific to their situation, rather, it considers platform work as one of the new forms of atypical work undertaken by those who may have the status of employee or self-employed.
The right to social security is enshrined in article 23 of the Belgian Constitution. It is the role of the legislator to implement it, to guarantee the right of all to lead a life in accordance with human dignity. Studies show that platform workers face major difficulties in terms of social protection. The aim of this article is to highlight the limits of existing legislative provisions regarding their ability to implement the fundamental right to social security for platform workers. With regard to these legislative provisions, we are interested in both the general regulations that shape the Belgian social security system and the recent measures adopted by the Belgian legislator with regard to the so-called sharing economy. An analysis of these provisions reveals that a number of platform workers are excluded from social security, both de facto and de jure. At the very least, this raises the question of whether the Belgian legislator is complying with the positive obligation to fulfil the constitutional right to social security for platform workers, and the negative obligation, at least, not to undermine it.