First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
To support the improved administration of social security programmes, this article presents a preliminary compliance risk management (CRM) model for social security institutions to use as a tool to help address the operational challenges of error, evasion and fraud. Within the model, error, evasion and fraud are collectively referred to as issues of non‐compliance. The model's framework addresses non‐compliance in an integrated manner with regard to the main functions of contribution collection and benefit administration. The model aims to facilitate tackling these important issues by better permitting the identified challenges to be prioritized and, thereafter, addressed based on the assessed severity of their impacts and the cost‐effectiveness of the selected responses. Three generic types of intervention are recommended to tackle non‐compliance worldwide: prevention, detection and deterrence. The article's objective is to contribute to ongoing work to develop an encompassing CRM framework for all social security systems.
This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy‐makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly‐available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions.
For a number of years, the Dutch, German and French health insurance systems have been attempting to contain costs and diversify their sources of finance, which traditionally have come mainly from social contributions. Diversification may involve broader‐based public finance, as well as greater recourse to private resources and operators. In the case of the Netherlands and Germany, the reforms go hand in hand with efforts to introduce competition between health insurance bodies. In France, private complementary insurance has become indispensable for adequate access to health care. However, these measures have repercussions for redistribution, which social assistance programmes have difficulty in addressing.
A frequently used indicator to measure social health protection performance is the extent of population coverage as stipulated in national legislation. However, this indicator does not provide meaningful information on performance in terms of effective access to benefits that are available, affordable and of acceptable quality, not least for the poor and workers in informal economies. This article proposes a new approach to measuring performance by applying a set of relevant indicators in an analytical framework for assessing the performance of social health protection. The approach allows policy‐makers to conclude from comparisons among groups of countries facing similar challenges. Preliminary results include comprehensive information on deficits that need to be addressed when striving for effective universal coverage. With further refinement, the suggested approach could become a standard assessment tool for measuring performance.
Ghana and Nigeria recently joined a number of countries that have incorporated fully‐funded defined contribution pension programmes into their national social security arrangements. Contemporary analyses of pension reforms, however, continue to focus on middle‐income countries in Latin America and Central and Eastern Europe, as well as on Member States of the Organisation for Economic Co‐operation and Development, thereby marginalizing recent pension policy reforms in sub‐Saharan African countries. This article examines the complete and partial shifts to defined contribution pension programmes in Nigeria and Ghana respectively, and points to a number of contextual and contingency factors that challenge the use of defined contribution schemes as a means to address problems of benefit adequacy in the sub‐Saharan African context.