First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
This article reviews the recent literature on existing mechanisms that allow for the portability of social security entitlements for migrant workers and finds that North–North migrants have the best access to portability. There is limited coordination between origin and destination countries regarding the portability of social entitlements of South–North migrants. These migrants are dealing with discourses and policies that treat them as second class citizens, even as they are providing much-needed labour to their host countries. South–South migrants are seeing new regional mechanisms addressing portability. However, many of the impacts of these mechanisms are not yet known. Other knowledge gaps on portability relate to internal and South–South migration, the role of gender and other social identities, migrants' occupations as well as their legal immigration status.
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.
Japan and the Republic of Korea achieved universal health insurance coverage for their populations in 1961 and 1989, respectively. At present, Japan continues to operate a multiple‐payer social health insurance system, while the Republic of Korea has moved to an integrated single‐payer national health insurance structure. This article analyzes the influence of political economy in shaping the policy divergence found between these two Bismarckian health insurance systems. Issues addressed include differences in political power, the policy influence of business, the extent to which regional autonomy has developed and regional traits have been preserved, the level of political democratization, the form of political leadership, and the scale of development of the health insurance system. The article offers policy lessons derived from the two countries' experiences.
One of the main challenges facing social policy in Latin American is to guarantee social security coverage for the entire population in the presence of a large informal sector. In Argentina, a regional pioneer in terms of the development of its pension system, more than one third of those of retirement age were without benefits in 2005. Since then, considerable progress has been made in extending coverage thanks to the introduction of a programme that has reduced contribution requirements and allocated benefits to a large number of seniors previously excluded from the system. This article analyzes the impact of this process in Argentina on the level and distribution of coverage, identifies changes in socio‐demographic factors which affect inclusion/exclusion in the social security system, and discusses remaining obstacles to the provision of universal coverage in the medium and long term.
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.
This article discusses the process, results and implications of a financial feasibility assessment of social health insurance (SHI), as one part of Lesotho's exploration of how to move towards achieving universal health care coverage. Quantitative data from government and other sources, and qualitative data from discussions with stakeholders, were entered into SimIns, a health insurance simulation software, through which SHI revenue and expenditure for 11 years was projected. In principle, the assessment reveals that through a mix of tax financing and SHI contributions, all citizens of Lesotho could be covered with a defined benefit package of health services under the defined policy assumptions. Such a financing scheme would provide financial risk protection and enhance equity in access and health financing.
Access to social protection differs widely among international migrants. This article focuses on the issue of earnings‐related contributions to social security programmes and their (frequent) lack of portability across borders — a problem that particularly affects South‐South migrants. Furthermore, attention is drawn to the fact that in many low‐income countries a lack of administrative capacity in the operation of social security programmes is often, in the first instance, a greater problem than the lack of portability of any potential earned rights to cash benefits provided under them. Commonly, the inability of migrants to benefit, both from social security programmes that are in place in the country of origin and in the host country detracts significantly from the well‐being and security of migrants and their families. The article concludes that South‐South migration must be understood as being significantly different from North‐North migration, where social protection issues are much more tractable.