First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
In 2019, the Government of Egypt issued a new legal framework for its social insurance system. Aside from providing a unified scheme covering different groups of workers, the new regulation allowed for systemic and parametric reforms that were aimed in large part at addressing the challenge of workers’ low enrolment in social insurance, with an emphasis on informal workers. The reforms reduced the rate of contributions paid by employees and employers, increased the penalties for employers who do not register their workers, and improved the benefits structure. The law also specified provisions to facilitate the enrolment of informal workers by offering to cover the employer’s share of their contributions. However, the law limited such improved access to nine specific categories of informal workers, a decision that fails to recognize the diversity of informal forms of work. Based on the analysis of the characteristics of contributors to the previous system, this article argues that structural barriers pertaining to the large numbers of low-earners and informal enterprises in the economy will likely hinder the expansion of system enrolment despite the legal reforms.
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.