The new Law on Social Protection (LSP in further text) in the Republic of North Macedonia was adopted in 2019 as part of a social reform process in line with the key strategic goals within the social protection system. The main aspects of the new regulation focus on types, procedures and realization of social protection activities, the system, organization and institutional framework of social protection, as well as cadres, financing and oversight and other issues of importance for realization of social protection. The new LSP introduced many systemic changes which are reasonably interlinked in the text and provide for unhindered accomplishment of the key ongoing processes in social protection, such as deinstitutionalization, decentralization and pluralization in social services delivery. This article aims to identify impact and challenges related to implementation of the new social legislation, with focus on delivery and financing of social services. The content of this paper is a result of an analysis conducted in 2021 based on qualitative methodological approach and application of techniques of content analysis of relevant laws, bylaws, statistical data, reports, as well as expert interviews with representatives from relevant institutions โ Ministry of Labour and Social Policy, Institute for Social Activities and representatives from national social service providers (public and private).
Joan CostaโFont, Cristiano Gori, Silvina Santana
The progressive ageing of the European population and the transformation of family care giving arrangements bring to the fore the question of how best to Finance long-term care (LTC). Particularly important is the specific financial organization of LTC systems when both social and demographic constraints compete with economic motivations to rationalize public insurance schemes. LTC provides support for old age dependants that need some health care, but primarily social care. However, Southern European countries are facing the paradox of health care being a top policy priority as in almost all European countries, whilst social care is nearly privatized or has been heavily decentralized to local authorities, and subject to means- as well as needs-testing (Costa-Font and Font-Vilalta, 2006; Gil, 2009; CostaFont, 2010a; Santana, 2010). Private financing is primarily dominated by intra-household interactions and self Financing. The role of private financing alternatives is developing in some countries such as Spain, but is still far from taking off. These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
David E. Bloom, Ajay Mahal, Larry Rosenberg, Jaypee Sevilla
Abstract The rapid ageing of India's population, in conjunction with migration out of rural areas and the continued concentration of the working population in the informal sector, has highlighted the need for better economic security arrangements for the elderly. Traditional family ties that have been key to ensuring a modicum of such security are beginning to fray, and increased longevity is making care of the elderly more expensive. As a result, the elderly are at increased risk of being poor or falling into poverty. In parallel with its efforts to address this issue, the Government of India and some of the Indian states have initiated an array of programmes for providing some level of access to health care or health insurance to the great majority of Indians who lack sufficient access. Formalโsector workers have greater social security than those in the informal sector, but they only represent a small share of the workforce. Women are particularly vulnerable to economic insecurity. India's experience offers some lessons for other countries. Although there is space for private initiatives in the social security arena, it is clear that most such efforts will need to be taxโfinanced. The role that private providers can play is substantial, even when most funding comes from public sources, but such activity will face greater challenges as more individuals seek benefits. India has also shown that implementation can often be carried out well by states using central government funds, with a set of advantages and disadvantages that such decentralization brings. Finally, India's experience with implementation can offer guidance on issues such as targeting, the use of information technology in social security systems, and human resource management.
Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article investigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and grade-for-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services.
Many low and middle-income countries have decentralized their public health services in an effort to improve their equity, efficiency and effectiveness. This paper presents a case study of a poor rural county in China that devolved finance and management of basic health services to townships, the lowest level of government. It finds little evidence that townships mobilized additional financial resources or that they were able to address major management problems effectively. It cautions against unrealistically rapid decentralization of health services in poor rural areas. Copyright ยฉ 2000 John Wiley & Sons, Ltd.
Advanced industrial countries around the world are making or contemplating major reforms of their systems for financing and organizing long-term care for the elderly. The paper describes major reform efforts including: the pursuit of cost efficiencies from further differentiation of the acute and long-term care delivery systems, promotion of home and community-based care alternatives to traditional institutions, and โsystems integrationโ involving consolidation of responsibility for long-term care at one level of government. The paper concludes by discussing the special relevance to the long-term care reform debate in the U.S. of recent British and German decisions to, respectively, decentralize versus centralize responsibility for long-term care.
The Korean family planning program from 1964 to 1968 is considered in its entirety. The program is financed primarily by Korean government appropriations (averaging about $2 million in past years from central and local budgets) but also is supported substantially by foreign agencies such as the Population Council SIDA and AID. The Planned Parenthood Federation of Korea working in cooperation with the government is financed by about $200000 yearly from Korean government and foreign sources. The program has offered the IUD condom and vasectomy to every couple without charge. Accomplishments include adoption of the loop or vasectomy by 1/3 of couples with wife below age 45 elicitation of the best response among illiterate and low-income families and in rural areas reduction of crude birth rate by roughly 10% as of 1968 by IUDs inserted through mid-1968 and launching a pill program for IUD drop-outs starting with an unknown method a population of 30 million was informed of it and their approval won. Approaches used in the program have included strong governmental policy; implementation through the existing health structure; decentralization of functions to local and provincial government levels; payment by government of physicians and fieldworkers involved as well as vasectomy acceptors for work lost; high fieldworker density; fixation of target quotas with positive and negative sanctions on workers; and full use of mass media. Problems to be dealt with involve funding doctorless and remote areas and termination rates. The problems have been obtaining the funds; areas that are doctorless and that are remote; the training of workers; funds for maintenance and supply systems; shortcomings of the present contraceptive methods; and the changing of field-worker duties.
Open access
Diverse Approaches in Healthcare and Education Studies