Transcript Slide 1

Extending social security to the poor
Wouter van Ginneken
Antwerp, 18 December 2003
Outline of presentation
1. Social security shortfalls: Extent and
reasons
2. Social security and poverty
3. Extending health insurance
4. Global campaign on social security and
coverage for all
5. Conclusions
1. Social security shortfalls:
Extent and reasons
• Definition of social security: ensure access to
health care and guarantee income security
(contributory and tax-financed systems)
• 5-10% coverage in low-income countries.
• Rising informal economy employment.
• Adjustment, governance and decentralization.
• Workers in the informal economy have different
priority needs and low contributory capacity.
2.1 Poverty, social security and other social policies
Needs and capabilities
Social security
Other social policies
Risks related to employment capacity and family cohesion
Unemployment
Unemployment (insurance)
benefits
Regulatory and other labour market
policies
Sickness, disability and
survivors
Social (insurance) pensions
Care, rehabilitation and
reintegration; safety & health
Old-age
Social (insurance) pensions
Home help; old people’s homes
Family cohesion
Maternity, child and family
benefits
Child care; parental leave
Subsistence
Tax-financed benefits
Social work; anti-poverty policies
Health
Health insurance
National health service; health
policy
Education
Fee waivers
School meals and books; education
policy
Housing
Rent and energy subsidies
Social housing
Food
Food stamps and subsidies
Food aid
Basic needs and capabilities
2.2 Social security:
micro and macro impact
Micro-impact:
• Supports employment capacity and family
cohesion (f.e. health & maternity protection)
• Income security in case of lack of
employment capacity
Macro-impact:
• Social cohesion (through security and social
dialogue), leading to predictable economic
situation (investment climate and acceptance
of structural change).
3.1 Extending health insurance:
middle-income countries
• The achievers: South Korea and Costa Rica
(political commitment, public expenditure and
formal labour force).
• Striving for universal coverage: Colombia and
Tunisia (fast-track versus gradualist; effective
design and organization; constitutional
commitment).
• Policy issues: (i) when to go for universal
compulsory coverage? (ii) how to deal with
the self-employed? (iii) impact of voluntary
associations.
3.2 Low-income countries: The
emergence of micro-insurance
• Efficient solution to immediate needs
• Coordination network (« la concertation »)
between mutual health organizations in 11
West African countries.
• How to up-scale: training in design and
management; monitoring and regulation;
co-financing arrangements; re-insurance.
3.3 The potential of districtbased schemes
Actors: district government, civil society, social partners,
health care providers
Advantages of district-level approach:
• Greater social control
• More effective management options
• Greater chance to achieve universal coverage
Developing district-based schemes:
• Establish unsatisfied demand for health care
• Design an overall system that covers everyone, in a
process of social dialogue
• Experiment with various extension mechanisms.
4. The global campaign on social
security and coverage for all
Knowledge development
• Research (best practice, ESS Papers)
• New mechanisms (experimenting with
community - and district - based HI schemes)
Technical cooperation
• Extension through social dialogue (Mali,
Honduras and Sri Lanka)
• Basic social pension (Global Social Trust).
Partnerships
• African initiative for 2004.
• Health care coverage in Latin America
5. Conclusions
• Social security and poverty
• Extending Health insurance: combination
of top-down and bottom-up approaches
• Global Campaign on Social Security and
Coverage for All