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PubMed1999

[Welfare and health in the century of social security].

Great achievements for public health in this century include penicillin, oral contraception, vaccination and transplantation, but the greatest contribution to the health of Norwegians may have been made by social security and the welfare state policies. The beneficial effects of social security include: less social inequality, a factor which in itself makes for better health, some degree of financial security for people who are ill and unable to support themselves or their families, universal availability of medical and health services. This paper explores the ideas and sources from which present-day social security legislation stems. The emergence of state based welfare legislation was inspired by developments in Germany under Bismarck; accident insurance for industrial workers was the first to be introduced in 1894. Several periods of active social security legislation followed at times when labour unions and socialist ideas were strong, supported, to some degree, by radical clergy and public health doctors. Social democratic governments, inspired by the British Beveridge plan towards the end of World War II, took the lead during the long post-war period until the mid 1970s. The Scandinavian model of social security is based on universal coverage and a single payer system. However, since the 1980s, as in other countries of Northern Europe, the social security system has come under pressure from market liberalism. Now at the turn of the century, increasing social inequalities cause some concern for the future of the welfare state.

Europe↗
PubMed1999

[Generic drugs and right of substitution. Relating to Article 29 of the 1999 *social Security Financing Act].

The 1999 Social Security Financing Act grants the right of substitution to pharmacists. If the prescriptor does not object, the pharmacist can replace a medicine by its generic. After reiterating that generic medicines are essentially similar but not strictly identical to the original or to each other, we analyze the discussions which took place at the National Assembly and Senate which should have resulted in some further modifications to the recently adopted legislative text.

Drug Prescriptions↗
PubMed1992

The development and use of industry data by the Social Security Administration.

Over the past few years the Social Security Bulletin has published a series of technical articles that describe various Social Security Administration (SSA) data files. This article provides an overview of SSA's industry-related data files and statistical systems from both a current and a historical perspective. The author begins by explaining how SSA first collected business data from employers (starting in 1937) as a by-product of the requirement that employers report employee wages for benefit computation purposes. She describes the administrative methods by which the data are collected, SSA's coordination of its activities with other agencies, the data collection forms used, the scheme by which the data are coded, and the employer files into which the data are classified. In her closing, the author provides examples of the various uses of the industry data and the ways that these data relate to SSA's statistical program needs and to those of other agencies as well.

Data Collection↗
PubMed1980

Worldwide trends in social security, 1979.

The data in Social Security Programs Throughout the World, 1979 indicate that new programs and improved benefits continue to be developed in many countries to increase protection against the economic consequences of old age, invalidity, sickness, work injury, unemployment, and death. A comparison with previous reports in the series reveals that payroll contribution rates have generally been raised to pay for the increased costs generated by improved programs coupled with inflation. Financial difficulties have frequently been compounded by a deteriorating ratio of contributions to beneficiaries as the growth of active workers tends to shrink and that of retirees to rise. As a supplement to higher contribution rates, some countries have sought to meet financial requirements by a number of measures, including expansion of the proportion of earnings subject to contributions, cutbacks in certain benefits, tighter controls on eligibility, and a search for ways to reduce expenses, particularly in the health care area. Also noteworthy are the greatly increased efforts being undertaken worldwide to attain equal treatment of men and women.

Europe↗
PubMed1999

The social security scheme in Thailand: what lessons can be drawn?

The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

Capitation Fee↗
PubMed1997

Retooling Social Security for the 21st century.

Because of the imbalance between promised benefits and available taxes, some reform of Social Security is inevitable. At the same time, perceptions of Social Security are changing rapidly as it moves away from a system where all recipients--whether rich or poor--received more in benefits than they paid in taxes, and where those who were richer consistently received larger net transfers than those who were poorer. Reform is most likely to succeed if it returns to basic principles such as progressivity, equity, and efficiency. Although these principles sometime conflict, they also provide much common ground. For example, if Social Security is meant to meet the greatest needs of the elderly, then increasing the retirement age (which mainly affects the younger and richer elderly) would be preferable to removal of the cost-of-living adjustment (which mainly affects the older and poorer elderly). Efficiency and equity principles, in turn, call attention to some groups--second earners in households, those with few employee tax preferences, those who work many years, and elderly workers--whose net benefits are lower than others who should have less claim to Social Security resources.

Aged↗
PubMed1993

Treatment of women in the U.S. Social Security system, 1970-88.

This article, a reprint of a paper presented in 1988 to the International Social Security Association, traces the debate from 1970 through 1988 over treatment of women in the Social Security system. It traces issues relating to working women, couples with two earners, homemakers, widows, and divorced women. It describes the debate that led to widespread support for the concept of earnings sharing. It then addresses the paradox that despite continued widespread support for earnings sharing, despite continuation of the factors underlying its proposal, by 1988 no comprehensive legislation related to the treatment of women under Social Security had been enacted nor was being generally contemplated. This is still true in 1993. The article argues that apparently insoluble, inherent conflicts among the objectives underlying earnings sharing ultimately doomed its enactment. Cost considerations, the realization of unintended side effects, and issues relating to transition to a very different Social Security system also helped remove earnings sharing from the legislative agenda. The article also describes the role policy analysis played in the debate over this proposed reform.

Budgets↗
PubMed1984

Population age structure and the size of social security.

"This paper uses a general overlapping generations model to analyze social security. Rather than focusing on intertemporal price and income considerations, however, the paper focuses on the effect of contemporaneous (same period) prices and income. The analysis shows that the old-age dependency ratio acts as a shadow price for old-age benefits. With this new shadow price, the equilibrium price and quantity of social security benefits and the level of the payroll tax rate are determined in a demand-supply framework with individual utility maximization. Three explicit demand functions (intergenerational contracts) are analyzed. The model is tested using [U.S.] time series data for the social security Old-Age and Survivors (OASI) program."

Adult↗
PubMedDate not supplied

Lifetime distributional effects of Social Security retirement benefits.

This article presents three measures of the distribution of actual and projected net benefits (benefits minus payroll taxes) from Social Security's Old-Age and Survivors Insurance (OASI) for people born between 1931 and 1960. The results are based on simulations with the Social Security Administration's Model of Income in the Near Term (MINT), which projects retirement income through 2020. The base sample for MINT is the U.S. Census Bureau's Survey of Income and Program Participation panels for 1990 to 1993, matched with Social Security administrative records. The study population is grouped into 5-year birth cohorts and then ranked by economic status in three ways. First, the population is divided into five groups on the basis of individual lifetime covered earnings, and their lifetime present values of OASI benefits received and payroll taxes paid are calculated. By this measure, OASI provides much higher benefits to the lowest quintile of earners than to other groups, but it becomes less redistributive toward lower earners in more recent birth cohorts. Second, people are ranked by shared lifetime covered earnings, and the values of shared benefits received and payroll taxes paid are computed. Individuals are assumed to split covered earnings, benefits, and payroll taxes with their spouses in the years they are married. By the shared covered earnings measure, OASI is still much more favorable to persons in the lower income quintiles, although to a lesser degree than when people are ranked by individual covered earnings. OASI becomes more progressive among recent cohorts, even as net lifetime benefits decline for the entire population. Finally, individuals are ranked on the basis of their shared permanent income from age 62, when they become eligible for early retirement benefits, until death. Their annual Social Security benefits are compared with the benefits they would have received if they had saved their payroll taxes in individual accounts and used the proceeds to buy either of two annuities that provide level payments from age 62 until death: a unisex annuity that is based on the average life expectancy of the birth cohort or an age-adjusted annuity that is based on the worker's own life expectancy. On the permanent income measure, OASI is generally more favorable to people in higher income quintiles. Moreover, it is particularly unfavorable to those in the lowest quintile. Because people in the lowest quintile have a shorter life expectancy, they receive OASI benefits for a shorter period. This group would receive greater benefits in retirement if they invested their payroll taxes in the age-adjusted annuity. OASI is more favorable to them than the unisex annuity, however, OASI is becoming more progressive in that the net benefits it provides drop more rapidly among higher income quintiles than lower ones. This article also examines how OASI affects individuals by educational attainment, race, and sex. On both the lifetime covered earnings and the permanent income measures, OASI is more favorable to workers with less education and more favorable to women. The results by race and ethnicity are mixed. When people are ranked by the present value of their shared lifetime covered earnings, OASI appears more favorable to non-Hispanic blacks and Hispanics than to non-Hispanic whites. When people are ranked by shared permanent income in retirement, however, OASI produces negative returns for both non-Hispanic blacks and non-Hispanic whites in the most recent birth cohorts, with non-Hispanic blacks faring relatively worse. The changes across cohorts occur partly because of changes in tax rates and benefits, but more importantly because of changing demographics and earnings patterns of the workforce. Of particular importance is the increasing share of beneficiaries who receive worker benefits instead of auxiliary benefits as wives or widows. OASI benefits are based on the lifetime covered earnings of current or former married couples, as well as on earned retirement benefits of individuals. The reduced importance of auxiliary benefits (due to the higher lifetime covered earnings of women) and the increased proportion of divorced retirees make OASI more progressive--even as net benefits decline--for current and future cohorts than for cohorts who retired in the 1990s. Analysis of these findings suggests that simulations of policy changes in Social Security must take into account the decreasing importance of auxiliary benefits across birth cohorts and the complex changes in individuals' marital histories.

Actuarial Analysis↗
PubMed2004

Effects of macroeconomic trends on social security spending due to sickness and disability.

OBJECTIVES: We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability. METHODS: We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980-1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor's pensions, and total spending. RESULTS: A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings. CONCLUSIONS: Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.

Accidents, Occupational↗
PubMed1999

Who is "62 enough"? Identifying respondents eligible for Social Security early retirement benefits in the Health and Retirement Study.

Workers are not instantly eligible for Social Security retirement benefits on their 62nd birthdays, nor can they receive benefits in the month they turn 62. This note discusses how well researchers can do using data from the Health and Retirement Study (HRS) to identify respondents old enough to receive and report early Social Security retirement benefits. It shows that only some workers aged 62 at the time of an HRS interview will be "62 enough" to have received a Social Security benefit and reported it in the survey. In general, workers become eligible for a retirement benefit the month after they turn 62, and they may receive their first payment the month after that. Until recently, payments were received very early in the month, but in mid-1997 and later, the Social Security Administration (SSA) staggered benefit payments over the course of a month. Therefore, many beneficiaries will not be able to report the receipt of their first benefit payment until the third month after their birthday in more recent HRS interviews. This note describes the best approach for approximating the pool of HRS respondents who are old enough to have reported the receipt of their first retirement benefit. It then applies the procedure to an analysis by Burkhauser, Couch, and Phillips, who used the 1994 HRS data to distinguish between those who took early retirement benefits upon turning 62 and those who postponed the receipt of benefits. Because these authors did not provide for respondents who were not "62 enough" to receive a benefit at the time of the interview, they understated the proportion of respondents who took retirement benefits at age 62.

Age Factors↗
PubMed1996

Who takes early Social Security benefits? The economic and health characteristics of early beneficiaries.

Using the 1992 and 1994 Waves of the Health and Retirement Survey, we compare individuals who first take Social Security benefits at age 62 with those who don't and find that the income and net assets of these two groups are similar in the years just prior to eligibility. However, there is great diversity within the groups, so that poor health appears to be more closely related to lower economic well-being than is early Social Security acceptance status. Our results suggest that raising the Social Security retirement age is not likely to dramatically lower the economic well-being of the typical person aged 62 since only 3% of men aged 62 are receiving Social Security retirement benefits, are in poor health, and have Social Security retirement benefits as their only source of pension income.

Aged↗
PubMed1992

Developments and trends in Social Security, 1990-1992: overview of principal trends.

The article that follows is a reprint of Part I of a report presented by Dalmer D. Hoskins, Secretary General of the International Social Security Association (ISSA), to the organization's XXIVth General Assembly (November 1992, Acapulco). It identifies and interprets the major trends currently influencing the evolution of social security programs around the world, and analyzes these developments against the backdrop of the current economic, demographic, and social environment in which these programs operate. (Part II of the report analyzes the changes according to each major branch of social security; an annex to the report provides more detailed information and source citations in reference to these changes.) The ISSA is a nongovernmental international organization headquartered in Geneva, Switzerland. It is made up of 321 social security-related institutions, including the U.S. Social Security Administration, in 122 countries. The Association's aim is to protect, promote, and develop social security worldwide.

International Agencies↗