Supplemental Security Income enrollment and health care and social assistance employment and wages.

We examine the relationship between disabled working-age Supplemental Security Income (SSI) enrollment and health care and social assistance employment and wages. County-level data are gathered from government and other publicly available sources for 3144 US counties (2012 to 2015). Population-weighted linear regression analyses examine associations between each health care and social assistance employment and wage measure and SSI enrollment, controlling for factors associated with health care and social assistance employment and wages. Results show positive associations between county-level percent of the population enrolled in the SSI program and health care and social assistance employment and wages with strong associations identified for social assistance employment. A one standard deviation increase in SSI enrollment is associated with a 5.6% increase in the health care and social assistance sector employment percent compared with the mean and 9.7% and 7.3% increases in health care and social assistance sector employment and wage shares, respectively, when compared with the means. We find working-age adult SSI enrollment is positively associated with employment outcomes, primarily in the social assistance organization subsector and in lower wage paying jobs. Evolving federal disability policy may influence existing and future SSI enrollment, which has implications for health care workforce employment and composition.

The growing disconnect between food prices and wages in Europe: cross-national analysis of food deprivation and welfare regimes in twenty-one EU countries, 2004-2012.

OBJECTIVE: Food insecurity has been rising across Europe following the Great Recession, but to varying degrees across countries and over time. The reasons for this increase are not well understood, nor are what factors might protect people's access to food. Here we test the hypothesis that an emerging gap between food prices and wages can explain increases in reported inability to afford protein-rich foods and whether welfare regimes can mitigate its impact. DESIGN: We collected data in twenty-one countries from 2004 to 2012 using two databases: (i) on food prices and deprivation related to food (denoted by reported inability to afford to eat meat, chicken, fish or a vegetarian equivalent every second day) from EuroStat 2015 edition; and (ii) on wages from the Organisation for Economic Co-operation and Development 2015 edition. RESULTS: After adjusting for macroeconomic factors, we found that each 1 % rise in the price of food over and above wages was associated with greater self-reported food deprivation (ß=0·060, 95 % CI 0·030, 0·090), particularly among impoverished groups. However, this association also varied across welfare regimes. In Eastern European welfare regimes, a 1 % rise in the price of food over wages was associated with a 0·076 percentage point rise in food deprivation (95 % CI 0·047, 0·105) while in Social Democratic welfare regimes we found no clear association (P=0·864). CONCLUSIONS: Rising prices of food coupled with stagnating wages are a major factor driving food deprivation, especially in deprived groups; however, our evidence indicates that more generous welfare systems can mitigate this impact.

Nursing Under the Old Poor Law in Midland and Eastern England 1780-1834.

This article uses data drawn from the overseers' accounts and supporting documentation in thirty-six parishes spread over four English counties, to answer three basic questions. First, what was the character, extent, structure, range of activities, and remuneration of the nursing labor force under the Old Poor Law between the late eighteenth century and the implementation of the New Poor Law in the 1830s? Second, were there regional and intra-regional differences in the scale and nature of spending on nursing care for the sick poor? Third, how might one explain such differences? The article suggests that nursing became an increasingly important category of spending for the poor law from the later eighteenth century, but that there were significant variations within and (particularly) between English counties in parochial attitudes toward the provision of nursing for the sick poor. These variations can be explained by applying a matrix of explanatory variables ranging from the minor (differences in how parishes defined "nursing") through to the major (long-standing cultural attitudes toward the responsibility of parishioners to their sick compatriots and the ingrained expectations of the sick poor). The article also throws new light on the hidden aspects of female labor force participation, pointing to the development of professional nursing networks long before the later nineteenth century.

Paid sick leave status in relation to government sponsored welfare utilization.

Nearly a third of all U.S. workers, primarily lower-paid employees, do not have paid sick leave benefits, prompting some lawmakers to consider mandating paid sick leave for all U.S. employees so workers can access timely health care without lost wages. A representative sample of 19,537 workers in current paid employment was examined, searching for the association between access to paid sick leave benefits and receipt of six different welfare and welfare-related services. After controlling for relevant demographic, work, income, and medical/health care variables, results of the logistic models indicate that, among working adults age 18-64, those without paid sick leave are 1.41 times more likely to receive income from a state or county welfare program, 1.36 times more likely to receive other welfare assistance (transportation and child care supports), 1.33 times more likely to received sponsored rental assistance, and 1.34 times more likely to receive Supplemental Nutrition Assistance Program benefits (referred to as food stamps commonly and in this article). Mandating paid sick leave benefits may impact usage of social welfare assistance since families with paid sick leave do not have to lose wages when work is missed because of health and caregiver responsibilities. (PsycINFO Database Record

The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review.

While pay-for-performance (P4P) programs are increasingly common tools used to foster quality and efficiency in primary care, the evidence concerning their effectiveness is at best mixed. In this article, we explore the influence of welfare systems on four P4P-related dimensions: the level of healthcare funders' commitment to P4Ps (by funding and length of program operation), program design (specifically target-based vs. participation-based program), physicians' acceptance of the program and program effects. Using Esping-Andersen's typology, we examine P4P for general practitioners (GPs) in thirteen European and North American countries and find that welfare systems contribute to explain variations in P4P experiences. Overall, liberal systems exhibited the most enthusiastic adoption of P4P, with significant physician acceptance, generous incentives and positive but modest program effects. Social democratic countries showed minimal interest in P4P for GPs, with the exception of Sweden. Although corporatist systems adopted performance pay, these countries experienced mixed results, with strong physician opposition. In response to this opposition, health care funders tended to favour participation-based over target-based P4P. We demonstrate how the interaction of decommodification and social stratification in each welfare regime influences these countries' experiences with P4P for GPs, directly for funders' commitment, program design and physicians' acceptance, and indirectly for program effects, hence providing a framework for analyzing P4P in other contexts or care settings.

Neoliberalism, "globalization," unemployment, inequalities, and the welfare state.

This analysis of "neoliberalism" and its economic and social consequences is presented in six sections. Section I begins by describing the impact of neoliberal public policies on economic growth and inflation, on business profits and business investments, on productivity, on business credit, on unemployment and social inequalities, on social expenditures, and on poverty and family debt. The author shows that, except in the area of business profits and control of inflation, neoliberal policies have not proved superior to those they replaced. Section II deals with unemployment and social polarization in the developed capitalist countries. The author criticizes some of the theories put forward to explain these social problems, such as the introduction of new technologies and globalization of the economy, and suggests that a primary reason for these problems is the implementation of neoliberal policies. Section III challenges the widely held neoliberal perception that the U.S. economy is highly efficient and the E.U. economies are "sclerotic" due to their "excessive" welfare states and "rigid" labor markets. The author shows that the U.S. economy is not so dynamic, nor the E.U. economies so sclerotic. Some developed countries with greater social protection and more regulated labor markets are shown to be more successful than the United States in producing jobs and lowering unemployment. The reasons for the growing polarization in developed capitalist countries, rooted in political rather than economic causes, are discussed in section IV--especially the enormous power of the financial markets and their influence on international agencies and national governments, and the weakness of the labor movements, both nationally and internationally. Section V questions the major theses of globalization. The author shows that rather than globalization of commerce and investments, we are witnessing a regionalization of economic relations stimulated by political considerations. He also analyzes the globalization of capital finance, criticizing the thesis that capital markets are determining public policies. The economic determinism that underlies the globalization position is questioned, uncovering the importance of political explanations for understanding major social problems such as unemployment. Finally, section VI shows that neoliberal public policies on the deregulation of labor markets are creating enormous instability in the labor force, worsening the living conditions of the majority of the populations.

Welfare gains and losses caused by clinical practice guidelines.

Clinical practice guidelines (CPGs) for health professionals can have a variety of welfare implications. These may result from a reduction in practice variation in the form of overuse, underuse and misuse or a shift in resources between patient groups. The purpose of this article is to discuss welfare gains and losses caused by CPGs for health professionals. To this end, the article distinguishes between CPGs with and without the inclusion of economic evidence. Based on a framework, this article shows that CPGs, which include economic evidence, can actually lead to a welfare loss by misjudging the maximum cost-effectiveness threshold or ignoring altruistic concerns for patients. Given that a significant portion of CPGs currently considers costs and cost-effectiveness of treatment, this practice may need to be reassessed in jurisdictions where a cost-effectiveness threshold has not been appropriately defined and a public consensus on the trade-off between cost-effectiveness and equity does not yet exist.

Roll-out of a nurse-led welfare benefits screening service throughout the largest Local Health Care Co-operative in Glasgow: an evaluation study.

OBJECTIVE: To evaluate the roll-out of a nurse-led Attendance Allowance (AA) screening programme in 24 general practices located within the largest Local Health Care Co-operative in Glasgow. STUDY DESIGN: Evaluation study METHODS: Six hundred and thirty participants aged over 64 years who, in the nurses' clinical judgement, appeared to have care needs were recruited opportunistically by community nurses over a 15-month period. A money advice worker contacted all potential underclaimers offering a home visit to assess for unclaimed benefits. The main outcome measured was the total amount of unclaimed AA, linked benefits and grants. RESULTS: Three hundred and sixty-three participants and 13 relatives were awarded a total of 1,136,424.10 pounds. Of this, 1,016,908.70 pounds was on a recurrent annual basis and 119,515.44 pounds was awarded as lump sums. CONCLUSIONS: This method of benefits assessment (community-nurse-led pre-AA screening followed by a home visit from a money advice worker) would appear to be an efficient and effective method of income maximization that could be rolled out nationally within primary care settings located in deprived areas.

Changing safety net of last resort: downsizing general assistance for employable adults.

General assistance (GA) has served as an income support program of last resort for people not eligible for other programs. Because each state has complete discretion to design its program, the GA services model parallels Temporary Assistance for Needy Families (TANF) in its reliance on decentralized government decision making. Thus, GA programs can provide lessons about services variability and common program features that have arisen in a decentralized income support system. This study examined the characteristics of state GA programs across several program dimensions--eligibility criteria, work requirements, time limits, administrative arrangements, and caseloads. The authors show that GA programs have changed from 1989 to 1998. Although most states retained GA programs in some form, caseloads declined as a result of tightening eligibility requirements for people considered employable. This casts doubt on the viability of GA as a safety net program for economically vulnerable people, including those who do not qualify for or exceed time limits under TANF.

Modernization, globalization and the welfare state: a comparative analysis of old and new convergence of social insurance since 1930.

Convergence of policies and institutions across countries has been a recurrent theme within social sciences. 'Old' and 'new' convergence hypotheses have been associated with changing concepts and catchwords, such as modernization, logic of industrialism, post-industrialism, post-Fordism and globalization, but share some underlying theoretical perspectives. The purpose of this paper is to analyse tendencies towards convergence of social insurance systems in 18 OECD countries between 1930 and 1990, a period which has seen our sample of countries develop from predominantly agricultural societies to industrial or post-industrial market democracies. Data from the Social Citizenship Indicator Program (SCIP) are used to examine the development of institutional variables within the various national social insurance systems. Sub-samples of larger and smaller countries are examined separately, in order to test the open-economy hypothesis that smaller countries, being more exposed to international pressures than larger ones, could be expected to show higher degrees of social protection and also more convergence. Hypotheses on differentiated institutional barriers against pressures from the processes of transnationalization of the economy, as well as possible convergence effects of the supra-national policy making within the European Union, are discussed in the last section.