America's Health Care Safety Net explains how competition and cost issues in today's health care marketplace are posing major challenges to continued access to care for America's poor and uninsured. At a time when policymakers and providers are urgently seeking guidance, the committee recommends concrete strategies for maintaining the viability of the safety netâ€"with innovative approaches to building public attention, developing better tools for tracking the problem, and designing effective interventions. This book examines the health care safety net from the perspectives of key providers and the populations they serve, including: Components of the safety netâ€"public hospitals, community clinics, local health departments, and federal and state programs. Mounting pressures on the systemâ€"rising numbers of uninsured patients, decline in Medicaid eligibility due to welfare reform, increasing health care access barriers for minority and immigrant populations, and more. Specific consequences for providers and their patients from the competitive, managed care environmentâ€"detailing the evolution and impact of Medicaid managed care. Key issues highlighted in four populationsâ€"children with special needs, people with serious mental illness, people with HIV/AIDS, and the homeless.
The need for social safety nets has become a key component of poverty reduction strategies. Over the past three decades several developing countries have launched a variety of programs, including cash transfers, subsidies in-kind, public works, and income-generation programs. However, there is little guidance on appropriate program design, and few studies have synthesized the lessons from widely differing country experiences. This report fills that gap. It reviews the conceptual issues in the choice of programs, synthesizes cross-country experience, and analyzes how country- and region-specific constraints can explain why different approaches are successful in different countries.
Poverty remains a pervasive and complex phenomenon in Sub-Saharan Africa. Part of the agenda in recent years to tackle poverty in Africa has been the launching of social safety nets programs. All countries have now deployed safety net interventions as part of their core development programs. The number of programs has skyrocketed since the mid-2000s though many programs remain limited in size. This shift in social policy reflects the progressive evolution in the understanding of the role that social safety nets can play in the fight against poverty and vulnerability, and more generally in the human capital and growth agenda. Evidence on their impacts on equity, resilience, and opportunity is growing, and makes a foundational case for investments in safety nets as a major component of national development plans. For this potential to be realized, however, safety net programs need to be significantly scaled-up. Such scaling up will involve a series of technical considerations to identify the parameters, tools, and processes that can deliver maximum benefits to the poor and vulnerable. However, in addition to technical considerations, and at least as importantly, this report argues that a series of decisive shifts need to occur in three other critical spheres: political, institutional, and fiscal. First, the political processes that shape the extent and nature of social policy need to be recognized, by stimulating political appetite for safety nets, choosing politically smart parameters, and harnessing the political impacts of safety nets to promote their sustainability. Second, the anchoring of safety net programs in institutional arrangements †“ related to the overarching policy framework for safety nets, the functions of policy and coordination, as well as program management and implementation †“ is particularly important as programs expand and are increasingly implemented through national channels. And third, in most countries, the level and predictability of resources devoted to the sector needs to increase for safety nets to reach the desired scale, through increased efficiency, increased volumes and new sources of financing, and greater ability to effectively respond to shocks. This report highlights the implications which political, institutional, and fiscal aspects have for the choice and design of programs. Fundamentally, it argues that these considerations are critical to ensure the successful scaling-up of social safety nets in Africa, and that ignoring them could lead to technically-sound, but practically impossible, choices and designs.
Officially over in 2009, the Great Recession is now generally acknowledged to be the most devastating global economic crisis since the Great Depression. As a result of the crisis, the United States lost more than 7.5 million jobs, and the unemployment rate doubled—peaking at more than 10 percent. The collapse of the housing market and subsequent equity market fluctuations delivered a one-two punch that destroyed trillions of dollars in personal wealth and made many Americans far less financially secure. Still reeling from these early shocks, the U.S. economy will undoubtedly take years to recover. Less clear, however, are the social effects of such economic hardship on a U.S. population accustomed to long periods of prosperity. How are Americans responding to these hard times? The Great Recession is the first authoritative assessment of how the aftershocks of the recession are affecting individuals and families, jobs, earnings and poverty, political and social attitudes, lifestyle and consumption practices, and charitable giving. Focused on individual-level effects rather than institutional causes, The Great Recession turns to leading experts to examine whether the economic aftermath caused by the recession is transforming how Americans live their lives, what they believe in, and the institutions they rely on. Contributors Michael Hout, Asaf Levanon, and Erin Cumberworth show how job loss during the recession—the worst since the 1980s—hit less-educated workers, men, immigrants, and factory and construction workers the hardest. Millions of lost industrial jobs are likely never to be recovered and where new jobs are appearing, they tend to be either high-skill positions or low-wage employment—offering few opportunities for the middle-class. Edward Wolff, Lindsay Owens, and Esra Burak examine the effects of the recession on housing and wealth for the very poor and the very rich. They find that while the richest Americans experienced the greatest absolute wealth loss, their resources enabled them to weather the crisis better than the young families, African Americans, and the middle class, who experienced the most disproportionate loss—including mortgage delinquencies, home foreclosures, and personal bankruptcies. Lane Kenworthy and Lindsay Owens ask whether this recession is producing enduring shifts in public opinion akin to those that followed the Great Depression. Surprisingly, they find no evidence of recession-induced attitude changes toward corporations, the government, perceptions of social justice, or policies aimed at aiding the poor. Similarly, Philip Morgan, Erin Cumberworth, and Christopher Wimer find no major recession effects on marriage, divorce, or cohabitation rates. They do find a decline in fertility rates, as well as increasing numbers of adult children returning home to the family nest—evidence that suggests deep pessimism about recovery. This protracted slump—marked by steep unemployment, profound destruction of wealth, and sluggish consumer activity—will likely continue for years to come, and more pronounced effects may surface down the road. The contributors note that, to date, this crisis has not yet generated broad shifts in lifestyle and attitudes. But by clarifying how the recession’s early impacts have—and have not—influenced our current economic and social landscape, The Great Recession establishes an important benchmark against which to measure future change.
This paper addresses the problems of defining and measuring government subsidies, examines why and how government subsidies are used as a fiscal policy tool, assesses their economic effects, appraises international empirical evidence on government subsidies, and offers options for their reform. Recent international trends in government subsidy expenditure are analyzed for the 16-year period from 1975 to 1990, using general government subsidy data for 60 countries from the System of National Accounts (SNA) and central government expenditure on subsidies and other current transfers for 68 countries from Government Finance Statistics (GFS). The paper reviews major policy options for subsidy reform, focusing on ways to improve the cost-effectiveness of subsidy programs.
In the Middle East and North Africa (MENA) countries price subsidies are common, especially on food and fuels. However, these are neither well targeted nor cost effective as a social protection tool, often benefiting mainly the better off instead of the poor and vulnerable. This paper explores the challenges of replacing generalized price subsidies with more equitable social safety net instruments, including the short-term inflationary effects, and describes the features of successful subsidy reforms.
Financial systems around the world are undergoing a process of modernization due to many different forces. Advances in information technology, product and market innovations, and recent regional financial crises have contributed to this movement. As a result, evolution in the financial sector is leading to larger, more complex financial organizations that render inadequate the supervisory and regulatory structures currently in place. While some changes in regulatory policies have already occurred, the adaptation of supervisory oversight and regulation in the face of these new developments is expected to continue for many years to come. This book collects papers originally presented in September 1998 at the Financial Modernization and Regulation Conference co-sponsored by the Federal Reserve Banks of Atlanta and San Francisco. Revised before publication, the papers seek to identify the reasons for changes in the financial services sector, and the implications these changes pose for financial supervision and regulation. Taken together, the papers offer valuable insights on 1) the forces behind financial modernization; 2) the implications financial modernization poses for corporate structure, market discipline, and financial regulation; 3) how to price deposit insurance accurately to reflect banks' risk-taking; and 4) balancing private versus public interests and managing potentially conflicting public policy goals.
America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
The State of Social Safety Nets 2018 Report examines global trends in the social safety net/social assistance coverage, spending, and program performance based on the World Bank Atlas of Social Protection Indicators of Resilience and Equity (ASPIRE) updated database. The report documents the main social safety net programs that exist globally and their use to alleviate poverty and to build shared prosperity. The 2018 report expands on the 2015 edition, both in administrative and household survey data coverage. A distinct mark of this report is that, for the first time, it tells the story of what happens with SSN/SA programs spending and coverage over time, when the data allow us to do so. This 2018 edition also features two special themes †“ Social Assistance and Ageing, focusing on the role of old-age social pensions, and Adaptive Social Protection, focusing on what makes SSN systems/programs adaptive to various shocks.
