Few discussions in modern social science have occupied as much attention as the changing nature of welfare states in Western societies. Gosta Esping-Andersen, one of the foremost contributors to current debates on this issue, here provides a new analysis of the character and role of welfare states in the functioning of contemporary advanced Western societies. Esping-Andersen distinguishes three major types of welfare state, connecting these with variations in the historical development of different Western countries. He argues that current economic processes, such as those moving toward a postindustrial order, are shaped not by autonomous market forces but by the nature of states and state differences. Fully informed by comparative materials, this book will have great appeal to all those working on issues of economic development and postindustrialism. Its audience will include students of sociology, economics, and politics."

The Three Worlds of Welfare Capitalism

OBJECTIVES: Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality. METHODS: In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state. RESULTS: Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart d...

https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.87.9.1491

Social capital, income inequality, and mortality.

This essay seeks to lay the foundation for an understanding of welfare state retrenchment. Previous discussions have generally relied, at least implicitly, on a reflexive application of theories designed to explain welfare state expansion. Such an approach is seriously flawed. Not only is the goal of retrenchment (avoiding blame for cutting existing programs) far different from the goal of expansion (claiming credit for new social benefits), but the welfare state itself vastly alters the terrain on which the politics of social policy is fought out. Only an appreciation of how mature social programs create a new politics can allow us to make sense of the welfare state's remarkable resilience over the past two decades of austerity. Theoretical argument is combined with quantitative and qualitative data from four cases (Britain, the United States, Germany, and Sweden) to demonstrate the shortcomings of conventional wisdom and to highlight the factors that limit or facilitate retrenchment success.

http://pluto.mscc.huji.ac.il/~mshalev/sem/Pierson_NewPolitics(1996).pdf

The New Politics of the Welfare State

Symposium Review: 25th Anniversary of Moral Boundaries by Joan Tronto

the structure of welfare state institutions. (2) A trade-off exists between the degree of low-income targeting and the size of redistributive budgets. (3) Outcomes of market-based distribution are often more unequal than those of earnings-related social insurance programs. We argue that social insurance institutions are of central importance for redistributive outcomes. Using new data, our comparative analyses of the effects of different institutional types of welfare states on poverty and inequality indicate that institutional differences lead to unexpected outcomes and generate the paradox of redistribution: The more we target benefits at the poor and the more concerned we are with creating equality via equal public transfers to all, the less likely we are to reduce poverty and inequality. Social scientists and social reformers have long debated how the welfare state and social policies should be designed so as to best reduce poverty and inequality. This debate involves two different issues. One question concerns whether social policies should be targeted or universal, that is, should they be organized for the poor only or should the welfare state include all citizens? In the context of nontargeted programs, another question concerns the level of benefits: Should benefits be equal for all, or should they be related to previous earnings and in

https://www.econstor.eu/bitstream/10419/160846/1/lis-wps-174.pdf

The Paradox of Redistribution and Strategies of Equality: Welfare State Institutions, Inequality and Poverty in the Western Countries

The Distribution of Public Expenditure on Health Care Revisited (Journal of Health Economics, 10, 239-245, 1991)

Nick Timmins is a phenomenon. Not only has he been the leading public policy journalist of our era, but he is a true social scientist: an objective analyst who can take the messy complexity of reality, impose order on it and draw out the appropriate generalisations – all the time writing it up in a style that entertains without dumbing down the ideas. All this he did in his magisterial volume on the history of the welfare state The Five Giants (Timmins, 2001); and he has pulled it off again with his book on the story of the 2012 Health and Social Care Act, Never Again? (Timmins, 2012). Produced at incredible speed, he has provided a riveting account of the extraordinary story of this Act and its turbulent passage and has drawn out some of the important lessons. We both figure in the book and we would like to use Timmins’ account as an opportunity to reflect on two of the issues with which we were directly involved. One is extensively discussed by Timmins and concerns the alleged ‘revolutionary’ nature of the reforms. The other is not so emphasised in the book, but is nonetheless important, as well as likely to be of particular interest to readers of this Journal. It concerns evidence-based policy: the use of evidence to inform policy, the discussion of which in turn raises issues concerning the role of academic research, and of the researchers who undertake it, providing the information that may be used in highly politicised debates.

Framing health reform

Defending the NHS

In October 2003, I started a secondment from the London School of Economics (LSE), where I hold the Richard Titmuss Chair of Social Policy, to No 10 Downing Street, where I worked as a senior policy adviser to the Prime Minister, Tony Blair. I began working initially on a specific project: developing policies on extending user choice in public services, with particular reference to health care and education. Then I was asked to be the Prime Minister’s health policy adviser, a role I agreed to take on up to the general election that took place in May 2005. In the event I stayed on a few weeks after the election until August of that year, when I returned to LSE. So I worked for nearly two years in Downing Street. Mine was an unusual appointment. Most of my Downing Street colleagues were much younger than me; unlike me, all had had experience of working as political or policy advisers in government, despite their relative youth; and none were academics. Although interchange between government and academia is not uncommon in the United States, it is rare in the UK and other countries. So the editors of this journal felt that readers might be interested in my reflections on the experience, especially the differences between being an academic in a university and an academic in government: the squarish peg of academia in the round hole of politics and policy. Of course, the most obvious difference was in working style. As a senior academic at a good university, your time is broadly your own to allocate as you will – apart from the occasional lecture or seminar series, and even those you can usually re-arrange if necessary. But in government, as Harold Macmillan so famously noted, you are at the mercy of events. So often I would wake up in the morning, switch on the radio, hear about the latest outbreak of MRSA in a National Health Service (NHS) hospital or the mile-long queue of people waiting to register for a new NHS dentist, and know that the reflective paper the Prime Minister wanted on the pros and cons of more patient choice was going to have to be put off yet again. Rarely did days work out as planned; indeed, rarely did minutes work out as planned.

/pdf/academia-policy-and-politics-567ekwdxec.pdf

Academia, policy and politics.

In this paper, we review some of what is known about economic incentive schemes and also consider the potential role of agencies involved in policy that directly or indirectly affect health in these areas. We apply five criteria to help identify the relative strengths and weaknesses of different schemes: their effectiveness, their cost relative to effectiveness, their impact on equity, their feasibility and their impact on individual and local autonomy. We consider schemes targeted at NHS commissioners, other government agencies, providers, employers and individuals.

Julian Le Grand

Papers

The Distribution of Public Expenditure on Health Care Revisited (Journal of Health Economics, 10, 239-245, 1991)

Framing health reform

Defending the NHS

Academia, policy and politics.

Incentives for prevention: Health England report no. 3