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 aim of this paper is to compare academic interpretations of the term social exclusion with the understanding of people with direct experience of the phenomenon. A pre-selected group of residents of deprived neighbourhoods were asked about various aspects of the concept and their responses compared with the definitions of social exclusion used by Burchardt, Le Grand and Piachaud in their 1999 article in the journal Social Policy and Administration. In general, the residents? understanding of the term corresponded well with the more academic definitions; however, in one or two key areas there were significant differences, for example, the importance of neighbourhood and ?service poverty?, and the need for action against aspects of social exclusion on the grounds of social justice. This confirms that it might be useful for more academic concepts to be tested against the views of those with experience of the phenomenon which the concept is trying to capture.

Outsider and Insider Expertise: The Response of Residents of Deprived Neighbourhoods to an Academic Definition of Social Exclusion

All rights reserved. No part of this paper may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this publication is available from the British Library. The central question of the paper is whether the NHS is inequitable and if so, what form the inequity takes and what are its principal causes. The paper begins with a brief discussion of the meaning of equity in the context of the NHS. The definition adopted regards observed inequalities in utilisation as proxies for inequalities in access. The paper reviews the available evidence on the existence of inequity in the NHS from macro-studies and micro-studies. Evidence from macro-or aggregate studies is not clear-cut. Early studies showed utilisation by higher income groups was higher than lower income groups adjusted for need. More recent studies using similar aggregated data suggest that this pattern has changed and the NHS is now pro-poor. However, a study using more disaggregated data and the majority of the micro-studies suggest that inequities in access persist. There is strong evidence that lower socioeconomic groups use services less in relation to need than higher ones from many studies of specific NHS services. An attempt is made to explain the conflict through an assessment of the methodologies and data used. Finally, the paper discusses the evidence concerning potential barriers to access such as lack of suitable transport and restrictions on time; superior connections and communications by middle class patients; and differences in beliefs about severity of illness and the need to seek medical attention. The paper concludes that policy-makers need to understand these barriers to access when devising policy aimed at eliminating persisting inequities in access identified in this review. Acknowledgements: We would like to thank Franco Sassi for his comments. The views expressed in this paper are those of the authors and not necessarily those of the Department of Health or the No 10 Policy Unit.

Is the NHS equitable?: a review of the evidence

The economic analysis of inequalities in health.

The political economy of public choice

There are substantial inequities within the current National Health Service (NHS), with people in lower socioeconomic groups (SEGs) using a wide range of services less relative to their needs than people in higher SEGs. These inequities are likely to arise due to factors on both the demand and the supply side of the system. On the demand side, they could arise from differences in patients' beliefs, knowledge, costs, resources and capabilities. On the supply side, professional beliefs and attitudes, and risk selection or cream-skimming by providers may result in inequities. This paper discusses whether these factors are at play within the English NHS and analyses whether current policy to extend patient choice of provider is likely to reduce or increase these inequities. It shows that extending patient choice may leave unchanged inequity due to differences in health beliefs (because choice does not affect these directly), increase inequity due to unequal resources (because patients may have to travel furth...

Julian Le Grand

Papers

Outsider and Insider Expertise: The Response of Residents of Deprived Neighbourhoods to an Academic Definition of Social Exclusion

Is the NHS equitable?: a review of the evidence

The economic analysis of inequalities in health.

The political economy of public choice

Is greater patient choice consistent with equity? The case of the English NHS.