Many older adults will need Medicaid to cover health and long-term care costs, yet the process by which these older adults gain access to Medicaid is poorly understood. In a case study of family caregivers and key program staff at a skilled nursing facility in a large, urban county in North Carolina, I document the experiences of older adults' families applying for Medicaid. Participants report challenges with the application process and their own assets creating barriers to enrollment, while having a health event requiring institutionalised care precipitated access. Given these results, I use data from 11 waves of the Health and Retirement Survey to test these hypothesised factors, demonstrating that prior hospitalisation and having limited assets both accelerate time to Medicaid enrollment. Expanding Medicaid to cover older adults with incomes greater than the federal poverty line and simplifying eligibility requirements and application processes can improve the well-being of older adults and their families.

The increased private provision of publicly funded health and social care over the last 75 years has been one of the most contentious topics in UK public policy. In the last decades, health and social care policies in England have consistently promoted the outsourcing of public services to private for-profit and non-profit companies with the assumption that private sector involvement will reduce costs and improve service quality and access. However, it is not clear why outsourcing often fails to improve quality of care, and which of the underlying assumptions behind marketising care are not supported by research. This article provides an analysis of key policy and regulatory documents preceding or accompanying outsourcing policies in England (e.g., policy document relating to the 2012 and 2022 Health and Social Care Acts and the 2014 Care Act), and peer-reviewed research on the impact of outsourcing within the NHS, adult's social care, and children's social care. We find that more regulation and market oversight appear to be associated with less poor outcomes and slower growth of for-profit provision. However, evidence on the NHS suggests that marketisation does not seem to achieve the intended objectives of outsourcing, even when accompanied with heavy regulation and oversight. Our analysis suggests that there is little evidence to show that the profit motive can be successfully tamed by public commissioners. This article concludes with how policymakers should address, or readdress, the underlying assumptions behind the outsourcing of care services.

Whether charitable fundraising might play a part in funding Britain's ostensibly tax-funded NHS has been a longstanding dilemma, which until recently has received only occasional scholarly attention. In 1946, Aneurin Bevan argued that one of the main goals of the reformed health care system was to liberate health care from the 'caprice of private charity'. Seven decades later, NHS Charities Together's Urgent Covid-19 Appeal became a powerful societal rallying cry in the health emergency of the pandemic and raised £150 million in the process. This paper draws together findings from new archival research, a witness seminar with key actors in the NHS charity sector, and qualitative research based on interviews with NHS charity staff and trustees ( = 13), all conducted between 2021 and 2023. We investigate the way in which appeals have been proposed, debated and implemented at different times in the NHS's history. We trace the recurrence of conflicting ideas about the acceptability of national fundraising for the NHS, about whether public loyalties are to their local services or the national 'brand' and about the introduction of national appeals into a complex ecology of local NHS charities. The history of charitable fundraising for the NHS is, we argue, neither a simple story of spontaneous public generosity, nor often of formal policy reform, but is an artefact of more complex dynamics between a changing cast of local and national actors over the last 75 years.

Do political parties approach education with different social policy aims? We argue that while parties have adopted a common language of equality as an aim of education, they draw on different conceptions of it linked to diverging social projects. To make this argument, we first normatively distinguish education as a tool for creating equal opportunity, equal outcomes, and representational diversity. We then draw on an original dataset coding the educational content in the political manifestos of the largest center-left and center-right party across 19 Western democracies from 1950 to present. The analysis shows that left parties emphasise more equality of outcome than rightwing parties and pay less attention to equality of opportunity, and that they associate equality-related aims more extensively with promises of resources. These findings suggest that there remain critical differences in parties' understanding of education as a tool of social policy.

This paper theorises and empirically assesses how education and active labour market policy (ALMP) relate to each other in shaping individuals' employment chances in Europe. It provides a theoretical base for assessing policy complementarities building on sociological skill-formation literature, varieties of capitalism and social investment literature. Two hypotheses of complementarity are advanced: reinforcement whereby higher investment in general skills via education boosts ALMP effectiveness; and substitution-compensation whereby investments in either policy suffice, rendering individual employment chances less dependent on ALMPs at higher (prior) educational investment levels. The advanced theoretical propositions are empirically tested by looking at how individual employment chances are affected by national ALMP efforts conditional on workforce education, distinguishing between individual- and national-level educational attainment. Analyses draw on micro-level EU-SILC longitudinal data 2003-2015 from 29 European countries and 285 country-years applying mixed-effects dynamic panel regression models. Results highlight the complementarity of education in the functioning of ALMPs and show that the education-ALMP interplay follows different dynamics when individual or national education are considered, with substitution-compensation for the former and reinforcement for the latter. Higher individual educational attainment is associated with lower marginal returns from national ALMP efforts, with higher ALMP effectiveness among the lower-educated. By contrast, higher national educational attainment is associated with increased ALMP effectiveness, with ALMPs tending to be far less effective at low levels of highly educated workforce. Different interaction patterns are observed for youth, indicating increased difficulty in activating this risk group.

How does the public decide who is deserving of welfare benefits? To shed light on this question, we investigate whether the CARIN principles of deservingness-specifically the ideas of control, attitude, reciprocity, identity, and need-impact the public's perception of American welfare target groups. We draw contrast between traditional welfare programs and pandemic-related programs to gain a more comparative understanding of the principles' effects as well as to determine what role the pandemic may play in shaping welfare perceptions. We report that positive, deserving social constructions exist for recipients of both traditional and pandemic-related welfare programs, and we find evidence that the distinction between traditional and pandemic-related programs is important for deservingness perceptions in the US. Overall, these results suggest the importance of the CARIN criteria in an American context.

This article focuses on one particular and under-investigated dimension in the study of social policy - crisis events and their special function in promoting and shaping social protection programs. Crises are usually regarded as negative social events that tempestuously challenge the pre-existing socio-economic order, triggering social conflicts and disruption, either temporarily or in a more enduring fashion. However, social crises may also foster new opportunities for social investment, public finance expansion and welfare state building after the outbreak of a crisis and even during the post-crisis period. This article first examines the SARS pandemic and analyzes its developmental trajectory, reconstructing the national debates and discourses on the negative consequences and lessons learned in the SARS and post-SARS period. I argue that this crisis event revealed many loopholes in the Chinese public health system, constituting a powerful driving force for rebuilding the medical insurance system and health governance in China, and strengthening public discourse on welfare state responsibility. Second, I explore how, during the COVID-19 pandemic, scholars and experts have constructed the 'short board' of Chinese social policy, calling for further social policy reforms to narrow the gaps in health protection resources among social classes and to eliminate the fragmentation of health resource distribution.

Europe is witnessing a 'double dualisation' process, whereby inequalities have increased both between labour market insiders and outsiders, and between core and peripheral countries. We test the double dualisation hypothesis in the context of the first wave of the COVID-19 pandemic. Did the COVID crisis exacerbate income inequalities between insiders and outsiders? Did cross-country territorial divides also increase? Did national governments' emergency measures contribute to containing or widening double dualisation? We deploy a multi-method research design that combines original survey data on seven old EU member states with three case studies on Germany, Italy, and the Netherlands. Results show that, in the short term, the COVID-19 pandemic has been a catalyst of double dualisation: outsiders bore the greatest burden, especially in southern European countries. National emergency measures largely depended on the fiscal leeway available to governments and followed pre-existing welfare trajectories, thus worsening cross-country inequalities, with potentially severe consequences for the European integration process.

In this paper, we examine the mental health effects of lowering the UK's benefit cap in 2016. This policy limits the total amount a household with no-one in full-time employment can receive in social security. We treat the reduction in the cap as a natural policy experiment, comparing those at risk of being capped and those who were not, and examining the risk of experiencing poor mental health both before and after the cap was lowered. Drawing on data from ~900,000 individuals, we find that the prevalence of depression or anxiety among those at risk of being capped increased by 2.6 percentage points (95% confidence interval: 1.33-3.88) compared with those at a low risk of being capped. Capping social security may increase the risk of mental ill health and could have the unintended consequence of pushing out-of-work people even further away from the labour market.

This paper reports on in-depth qualitative interviews conducted with 69 disabled people in England and Scotland, and with 28 key informants from infrastructure organisations in the voluntary and statutory sectors, about the impact of COVID-19, and measures taken to control it. Participants were recruited through voluntary organisations. As with everyone, the Pandemic has had a huge impact: we discuss the dislocations it has caused in everyday life; the failures of social care; the use of new technologies; and participants' view on leadership and communication. We conclude with suggestions for urgent short term and medium term responses, so that the United Kingdom and other countries can respond better to this and other pandemics, and build a more inclusive world.

Individualized funding schemes are designed to offer people with disability greater choice and control over the services they receive. In this research, we report on a survey of over 700 families to explore how Australia's National Disability Insurance Scheme (NDIS) supported children and young people and their families to learn remotely during COVID-19. NDIS funding to support education during the first COVID-19 lockdown period forms an important case study of the flexibility of individualized funding schemes. Our results suggest that participant experiences varied widely, with some people able to make the changes they required and others left with a significant service gap. This shows that individual funding schemes are not necessarily more flexible than traditional systems in an emergency situation-useful flexibility depends on many factors, such as clarity of information giving, all actors having a shared message, proactive support of flexibility initiatives, and participants' ability to quickly navigate a complicated system. This research also highlights problems with the interface between the NDIS and mainstream services such as education.

Welfare to work interventions seek to move out-of-work individuals from claiming unemployment benefits towards paid work. However, previous research has highlighted that for over-50s, particularly those with chronic health conditions, participation in such activities are less likely to result in a return to work. Using longitudinal semi-structured interviews, we followed 26 over-50s during their experience of a mandated welfare to work intervention (the Work Programme) in the United Kingdom. Focusing on their perception of suitability, we utilise and adapt Candidacy Theory to explore how previous experiences of work, health, and interaction with staff (both in the intervention, and with healthcare practitioners) influence these perceptions. Despite many participants acknowledging the benefit of work, many described a pessimism regarding their own ability to return to work in the future, and therefore their lack of suitability for this intervention. This was particularly felt by those with chronic health conditions, who reflected on difficulties with managing their conditions (e.g., attending appointments, adhering to treatment regimens). By adapting Candidacy Theory, we highlighted the ways that mandatory intervention was navigated by all the participants, and how some discussed attempts to remove themselves from this intervention. We also discuss the role played by decision makers such as employment-support staff and healthcare practitioners in supporting or contesting these feelings. Findings suggest that greater effort is required by policy makers to understand the lived experience of chronic illness in terms of ability to RTW, and the importance of inter-agency work in shaping perceptions of those involved.

Nordic welfare states are known for their universalistic and all-encompassing approach to welfare and having a long tradition for active labour market policy as tool in economic crises with adverse impact on employment. They have had a long tradition for strong egalitarian approaches and their residents are consistently among the happiest in the world. A key issue is whether a crisis like the COVID-19 outbreak is changing the Nordic welfare states. This article focuses on providing a description of what instruments the Nordic countries have taken or expect to use as part of dealing with the welfare challenges resulting from rising unemployment and greater social and economic insecurity in the wake of the crisis. The tentative conclusion is that the crisis so far has strengthened key characteristics of the Nordic welfare states by the state taking on a strong central role not only for the functioning of the market but also continued in a path-dependent way with universal and relatively generous benefits such as for those who become unemployed or have reduced income because of the crisis.

This article documents and compares the social policies that the governments in Central and Eastern Europe (CEE) implemented to combat the first wave of COVID-19 pandemic by focusing on Hungary, Lithuania, Poland and Slovakia. Our findings show that governments in all four countries reacted to the COVID-19 crisis by providing extensive protection for jobs and enterprises. Differences arise when it comes to solidaristic policy responses to care for the most vulnerable population, in which CEE countries show great variation. We find that social policy responses to the first wave of COVID-19 have largely depended on precious social policy trajectories as well as the political situation of the country during the pandemic.

As the origin place of the COVID-19 outbreak, East Asian welfare states have largely survived the immediate health threats out of the pandemic shock but have yet to deal with its dire social consequences. This paper offers an institutionalist account-in terms of the institutional resilience of the welfare state-to grasp the policy dynamics in East Asia. We select four cases under scrutiny: China, Japan, Korea and Taiwan, to analyse the major trend of social policy responses in this region. With a systematic comparison of the policy responses, in particular reference to the unemployment protection and social assistance that have arisen as the major crisis responses, we identify striking similarities in institutional arrangements but also some variation in policy approaches. Given the effective containment of the pandemic spread and the comprehensive social safety nets, region-wide measures such as consumption vouchers, prolonged unemployment benefits and emergency relief aids are of a one-shot nature that will fall off once this crisis abates. The common trend of social policy responses to the crisis is largely an extension, not replacement or reinvention, of the existing institutional edifice of the East Asian welfare state. However, the pandemic crisis may offer a window of opportunity for gradual institutional change in light of the exacerbating social inequalities.

How have welfare states responded to the coronavirus pandemic? In this introductory article, we provide a synopsis of papers that comprise this special issue on social policy responses to COVID-19, an overview of some of the key questions they raise, and some provisional answers to these questions. Our conclusions are threefold: first, these social policy responses, while entailing new developments in many countries, nonetheless reflect, at least in part, existing national policy legacies. Second, these responses can be understood as a form of "emergency Keynesianism," which is characterized by the massive use of deficit spending during economic crises, with the aim of to supporting rather than challenging core capitalist institutions. Third, there are clear differences in terms of the nature of the reforms enacted during the initial phase of the COVID-19 crisis as compared to reforms enacted as a response to the 2008 financial crisis.

Social protection in Germany, Belgium and the Netherlands share Bismarckian roots. Over time, these welfare states were however in constant flux and incorporated to a greater or lesser extend elements of both the Anglo-Saxon and Nordic models. While the Netherlands has from the beginning deviated from the Bismarckian model, in recent years this welfare state has undergone important reforms that have made it increasingly evolve into a "Bismarck Beveridge" model. Germany and Belgium also witnessed a dual transformation, with retrenched earnings-related benefits for long-term unemployed and an increasing number of atypically employed people on the one hand and expanded social security to the so-called "new social risks" on the other. It is against this changing institutional background that we can understand the similarities and differences in the extent to which these three continental welfare states used traditional social insurance systems to buffer the social and economic consequences of confinement. First, all three countries strengthened to varying degrees social protection systems for the active age population. So conceived, the policy responses were a response to the dual transformation of social protection that took place in recent decades without, however, changing its course. Second, the extent to which continental welfare states made use of existing social insurance schemes seems to be related to the extent to which these welfare states have moved in the Anglo-Saxon direction.

In the context of very high mortality and infection rates, this article examines the policy response to COVID-19 in care homes for older people in the UK, with particular focus on England in the first 10 weeks of the pandemic. The timing and content of the policy response as well as different possible explanations for what happened are considered. Undertaking a forensic analysis of policy in regard to the overall plan, monitoring and protection as well as funding and resources, the first part lays bare the slow, late and inadequate response to the risk and reality of COVID-19 in care homes as against that in the National Health Service (NHS). A two-pronged, multidimensional explanation is offered: structural, sectoral specificities; political and socio-cultural factors. Amongst the relevant structural factors are the institutionalised separation from the health system, the complex system of provision and policy for adult social care, widespread market dependence. There is also the fact that logistical difficulties were exacerbated by years of austerity and resource cutting and a weak regulatory tradition of the care home sector. The effects of a series of political and cultural factors are also highlighted. As well as little mobilisation of the sector and low public commitment to and knowledge of social care, there is a pattern of Conservative government trying to divest the state of responsibilities in social care. This would support an interpretation in terms of policy avoidance as well as a possible political calculation by government that its policies towards the care sector and care homes would be less important and politically damaging than those for the NHS.

Sociologists have long acknowledged that being in a precarious labour market position, whether employed or unemployed, can harm peoples' health. However, scholars have yet to fully investigate the possible contextual, institutional determinants of this relationship. Two institutions that were overlooked in previous empirical studies are the regulations that set minimum compensation for dismissal, severance payments, and entitlements to a period of notice before dismissal, notice periods. These institutions may be important for workers' health as they influence the degree of insecurity that workers are exposed to. Here, we test this hypothesis by examining whether longer notice periods and greater severance payments protect the health of labour market participants, both employed and unemployed. We constructed two cohorts of panel data before and during the European recession using data from 22 countries in the European Union Statistics on Income and Living Conditions (person years = 338,000). We find more generous severance payments significantly reduce the probability that labour market participants, especially the unemployed, will experience declines in self-reported health, with a slightly weaker relationship for longer notice periods.

Although studies have examined the distribution and conditions of employer-provided work-family arrangements, we still lack a systematic investigation of how these vary for different countries and industries. Based on the European Working Conditions Survey 2010, this study examines the conditions under which firms provide family-friendly working time arrangements and what the differences are across four countries (Austria, Denmark, Italy and the UK) and four industries. The impact of employee representatives, employee involvement, manager support and female managers varies across countries and industries because of the institutional environment (prevailing family model, industrial relations) and workforce composition (gender). The impact of employee representatives depends on their co-determination rights, and the direction of their effect on the prevailing family model (e.g. negative in conservative countries such as Austria) and the gender composition of the workforce (negative in male-dominated production, but positive in services). Employee involvement in the work organization is significantly positive in Austria and Denmark (both with co-operative industrial relations), while manager support has the strongest effect in the UK (liberal regime). At the industry level, female supervisors are positively associated with family-friendly working time arrangements only in the male-dominated production industry. These findings suggest that the effects of agency variables and their direction vary depending on the institutional context.

As English social care services reconstruct themselves in response to the personalization agenda, there is increased interest in the contribution of micro-providers - very small community-based organizations, which can work directly with individuals. These micro-providers are assumed to be able to cater for the 'seldom heard' groups which have been marginalized within mainstream social care services. This article reviews recent literature from the UK published in peer-reviewed journals from 2000 to 2013 on support provision for people with protected characteristics under the Equality Act 2010. It considers the marginalising dynamics in mainstream, statutory social care support provision, and how far local community, specialist or small-scale services are responding to unmet need for support and advice among marginalized groups. The review found that there is a tradition of compensatory self-organization, use of informal networks and a mobilization of social capital for all these groups in response to marginalization from mainstream, statutory services. This requires recognition and nurturing in ways that do not stifle its unique nature. Specialist and community-based micro-providers can contribute to a wider range of choices for people who feel larger, mainstream services are not suitable or accessible. However, the types of compensatory activity identified in the research need recognition and investment, and its existence does not imply that the mainstream should not address marginalization.