Within both publicly and privately financed health care Systems different funding mechanisms have evolved, or have been proposed, to deal with the problem of ‘moral hazard’. Moral hazard arises when financial incentives within the health care System lead to either inefficient demands for care by consumers or inefficient supply of care by providers. In this paper the problem of moral hazard is outlined in more detail, and different ways of countering moral hazard are reviewed in terms of three criteria: effect on patient utilisation of health services in general; effect on utilisation by different groups of patients; and effect on health status. It is concluded that evidence on different methods of funding health services can only be judged in the context of objectives. If the objectives of health care delivery are ‘maintenance or improvement of health’ and ‘equal access for equal need’ then charges and finance of care through health maintenance organisations both appear to be less favourable than ‘free’ care at the point of delivery whilst the latter is not necessarily more costly as a resuit. Research on other suggested alternatives is required, otherwise radical changes to health care financing in the UK will simply result in movement from one unproven system to another.

Workfare increases requirements on welfare claimants: a major shift in UK social welfare policy post-1980s. Political, academic and cultural debates surround the ethical basis, and practical operations, of workfare schemes. Moreover, the UK government has claimed that workfare provides value for money in an age of austerity, ‘help and support’ for the long-term unemployed, and ‘incentives’ for increased claimant job-seeking. This article presents results gathered from sociological research into the UK's ‘Work Programme’ workfare scheme in order to contextualise these debates and contribute to wider academic and social policy workfare analyses. It finds a complex picture: a largely pointless scheme, resented by many participants, but providing a basic social service for some others.

The Work Programme's use of severe social security benefit sanctions reflects British coalition ministers’ belief that many people on out-of-work benefits do not want a job. While a substantial empirical literature has repeatedly demonstrated that in fact unemployed benefit claimants possess the same work values as the employed and that the vast majority want paid work, it has ignored some conservative authors’ pleas to consider the views and experiences of people who work with the unemployed. Forty employees of agencies contracted to help unemployed people into employment were interviewed in summer 2011. Respondents had spent an estimated combined total of 147,000 hours in the presence of people who have claimed Jobseeker's Allowance (JSA) for over six months. Most said that between a quarter and half of their present clients did not want employment. This finding does not contradict existing research, given that most JSA claimants re-enter employment within six months. However, all forty agreed that many others remained unemployed because they were choosy in the jobs they were willing to undertake, and, most strikingly, respondents overwhelmingly endorsed the view that a ‘dependency culture’ exists in households and neighbourhoods that have experienced joblessness for several generations.

We undoubtably live in a digitally infused world. From government administrative processes to financial transactions and social media posts, digital technologies automatically collect, collate, combine and circulate digital traces of our actions and thoughts, which are in turn used to construct digital personas of us. More significantly, government decisions are increasingly automated with real world effect; companies subvert human workers to automated processes; while social media algorithms prioritise outrage and ‘fake news’ with destabilizing and devastating effects for public trust in social institutions. Accordingly, what it means to be a person, a citizen, and a consumer, and what constitutes society and the economy in the 21st century is profoundly different to that in the 20th century.

Using voluntary blood donation as a case example, the study on which this article is based explored not only the extent, or breadth, of community involvement in social policy behaviours, but also the continuity, or depth, of this commitment. Demographic and motivational data were collected through a postal questionnaire returned by 1,784 persons who had voluntarily donated blood at least once in metropolitan Toronto between 1974 and 1978. An empirical distinction was also drawn between the ‘active’ and the ‘lapsed’ donor.

The study found that while certain sectors of society were probably disproportionately represented among those who chose to undertake voluntary social behaviours, the continuity of these actions could not be statistically associated with demographic or socio-economic variables. However, it did find that donors initially motivated by ‘external’ considerations such as convenience of location were more likely to lapse, while those for whom moral considerations and a sense of community were most important were more likely to continue as active donors.

The general conclusion suggests that manipulating the context may be useful to broaden the initial participatory base in voluntary actions, but to produce continuity in this involvement the challenge must be phrased in moral language.

In policy and research, migration and the welfare state are often seen as being at odds. When ‘strangers’ enter the welfare state, the financial and social foundations of solidarity are said to crumble. A prominent question, therefore, is whether immigrants should have the same rights as the autochthonous population. Within this frame, migrants are often ‘objects’. This paper reports on qualitative research exploring what different types of labour migrants themselves think about the Dutch welfare state in general, and about giving social rights to immigrants, in particular. The differences in national backgrounds and levels of education in labour migrants’ views are striking: lower-educated Turkish and Polish migrants show little interest in the welfare state, whereas higher-educated Western Europeans seek welfare state security. Higher-educated Indian migrants find the welfare state a totally new concept, although after a while some come to appreciate it. A significant proportion of the questioned migrants, moreover, believe that people should not be entitled to welfare state rights immediately upon arrival. They favour ‘earned citizenship’, with the welfare state being a ‘contribution state’, but stress that migrants should not have to wait too long before being entitled to such rights. The paper also suggests new topics for further research in the increasingly important field of migration, diversity and the welfare state.

This paper considers how varying discourses of social exclusion have informed policies regarding young people's participation in education, training and employment. Drawing on a cohort study of over 800 16–18 olds, the research suggests that the binary categories of exclusion/inclusion, and marginalisation/participation grow less and less adequate as parameters for understanding changing patterns of post-16 participation and non-participation. It is argued that a range of statutory, structural, financial and social pressures to normalise participation produce forms of inclusion that are ephemeral and that carry very different meanings from those implied in discourses of exclusion. The paper gives a brief overview of the changing context in which participation needs to be understood, then presents evidence and analysis of young people's trajectories after 16. Some interpretations are offered of a wide range of meanings of participation, which suggest that old notions of transition to independence are unsustainable for a substantial minority of young people, and that patterns of participation are increasingly complex, have multiple significances, and carry the potential to mask inequalities and new forms of exclusion. These readings have major implications for how we conceptualise social exclusion, and for policy developments associated with it.

In the context of population ageing and low retirement incomes, the UK government is encouraging delayed retirement. However, the OECD has argued that UK means-tested benefits disincentivise employment for the poorest, and Vickerstaff (2006b) has suggested managers have typically controlled opportunities to work beyond 65. In the US, contrastingly, benefits are meagre and difficult to access, and age discrimination legislation protects individuals from forced retirement. Would a US ‘self-reliance’ policy approach increase employment amongst the poorest over 65s in the UK and enhance or diminish their financial position? The evidence suggests that extending UK age discrimination legislation and restricting benefits would increase overall employment past 65, although not necessarily to US levels. Analysis of the English Longitudinal Study of Ageing and the US Health and Retirement Study finds the poorest over 65s were more likely to work in the USA than in England in 2002. However, within the USA, employment amongst the poorest was still low, especially compared with wealthier groups; logistic regression analysis primarily attributes this to lower levels of health and education. A US policy approach would therefore most likely damage the financial position of the poorest in the UK, as increased employment would not sufficiently compensate for lost benefits.

The independent sector domiciliary care market has always been an integral part of the social care system in England, but has become especially important in recent years. Its smooth running is crucial for the delivery of an effective community care policy. This paper argues that the motivations of these providers is an important aspect of this system's functioning, and derives a typology which captures the most important ingredients which theory and practice suggest should be taken into account in this regard. Four provider types are identified; they can be labelled satisfied team players; demoralised isolates; ambivalence-experiencing go-getters; and ambivalence-experiencing quiet lifers. The categories reflect both the balance of intrinsic and extrinsic motivations, and these providers' situational contexts, including the nature of the relationships developed with local authority purchasers. The latter exert exceptional power and influence in social care markets in England.

The implementation of the NHS and Community Care Act, the greatly increased use of voluntary sector providers and the switch from grants to contracts form the background to this study. The article brings together two main themes in current social policy debate in the personal social services: regulation and quality assurance. Contracts are seen as increasingly significant forms of input, process and output regulation, although their impact depends upon their type and specificity and upon the capacity of purchasers to monitor contract compliance, and the sanctions available to them. Clarification of the conceptual framework is followed by the report of an empirical study of the position in a single large county. The results from this study are then discussed in the context of evidence from other parts of Britain and the United States. The main issues identified in this discussion are competition, consumer choice, user involvement, the dangers of excessive and inappropriate regulation, the importance of trust and risk, and the relationship of resources to quality.

The national insurance system of contributory work-related benefits was designed for a ‘core’ workforce in continuous full-time employment. It provides incomplete coverage for the rising numbers of people in the peripheral workforce: part-time jobs, temporary work and self-employment. National estimates are presented for workers whose earnings are below the national insurance threshold, and who are thus excluded from social security benefits such as unemployment, sickness and retirement benefits—roughly 2 million in the period 1985–87. It is estimated that another million workers at least are within the NI net, but outside the income tax net. In addition, there are up to 2 million non-working people who have trivial earnings that leave them outside the NI and tax nets. Homeworkers are found in both these groups. The paper discusses the implications of these findings for claims about the size of the black economy and the characteristics of people participating in the black economy, and for the future development of the social insurance system.

A succession of Acts of Parliament passed between 1988 and 1990 mark the most decisive break in British social policy since the period between 1944 and 1948. This paper examines the extent to which common principles underlie this legislation. One of the most important common elements has been the reduction in the powers of local government and in the presumption that local authorities should be the main providers of social welfare outside the social security system. Schools, housing estates and social care services are to be given greater powers to run themselves or to become separate organisations. Local authorities are to use their resources to fund and contract with external agencies. The possible outcomes of this change in governance are discussed.

There has been a clear trend toward greater conditionality and coercion in labour market and social policy in recent decades, a key part of which is tougher sanctions for unemployment benefit claimants who refuse offers of employment or otherwise fail to comply with their obligations. Our understanding of this trend and its determinants is so far built only on a corpus of small-N evidence, while systematic comparative large-N analyses are lacking. As a result, the broad patterns of policy change and their general political drivers remain underexplored. This paper fills this gap by examining unemployment benefit sanction reforms in 20 democracies between 1980 and 2012 using an original dataset. It is shown that governments introduce tougher sanctions in order to reconcile two competing pressures that arise during economic downturns: an increased need for social protection and reduced fiscal revenues. The findings, which are also applicable to other historical periods and policy areas, provide an impulse for future comparative large-N research on ‘demanding activation’ policies.

This paper examines the influence of the Troika on the retrenchment and reform of social security in Ireland during its bailout between 2010 and 2013. To do this, it draws on data from in-depth interviews with senior civil servants and civil society organisation staff who met with the Troika as part of their quarterly missions to Ireland during this period. The key themes which emerged from these interviews include the largely domestic origins of social security retrenchment and reform; the surprising, and distinctive, positions adopted by the European Commission and the International Monetary Fund (IMF); the extent of the Irish government's room for manoeuvre in this area, and the ways in which the Irish government defended social security against proposals for additional cuts put forward by the Troika. The paper concludes by arguing that the scope for domestic decision-making was heavily constrained, yet non-trivial, and that the Troika's influence comprised not only ‘powering’ but also ‘persuasion’.

Scholarship in social policy in recent years has examined how policy positions users in a range of roles, particularly most recently in terms of their roles as ‘choosers’ through the increased use of markets in welfare. This article considers how choice policies have positioned users since the creation of the modern welfare state, presenting a history of choice policies, but also a comparative examination of how they have differed in the UK between housing, education and healthcare. It concludes by suggesting that although approaches to choice vary considerably between the three public services examined, policy-makers often appear unaware of these differences, leading to mistaken assumptions that policies can be transferred or transplanted unproblematically.

The shift to the workfare state has brought about ways of governing welfare subjects, the practical implementation of which has often been delegated to private state agents and their street-level bureaucrats. In the neoliberal paternalist state, the words and deeds of these street-level agents become even more relevant in order to understand the impact of contemporary social policies. This article focuses on the case of migrants in the Netherlands, who are problematised in particular as (potential) welfare subjects. By analysing the civic integration programme content for migrants, it reveals the responsibilising and disciplining discourses and practices used to promote the ideal of citizen-worker. That the task of inculcating the virtues and skills demanded by neoliberal policies has been transferred to private course providers makes state ideology all-invasive. While the lack of integration and participation is linked to individual failure, the state loses its social face in the process.

This article argues that our understanding of income and poverty dynamics benefits from taking a life-cycle perspective. A person's age and family circumstances – the factors that shape their life cycle – affect the likelihood of experiencing key life events, such as partnership formation, having children, or retirement; this in turn affects their probability of experiencing rising, falling, or other income trajectories. Using ten waves of the British Household Panel Survey, we analyse the income trajectories of people at different stages in their lives in order to build a picture of income dynamics over the whole life cycle. We find that particular life events are closely associated with either rising or falling trajectories, but that there is considerable heterogeneity in income trajectories following these different events. Typically, individuals experiencing one of these life events are around twice as likely to experience a particular income trajectory, but most individuals will not follow the trajectory most commonly associated with that life event. This work improves our understanding of the financial impact of different life events and provides an indication of how effectively the welfare state cushions people against the potentially adverse impact of these events.

Since the election of the Thatcher Government in 1979, public expenditure on the welfare state has undergone a series of changes. The nature of change has, however, often been obscured by the use of inadequate and misleading statistical data. This paper presents a systematic examination of public expenditure on education, health care, housing and social security over the period 1979/80 to 1984/85. It shows that, contrary to much political rhetoric, the major changes in the welfare state have not always arisen from reductions in programme expenditures, but from changes in the composition of expenditure. It is the latter that has often increased economic inequality and can be legitimately referred to as ‘restructuring’.

The passing of the Carers (Recognition and Services Act) 1995 was a step forward in trying to ensure that people who provide informal care to disabled, sick or elderly relatives or friends are properly recognised and properly supported. The Carers Act gave informal carers the right to an assessment of their own needs, and this article is based on a study into the impact of the legislation in four local authority social services departments. It is argued that the vision of supporters of the Carers Act, namely to achieve real benefits for many carers, has yet to be realised. The analysis draws on Klein et al.’s (1996) framework of service rationing strategies to demonstrate that decisions about priority setting and different forms of rationing of social care took place at three different levels: national government, local authority and front-line practitioner. Evidence is presented to show that some carers chose to impose rationing on themselves by reducing their demands. The article concludes with comments on the implications of rationing decisions for policy and practice.

Early childhood education and care (ECEC) is seen as a crucial element of the social investment state. Whilst the extent of social investment in ECEC depends on financial expenditure, its effectiveness depends on certain conditions being met: namely, affordable, high quality provision being available. We explore policy development and the role played by government in the funding, provision and regulation of ECEC in England, France and Germany and then compare availability, affordability and quality. We argue that for children aged three and over, social investment can be deemed to be broadly effective in France and Germany, but in England quality is compromised by low staff qualification levels in private childcare centres. For children under three, effective social investment is elusive in all countries, although as a result of different conditions not being met. Our findings lead us to question the limitations of the concept of social investment in ECEC, particularly in marketised contexts.