The Social Policy Digest went online in the summer of 2003. This means that the Digest, which used to be printed as part of the Journal of Social Policy, is now only available via the web.

The Social Policy Digest went online in the summer of 2003. This means that the Digest, which used to be printed as part of the Journal of Social Policy, is now only available via the web.

The Social Policy Digest went online in the summer of 2003. This means that the Digest, which used to be printed as part of the Journal of Social Policy, is now only available via the web.

The Social Policy Digest went online in the summer of 2003. This means that the Digest, which used to be printed as part of the Journal of Social Policy, is now only available via the web.

Extending choice in health care is currently popular among English, and other, politicians. Those promoting choice make an appeal to a simple economic argument. Competitive pressure helps make private firms more efficient and consumer choice acts as a major driver for efficiency. Giving service users the ability to choose applies competitive pressure to health care providers and, analogously with private markets, they will raise their game to attract business. The article subjects this assumption to the scrutiny provided by a review of the theoretical and empirical economic evidence on choice in health care. The review considers several interlocking aspects of the current English choice policy: competition between hospitals, the responsiveness of patients to greater choice, the provision of information, and the use of fixed prices. The article concludes that there is neither strong theoretical nor empirical support for competition, but that there are cases where competition has improved outcomes. The article ends with a discussion of the implications of this literature for policies to promote competition in the English NHS.

The risk of poverty is very unevenly distributed in society. Some groups – unemployed people, lone parents, large families, people with disabilities, and some ethnic groups – have much higher poverty rates than average. Some events – losing a job, marital breakdown, having children – also put people at high risk of poverty. But being in a high-risk group does not necessarily mean you will be poor, nor does experiencing an event with a high poverty risk attached to it. Some people avoid poverty, despite being in high-risk groups or facing high-risk events. This article focuses on one such group – low-paid workers – and explores whether and how people in low-paid jobs are able to avoid poverty. We consider three main options – own wages and in particular working long hours, living with other people and sharing income, and state transfers through the tax and benefit system – and compare these across different family and household types. The results highlight the importance of household living arrangements in protecting low-waged individuals against poverty.

Despite high levels of unemployment, South Africa's welfare system is premised on full employment: only those who are too young, too old or too sick to work qualify for social assistance. A government committee recently recommended the introduction of a universal Basic Income Grant (BIG) to address this hole in the welfare net. Now that highly active antiretroviral thereapy (HAART) is being rolled out through the public health sector for people sick with AIDS, the case for a BIG is even more compelling. People sick with AIDS qualify for a disability grant. The HAART rollout offers them the chance of restored health – but it comes at the cost of losing the disability grant because they will be deemed well enough to work. Given South Africa's high unemployment rates, many will not be able to find work, and hence will face a trade-off between health (taking HAART) and income (keeping the disability grant). This could undermine adherence to HAART and/or reduce the effectiveness of the treatment by compromising the nutritional status of patients, thereby facilitating the growth of drug-resistant HIV. Introducing a BIG could help resolve this unintended tension between health and welfare policy.

A significant, and probably increasing, proportion of older people are ‘asset rich, income poor’. This raises a number of social policy issues around poverty and living standards in later life. For example, perhaps older people are ‘living poor to die rich’ because they wish to pass on their assets to future generations or because they feel they have an ‘inalienable right’ to their property. Or perhaps they would like to use up their assets but find this difficult, for example, because of concerns around equity release products. This article focuses on attitudes to assets and inheritance, drawing on findings from in-depth interviews and focus groups. The data suggest that people generally take a balanced and pragmatic attitude to their resources. They do not wish to ‘live poor to die rich’ but nor are they keen to spend their resources recklessly as they wish to leave something to their families, while also maintaining a reasonable standard of living in later life. It concludes by suggesting that the current ‘asset-based welfare’ debate should broaden its focus on asset accumulation to consider issues around asset use.

Qualitative research is ambiguously placed as a source of evidence for policy. It provides a way of accessing the experiences and perspectives of those targeted by welfare interventions, yet it is routinely excluded from the evidence reviews undertaken to inform these interventions. The article explores what qualitative research – mapped and synthesised through a systematic review – can contribute to evidence and policy. Taking teenage motherhood as a case study, it juxtaposes the conclusions of quantitative reviews with themes emerging from a systematic review of qualitative studies of teenage mothers’ lives. It highlights how teenage motherhood, identified in quantitative reviews and in policy interventions as a route to social exclusion, emerges in these studies as an act of social inclusion. It highlights, too, how social disapproval as well as material hardship weigh on teenage mothers, and the potential role that policies could play in supporting the identities and resilient practices mothers develop in the face of material and social disadvantage.

The centrality of patient choice in the recent political rhetoric of both New Labour and the Conservative Party has prompted a renewed interest in the shift towards a more consumerist conception of health care in the UK. Accordingly, this article reports on early findings from a project in the ESRC/AHRB Cultures of Consumption Programme, exploring how the ‘consumer’ is constituted in narratives of health reform, and the ways in which policy documents present a particular image of the consumer as a rationale for institutional and cultural change. The article then goes on to look at the ways in which service delivery organisations have responded to New Labour's consumerist imperative. Drawing upon a series of interviews with senior health care managers in two case study locations, the article highlights ways in which choice, responsibility and empowerment have become critical points at which a consumerist orientation is articulated with established professional cultures, and how health organisations have experienced – and attempted to resolve – the tensions that result.

Poverty research has a long history in both Australia and Britain, but its influence on policy remains subject to political priorities and ideology. This can partly be explained by the limitations of defining poverty as low income and measuring it using an income poverty line. This article examines two national data sets that allow the income poverty profile to be compared with, and enriched by, the incidence of deprivation and social exclusion, measured using data that directly reflect experience. Although a degree of care must be applied when interpreting these new indicators within and between countries, a validated poverty measure is developed that reflects both low income and the experience of deprivation and exclusion. When results for the two countries are compared, they reveal stark differences between the alternative indicators. Britain has the higher income poverty rate and, although the incidence of both deprivation and exclusion are higher in Australia, Britain still has more validated poverty. The distributional profiles of deprivation and exclusion are shown to be very different in the two countries. These differences are explained by the very low incomes of low-income households in Britain, relative to other British households and relative to their Australian counterparts. Despite these differences, the results indicate that the same three groups face the greatest risk in both countries: lone parents, single working-age people and large (couple) families.

One frequently used direct measure of deprivation and poverty is the objective relative deprivation index (O-RDindex), developed by Mack and Lansley (1985). One assumption underlying the O-RDindex is that respondents can distinguish between what that they cannot afford and what they do not want. This assumption contradicts the subjective usage of the concept relative deprivation (S-RD), which suggests a connection between economic circumstances, choice of reference group and consumption preferences.

The present analysis supports the S-RD assumptions. People with limited access to economic resources are more likely to say they ‘do not want’ various consumable items. The results indicate a subjective bias that leads to underestimation of the incidence of O-RD among those suffering from the greatest economic hardship. However, it is also concluded that asking people to differentiate between choice and economic constraint improves our measurement of O-RD and decreases the risk that relatively well-off individuals will score high on the O-RDindex due to peculiar prioritising of consumption. Yet it is still the case that the social mechanisms related to S-RD most probably lead to underestimation of O-RD.

This paper takes issue with arguments emanating from the global social policy literature that neoliberal policy agendas have been largely a consequence of the interplay of international agencies with indigenous reform interests. While relevant, such arguments grasp only part of the story of social policy change. By means of a case study of Hungary between 1990 and 2002, this article emphasises the role played by the bureaucratic reconstitution of the state and changing forms of national economic governance in the explanation of social policy change. We show how the bureaucratic redesign of the Hungarian state generated a ‘finance-driven’ form of economic governance with the state bureaucracy reconfigured around the fiscal control of the Finance Ministry. These changes had significant implications, not simply for social expenditure, but for the intellectual nature and bureaucratic space for social policy-making. Whereas critiques of neoliberal social policy reform tend to focus on the ideological nature of the projects, this analysis highlights the need to develop visions of, and arguments for, an alternative to the finance-driven forms of economic governance that have become the de facto bureaucratic archetype for re-designing welfare states.

This article uses administrative data to explore benefit dynamics for children in Britain's second largest city, Birmingham, over the period January 1998 to June 1999. As the benefits in question (housing benefit and council tax benefit) are means tested, the dynamics are also informative about moves in and out of low income. The article is original in its use of quarterly data to provide a comprehensive picture of benefit dynamics, in treating the child rather than the benefit claimant as the unit of analysis, and also in including ethnic group differences in its analysis of benefit exit and re-entry. It provides a picture of substantial ‘welfare dynamics’: that is, movements in and out of benefit support. Living in a low-income family in receipt of benefit can be seen to be a part, and sometimes a recurring part, of the experience of a large proportion of children. It argues that policy needs to investigate and take account of the impact of insecure income as well as poverty when considering the welfare of children.

This article derives from a two year study of ‘Home Supervision’, conducted as part of a programme of research on the Children (Scotland) Act 1995. The focus is on children looked after by the local authority who are on a legal supervision order at home, primarily as a consequence of having been abused or neglected, having offended or having failed to attend school without reasonable excuse. Two assumptions, both arguably a legacy of Lipsky, are challenged: first, that non-implementation by street-level bureaucrats is in opposition to their managers; and, second, the passivity of clients in respect of policy making. It is argued that the street-level bureaucrats and managers in the Home Supervision study share assumptive worlds in respect of children on home supervision, and that clients, as agentic actors, reveal a capacity for shaping policy at the implementation stage. These issues are explored and their implications for implementation studies and child welfare are discussed.

The erosion of the traditional, male breadwinner model family – both normatively and in social reality – has opened up the possibility of more choice in terms of both partnering and the nature of the contributions that men and women make to households, but processes of ‘individualisation’ have also given rise to greater uncertainty.

We know relatively little about how people perceive their options for partnering, re-production and employment at the level of the household, and in particular what they are prepared to ‘take a chance on’, and what kind of security they seek. Yet this is important for policy purposes, particularly in view of the rapid pace of family and labour market change.

This article first addresses the kind of considerations that are necessary for a better understanding of the nature of risks and uncertainty arising from processes of individualisation. The substantive sections that follow draw on in-depth interviews with a heterogeneous sample of 21 cohabiting and married men and women, drawn from an Omnibus representative sample survey. The extent to which individuals regard partnering and childbearing as risks, and how they seek to manage them are explored and the implications for policy assessed.

Paradoxically, the focus on teen motherhood as an object of concern in the West has coincided with declining rates of teen birth. This suggests that the view of teenage motherhood as problematic is underpinned by changing social and political imperatives regarding the role of women in these countries. This article examines the literature surrounding teenage motherhood from the United States, United Kingdom and New Zealand, and explores the way in which normative perceptions of motherhood have shifted over the past few decades to position teenage mothers as stigmatised and marginalised. Two specific discourses – those of welfare dependency and social exclusion – are highlighted, and their mediation through scientific discourses examined. The increasing trend to evidence-based policy development has masked the ideological basis of much policy in this area and highlights the importance of critical evaluation of the discourses surrounding teenage motherhood. A critical examination of the literature suggests that teenage mothers are vilified, not because the evidence of poor outcomes for teen mothers and their children is particularly compelling, but because these young women resist the typical life trajectory of their middle-class peers which conforms to the current governmental objectives of economic growth through higher education and increased female workforce participation.

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.

The rise of the third sector has been a global welfare phenomenon. In China, the growth of social organisations has been a remarkable feature of the transitional society after the adoption of market reforms and political liberalisation. In its emergent welfare economy, the third sector has been hailed as a new growth point in social care as the state retreats from direct provision of welfare services. This article examines non-state care homes for older people in urban China based on a survey of 137 homes in three cities. It begins with a brief review of the theory of the third sector, non-governmental organisations and private markets in the production of welfare. This is followed by a discussion of third-sector organisations, markets and the state in the special context of China. The next section appraises the factors that contribute to the surge of non-state residential provision for the elderly. The final part of the article presents empirical findings on the development, key features and authority relations of 137 non-state care homes for older people. It is argued that their uniqueness marks them out as a special form of third-sector organisation in China's welfare economy.

We explore the dimensionality of attitudes towards the welfare state among university students in eight countries representing four worlds of welfare: liberal, radical, conservative and social democratic. We use new data from cross-nationally comparable 25-item questionnaires to derive a two-level bi-factorial hierarchical model that specifies six different attitude facets. These facets are clustered into two distinct sets of attitudes: the ‘market-based frame’, which entails (a) individualism, (b) work ethic and (c) internal attribution of inequality and the ‘welfare-statist frame’, which entails (d) egalitarian redistribution, (e) broad scope of welfare and (f) external attribution of social inequality. In line with our expectations, respondents across different regime types structured their welfare state attitudes according to the six a priori defined types of attitudes and two sets of opposing attitudes. The study also found that the six facets are differently affected by regime type, which further corroborates our argument that the construct of welfare attitudes is complex and inherently multidimensional.