Universal Health Coverage (UHC) and Social Health Protection (SHP) are key policy foci that cut across all dimensions of the 2030 Sustainable Development Goals agenda. Understanding of these two concepts, their fundamentals and relations would improve health policy development and implementation to attain UHC and effectively protect the health of people and save lives and livelihoods. The COVID-19 pandemic has provided useful lessons to improve multi-sector activities to strengthen and finance health and social protection systems. The aim of this article is to provide conceptual clarity on the contribution of the global frameworks on SHP to the policy goal of UHC. In doing so, the article contributes to health financing and social security related policy discussions and advocates for much needed integrated policy actions at global as well as country levels. It discusses the origins of the two concepts and the relevance of SHP to health systems financing for UHC. Although country situations differ, the main findings, especially for low- and middle-income countries, are highlighted and summarized.

Based on original evidence from the European Social Policy Network (ESPN), the article investigates the extent to which self-employed and non-standard workers, who are less protected by “ordinary” social protection, were included in “extraordinary” income protection and job retention schemes during the COVID-19 pandemic in the European Union (EU) and the United Kingdom. When the crisis hit, countries quickly introduced unprecedented emergency income replacement measures for the self-employed. Nevertheless, most of these schemes provided only basic support through lump sums and were, in some cases, subject to a variety of eligibility conditions. Non-standard workers were in general included in job retention schemes, but substantial gaps remained in some countries. The article discusses how such gaps were addressed in five EU Member States. The article concludes by highlighting some policy pointers for better and more adequate “extraordinary” income protection for the self-employed and non-standard workers in times of crisis.

In 2019, the Government of Egypt issued a new legal framework for its social insurance system. Aside from providing a unified scheme covering different groups of workers, the new regulation allowed for systemic and parametric reforms that were aimed in large part at addressing the challenge of workers’ low enrolment in social insurance, with an emphasis on informal workers. The reforms reduced the rate of contributions paid by employees and employers, increased the penalties for employers who do not register their workers, and improved the benefits structure. The law also specified provisions to facilitate the enrolment of informal workers by offering to cover the employer’s share of their contributions. However, the law limited such improved access to nine specific categories of informal workers, a decision that fails to recognize the diversity of informal forms of work. Based on the analysis of the characteristics of contributors to the previous system, this article argues that structural barriers pertaining to the large numbers of low-earners and informal enterprises in the economy will likely hinder the expansion of system enrolment despite the legal reforms.

This article analyses Cuba’s pension system from 2006–2021 with respect to its financial and actuarial sustainability and impact on the population. It includes discussion of the ageing population; the sharp cut in social expenditures since 2009; the deficit in pension financing and the impact of the 2008 parametric reform; the devaluation of pensions; structural reforms and the expansion of poverty and the curtailing of social assistance; the impact of the current economic crisis on pensions; and projections of the future financial sustainability of pensions.

In an effort to establish universal health coverage (UHC), Senegal set up two departmental health insurance units (UDAM) to scale-up health insurance to rural communities. Part of this innovation meant that health insurance was longer managed by volunteers, but by professionals. Several years after the conclusion of the project in 2017 that supported their initial development, both UDAMs still operate successfully. This mixed methods research aims to understand the factors that have contributed to the sustainability of both UDAMs, as well as discuss the remaining challenges. The factors deemed favourable to sustainability are actions undertaken to ensure financial stability and organizational risk taking. However, the mobilization of the population, relationships with health professionals and the role of the State have been more difficult to organize. Challenges concern the payment of subsidies and the supply of medicines by the State and partnership with the health care system, the maintenance of contributions, the digitalization of administration, as well as fraud and abuse.

Using unique administrative register data, we investigate old-age retirement under the statutory pension scheme in Finland. The analysis is based on multi-outcome modelling of pensions and working lives together with a range of explanatory variables. An adaptive multi-outcome LAD-lasso regression method is applied to obtain estimates of earnings and socioeconomic factors affecting old-age retirement and to decide which of these variables should be included in our model. The proposed statistical technique produces robust and less biased regression coefficient estimates in the context of skewed outcome distributions and an excess number of zeros in some of the explanatory variables. The results underline the importance of late life course earnings and employment to the final amount of pension and reveal differences in pension outcomes across socioeconomic groups. We conclude that adaptive LAD-lasso regression is a promising statistical technique that could be usefully employed in studying various topics in the pension industry.

This article analyses whether and to what extent social protection expenditure varies with institutional quality and people’s preferences using cross-section and cross-country panel data. It uses data on expenditure taken from the International Labour Office database focusing on 52 low- and middle-income countries and on 80 high-, low- and middle-income countries. The results show that both factors have an impact for the group of low- and middle-income countries, but also for all the countries in the sample. The estimates are robust to different definitions of the dependent variables and different measures for the quality of institutions. Our results suggest that it is worthwhile to continue enhancing the capacity of institutions and public authorities as well as to channel people’s preferences on social protection interventions into the planning and budgeting process where the decisions on social protection programmes are taken and resources allocated.

Using the Ghanaian LEAP benefit programme as a case study, we investigate how administrators, service personnel and beneficiaries perceive and respond to implementation dilemmas. The investigation focuses on the LEAP benefit for caregivers of children, which is conditional on children’s school attendance, health check‑ups and vaccinations. An ethical dilemma concerns whether non-compliance should be sanctioned, since this may push caregivers and their children deeper into poverty. Other dilemmas concern how administrative resources should be allocated for the targeting, monitoring, sanctioning and exiting of beneficiaries; how spending should be allocated between providing cash benefits and securing health and education services of sufficient quality; whether available money should be spread widely but thinly to provide incentives for many caregivers to send children to schools and attend health check-ups, or be targeted more narrowly to enhance relief for the very poorest; and whether funding would be less forthcoming if the minimum benefit was not a conditional cash transfer (CCT). We discuss whether similar dilemmas are likely to be present in other low- and middle-income countries operating similar CCTs, and whether some of these also apply to “active” minimum benefits implemented in high-income countries.

The impact of the COVID-19 pandemic threatens the viability of Chile’s defined contribution (DC) pension system, undermining its financial foundation and exposing its vulnerability to political risk. The COVID-19 crisis led to the approval of three rounds of emergency withdrawals of 10 per cent of pension savings (as of April 2021). Utilizing pension funds during an economic crisis is neither new nor uncommon – during the Great Recession, several countries in Central and Eastern Europe diverted DC pension funds to cope with the fiscal stresses. As Chile prepares to draft a new constitution, debates about the efficiency and equity of the pension system are ongoing. In this regard, and as the political response to the pandemic demonstrates, the DC system has failed to live up to its promise of ending political risk and preventing the diversion of pension funds for other expenditures.

Limited evidence on the design and implementation of social protection programmes for people with disabilities in low- and middle-income countries constrains understanding of how their impacts could be improved. The Disability Allowance programme in the Maldives is a non means-tested, monthly cash transfer targeting people with disabilities. Using qualitative methods, process evaluation was used to examine the intervention design, implementation, and likelihood of achieving its intended objectives. There were important strengths of the programme, including the broad definition of disability. We find that delivery could be strengthened through providing greater clarity on eligibility criteria and strengthening human resources to widen the programme’s reach. Intervention fidelity was challenged by inconsistent practice among implementers and lack of established protocols. Most importantly, the absence of linkages with the Medical Welfare scheme that provides assistive devices potentially limits the likelihood of the programme achieving intended objectives.

Addressing the social protection of platform workers, the French legislator in 2016 and then in 2019 made moves to incorporate these workers into the general social security regime with regard to certain covered risks (work injury and occupational diseases), and to improve adequacy (enabling possible access to complementary coverage). However, these moves rest on radically opposed perspectives. Rather than reasserting the legal responsibility of the employer vis-à-vis workers’ health and safety, we see responsibility placed with the platform, but only on a voluntary basis under the aegis of corporate social responsibility. This risks fragmenting social benefits, to be determined by each platform, thus weakening the practices of mutual protection and risk pooling among enterprises and workers that lie at the heart of social security. In doing so, the legislator has broken the link that had as its historic objective the goal of social inclusion and has encouraged in different ways the privatization, or a re-commodification, of social security in the commercial interest of private insurance companies. Moreover, this has been done using the Trojan Horse of the French labour code. This approach is in contrast to the converging position of international organizations, such as the European Union, International Labour Organization or the Organisation for Economic Co-operation and Development, recommending that States establish a right to social protection for all atypical workers and non-salaried workers. Instead of identifying the common challenges that face workers who work for platforms, and offering responses specific to their situation, rather, it considers platform work as one of the new forms of atypical work undertaken by those who may have the status of employee or self-employed.

The right to social security is enshrined in article 23 of the Belgian Constitution. It is the role of the legislator to implement it, to guarantee the right of all to lead a life in accordance with human dignity. Studies show that platform workers face major difficulties in terms of social protection. The aim of this article is to highlight the limits of existing legislative provisions regarding their ability to implement the fundamental right to social security for platform workers. With regard to these legislative provisions, we are interested in both the general regulations that shape the Belgian social security system and the recent measures adopted by the Belgian legislator with regard to the so-called sharing economy. An analysis of these provisions reveals that a number of platform workers are excluded from social security, both de facto and de jure. At the very least, this raises the question of whether the Belgian legislator is complying with the positive obligation to fulfil the constitutional right to social security for platform workers, and the negative obligation, at least, not to undermine it.

Studies on the social protection of platform workers in Spain have focused on the bike couriers (or “riders”) who deliver meals to customers’ homes and whose services are used by some of the best-known platforms on the country’s social and economic scene. Most of these workers are covered by the social security scheme for self-employed workers. However, a Supreme Court ruling issued on 25 September 2020 reclassified the relationship between Glovo and its couriers as a contract of employment. This decision has changed the outlook for platforms and prompted the Spanish Government to regulate platform work in Spain. Nonetheless, the government ruling is limited to couriers, whereas, in reality, the issue is much broader. In this article, we look at the current reality of Spain’s platform workers vis-à-vis the social security system and the latest court rulings.

In the Netherlands, the social security rights of platform workers have still not been formally defined. At present, the level of social security protection accorded to all workers is derived directly from the labour law qualification. In the continuing absence in the Netherlands of specific legislation for platform workers, specifically as regards labour law and social security law, the existing legislation is steering. This means that the platform worker is either included using the status of employee with the corresponding extensive protection package, or the status of self-employed with limited social protection. For the majority of platform workers, this second option is applied to date. Nevertheless, recent developments point to possible improvements in the social security position of platform workers in the Netherlands.

This article compares social security coverage for the self-employed and for employees on digital platforms in Switzerland. It sheds light on the particularities that have acted to slow down the evolution of Swiss social legislation to the new emerging forms of work, and summarizes the solutions provided by case law. These solutions are still being fine-tuned, but lean towards the reclassification of contracts as salaried work. Finally, despite the hesitance of the Swiss authorities to take political steps to encourage these new forms of work, which offer significant economic potential, and while also seeking to prevent the risk of precarity in work, we discuss the options available.

In a changing world of work, platform workers struggle to gain adequate protection, and effective access to the benefits provided by the social security system form a part of this. Social security benefits in Romania are particular in that access is based on a person having a professional income, regardless of the legal status of the worker (subordinate or self-employed). As a rule, all workers are covered in the event of illness and changing family circumstances as well as for pensions. In contrast, coverage for self-employed workers for unemployment benefits, workplace injury and occupational disease benefits, paid leave in the event of illness, protection against the risks related to pregnancy or to care for a sick child is voluntary. Given the diffusion of platform work, the article addresses the specific situation of platform workers in Romania, formally covered by the social security system, but who face obstacles related to eligibility criteria, administrative formalities, the risk of the automatic termination of work and intermittent work patterns.

Platform work confronts traditional social security law in two dimensions. First, it makes the distinction between dependent and independent work uncertain and unclear, as the borderlines between these blur. This is a profound challenge for social security law, because the criteria of dependent and independent work have to be precise. In the determination of work as dependent or independent, German law illustrates that a shift has taken place in determining employment status, moving from external and objective criteria to the contracting parties’ decision, which is to be executed under private law, but also respected under social security law. Second, platform work is heavily intertwined with digital communication, which has established a global environment for communication. Thereby, platform work can also facilitate international trade by making transnational work more accessible and efficient. Therefore, it seems necessary to examine the implications of platform work in international law. International law makes possible the choice of law, executed by the contracting parties. As a consequence, the protection of employees by social security law is related to the private law arrangements between the service provider and the service recipient. Gaps in social security protection of service providers are widespread. In many countries, awareness of the social protection deficits of platform workers has grown and responses to improve the social status of platform workers have come under scrutiny. Analysis reveals that there is a joint responsibility of the service provider and the service recipient to be bound to social security coverage under the same national legislation. Nevertheless, from an international law perspective, it is shown that reforms are confronted with restrictions under international law.

Are online platform “workers” in Denmark effectively and adequately protected against social and labour market risks?  This article discusses this fundamental issue in the context of the Danish labour market, which is known for having high levels of job insecurity but a rather generous social security system. The article finds that the Danish statutory social security system provides a necessary cushion against risk, but also identifies gaps in protection, which brings into question the system’s effective coverage and the adequacy of benefits.

This article highlights the debate on social security regimes applicable to platform workers in Italy. As social security regimes differ according to the type of employment or self-employment relationship, Italian case law dealing with platform workers’ employment status will be illustrated. Italian legislation, case law and collective bargaining on health and safety at work will then be presented, clarifying the coverage to which platform workers are entitled in the event of accidents at work and occupational diseases, with a focus on the COVID-19 pandemic impact. In turn, the two main Italian minimum income schemes and the related scholarly debate will be outlined, as well as their impact on the ability of digital labour platforms to avoid their responsibilities as regards workers’ rights, including access to adequate social protection.

This special issue of the International Social Security Review addresses the important topic of social protection for digital platform workers in Europe. The special issue highlights the risk that social protection systems may be largely undermined by a decline in social solidarity in favour of individualism, the partial or full privatization of social security, and a reduction in protection levels, all as a result of the emergence of digital platforms and the support they receive from legislators in most countries.