(Population: 45.72 million; Total area: 99,000 km2; Aging rate: 6.5%; Total fertility rate: 1.7; 1 won = 0.098 yen)
* Population, aging rate, and total fertility rate are as of the end of 1997, and the exchange rate is as of March 1999.
1. An Overview and Trends in the Social Security System
South Korea's social security system mainly comprises a social insurance system, public assistance and social welfare programs. The social insurance system consists of a national pension, medical insurance, employment insurance, and industrial disaster insurance. Public assistance includes daily living support, medical care support, and disaster and accident relief. The social welfare programs are mainly classified into five and designed for children, the elderly, people with disabilities, women, and the homeless.
(1) National Pension System
In South Korea, pension systems used to cover only public service employees, military personnel, and teachers and other employees of private schools. Its coverage was gradually expanded over the years, and the National Pension system was launched in 1988 covering employees of business establishments with ten or more employees, then being expanded to cover those of business establishments with five or more employees in 1992. The pension system for the people engaged in agriculture and fisheries was established in 1995. Due to recent reform in the National Pension system, employees of business establishments with five or less employees, day workers, temporary workers, and the self-employed in urban areas are to be covered by the National Pension, with the reduced benefits amount.
(2) Medical Insurance System
South Korea's medical insurance system was established in 1977. Its coverage was gradually expanded over the years into a universal insurance, which was started in 1989. In 1999, foreigners living in South Korea for at least one year and young people of the age 20 or younger are also subject to medical insurance.
The sources of revenues for medical insurance system include premiums paid by the insured, contributions from employers, and the governmental subsidies. Insurance benefits include treatment benefits and delivery benefits among others. A portion of the cost incurred is borne by patients (20% of inpatient care and 30 to 55% of outpatient care).
In order to improve medical insurance system, the government is considering of abolishing restriction on the present medical examination rights and introducing a relative-value remuneration system (i.e. point system).
There is a medical assistance system for the people, who are unable to earn a livelihood and qualified for public assistance.
(3) Welfare System for the Elderly
As of 1988, the elderly population of the age 65 and older occupied 6.6% of the whole population (3.05 million people). This percentage will be estimated to increase to more than 7% in 2000, and 14% in 2022. South Korea is expected to be an aging society.
Welfare policies for the elderly used to focus on facility service for the low-income elderly. According to the increase of elderly population, those services have been expanded to general coverage. The services include expansion and improvement of welfare facilities for the elderly, old-age pension system, health promotion programs for the elderly, in-home welfare service for the elderly, and promotion of the elderly's social participation, and spare-time activities and courtesy programs for the elderly.
"10-Year Plan for Senile Elderly"(1996-2005) is underway as the countermeasures against senile dementia. It includes establishment of special sanatoria for senile dementia, expansion of senile dementia care hospitals, and prevention and management of, and provision of information for senile dementia at health centers.
For the purpose of promoting in-home welfare services for the elderly, home helper dispatch centers, which provide daily services such as patients' care and bathing, are to be further improved.
For promoting social participation of the elderly, the government encourages to make use of the elderly's experiences and knowledge for the communities, expanding recreation facilities for the elderly and introducing the senior community volunteer leader system.
(4) Welfare System for Children
In South Korea, child population has been continuously decreasing since 1960 due to family planning. Child population of 1980 was 41% of the whole population, decreasing to 27.7% in 1997. It is estimated to be decreased to 21% in 2020.
Principal child welfare policies include child protection projects (counseling service, and establishment and management of general child-seeking centers), family protection system (adoption, and protection of families with minors being householders), and facility protection system (child welfare facilities, support for independence of children staying overtime at facilities), matchmaking support programs, nurturing of child protection idea, and child care programs.
According to the recent increase of women participating to the society and nuclear families, the government engages in expanding nursery care facilities such as office nurseries and giving assistance to nursery care expenses for low-income people.
(5) Public Health Policies
The Ministry of Health and Social Affairs is the national organization, and health centers and health center branches are local organizations, responsible for public health, respectively. General practitioners and other medical staff regularly work in these facilities provide preventive services and primary care. Nurses with a certain level of training (so-called regional health care staff) work in facilities called Primary Health Care Posts (PHP) to provide various preventive services and primary care in the areas where it is difficult to secure doctors.
More than 80% of medical institutions in South Korea are private institutions. Specialized doctors and medical institutions are concentrated in urban areas. Most patients visit well-known general hospitals in cities, and this is the reason that the government introduced a nationwide patient referral system in 1989. In this system, patients first see any available doctor in the designated districts. If necessary, the patient can be referred to a more advanced hospital.
Besides, public organizations engage in a variety of group health care activities: that is, countermeasures against infectious diseases (e.g. tuberculosis, and Hansen's disease), health and medical care services for remote areas, epidemics control, home-visit service, health care education, and education and guidance for long-term care. These organizations act the role to contain private institutions, with primary activities including giving guidance to medical organizations, drug and pharmaceutical control, and food hygiene management.
2. Summary of Public Assistance System
In South Korea, public assistance system is established based on the idea to secure the right to live pursuant to Article 34 of the Constitution, and mainly according to the Public Assistance Law (1961), National Medical Care Law (1979), and Disaster Relief Law (1962). National government is responsible for supplying benefits to the people, who are unable to spend their daily lives by themselves and need assistance.
Specific examples of public assistance include: public assistance for low-income people, assistance to spend independent lives, medical care assistance, relief from disasters. Public assistance, which supplies cash benefits or services for low-income people based on asset surveys, is classified into self-help assistance, in-home assistance, and facility assistance, depending on their working abilities. Self-help assistance is provided for those with abilities to work, and in-home or facility assistance for those without such abilities. Facility assistance is especially for the people who have no places to live or are unable to receive protection at their places.
In order to provide the services to low-income people more smoothly, social workers are allocated in the smallest administrative districts to provide services such as diagnostic surveys, consulting, and assistance to independence.
Local governments are responsible for giving surveys and benefits to the public assistance beneficiaries. Budget for public assistance system in 1999 is about 2,331.9 billion won (including the expenses for local areas). Cost-sharing rate between the national government and local governments are different in services. In case of living costs, the National Treasury subsidizes 50% in Seoul or 80% in other areas, of the costs, respectively.
Public assistance beneficiaries should have no dependents or live with anyone who is responsible for maintaining family members but have no ability to maintain those family members corresponding to any of the following:
Cash benefits are provided from 1992 for facility assistance beneficiaries and from 1995 for in-home assistance beneficiaries. The benefits covers the expenses including 1) basic living costs for foods, fuel, necessities, and winterization, 2) medical care, 3) education for junior high or high schools, 4) funeral and memorial services, and 5) deliveries.
Minimum amount for livelihood expenses is provided annually to set the standards for public assistance. In 1999, beneficiaries are classified into 36 categories by items such as income or family composition. Benefits per capita are 54,000 wons to 152,000 wons. Public assistance budget for FY1999 is about 2,331.9 billion wons including regional budgets. Budget allocation ratio between the central and local government is different depending on programs. In case of livelihood expenses, the central government is allocated 50%, and local governments 80% of the budget.
Number of the people qualified for public assistance in FY1998 is 1,175,000 persons. It occupies 2.6% of the total population of the country, consisting of 301,000 subject to in-home assistance, 76,000 subject to facility assistance, and 798,000 subject to self-help assistance.
3. Challenges of the Social Security System
(1) Unification of Insurance Systems
Recent reforms in social insurance include 1) coverage expansion, 2) adjustment in salary standards, 3) expansion in resources, pursuit of efficiency, and 4) improvement of management system. Specific measures are as follows: unification of medical insurance systems, realization of the nationwide pension system, expanded coverage for employment insurance and workmen's accident compensation insurance, adjustment in salary, and unified management of four largest social insurance systems.
(2) Improvement in Social Welfare Facility Management
Some of social welfare facilities have recently brought up several problems including violation of human rights, deterioration of facilities, shortage of facility staff, and inferior treatment in facilities; and these problems necessitate drastic countermeasures in facility management.
In order to improve the situation, the government is going to examine and evaluate social welfare facilities, encourage to classify and differentiate those facilities, and also entrust the periodical surveys on actual operation and improvement in fiscal transparency to community welfare ombudsmen. For the purpose of avoiding the civil right violation of the admitted people, the facilities are open to the communities.
(3) Unification of Health Care and Welfare
A plan is underway in five areas as a trial from 1995 to develop public social welfare system. In this plan, welfare organizations of cities, counties, wards, and smaller administrative districts are to be merged with the present health centers into health and welfare offices.
(4) Expansion of Social Safety Net
Increase of the number of the unemployed among low-income people due to the economic depression led the government to invest 200 billion won for special projects to protect low-income people and the homeless in big cities. In 1998, 330,000 persons were chosen to be qualified to receive temporary public assistance for living costs, school expenses, and medical expenses. In 1999, it is expected to give the assistance to 570,000 persons.
Such high unemployment rate will be expected to continue for the time being. Therefore, it is an urgent issue to establish some social safety net including expansion of public assistance.
(Population: 1,248.1 million; Total area: 9,571.3 thousand km2; Aging rate: 7.04%;Total fertility rate: 2.12; 1 yuan = 14.88 yen)
* The population is as of 1998, the aging rate is as of 1997, total fertility rate is as of 1995, and the exchange rate is as the end of March 1999 (medium price).
1. An Overview and Recent Trends in the Social Security System
The social security system in the People's Republic of China (hereinafter referred to as "China") was originated from establishment of the "Labor Insurance Act" in 1951, which institutionalized old-age benefits and medical benefits for governmental corporation employees. Subsequently, systems for public officials and people living in agricultural areas were gradually developed. Such occupational classification still continues, in principle.
The Cultural Revolution destroyed the social security system. Welfare system for workers was improved as enterprises paid all costs for pensions. At the Third Plenum (of the 11th Party Congress Central Committee) in 1978, it was stated that social security reform is one of the important policies among socialistic economic reform. Since then, rapid reform is underway. In the ninth five-year plan (1996-2000) this basic direction is stipulated as "to establish the basic stage of multi-layer social security system organically combining social insurance, social relief, social welfare, and welfare service for families of the deceased military personnel, mutual aid, private-saving type accumulation insurance altogether, as well as conduct reform insurance systems for pension, unemployment, and medical care."
In 1998, the Ministry of Labor and Social Security was established, it centrally engages in and supervises social security services, which spread across multiple divisions.
(1) Pension System
The endowment insurance system for company workers previously provided that enterprises were required to be responsible for supplying benefits. However, the system reform started in the 1980's. Diffusion of the nationwide unified basic endowment insurance system for company employees is underway.
This basic endowment insurance system corresponds to public pension in Japan, which everyone is obliged to join. The government encourages the citizens to join voluntarily any of complementary programs such as complementary endowment insurance (similar to corporate pension in Japan) and private-saving type endowment insurance (similar to private endowment insurance in Japan). As regards basic endowment insurance, citizens annually pay 11% of average wages of the previous year's average wages to their own accounts (originally 4% paid by citizens, and 7% by enterprises, but these ratios are to be changed to 8% for citizens and 3% for enterprises). Enterprises pay a fixed portions (20% or less of total wages including those paid to private accounts) of total wages amount to the fund. The social insurance fund for each area (e.g. provinces, districts, prefectures, and cities) manages individual accounts and fund.
Basic pension benefits are paid to men of the age 60 and older and women of the age 50 to 55 and older paying the premiums for more than 15 years. Paid amounts are equivalent to 20% of the average monthly salaries of the areas, as well as additional benefits in about 0.8% of the amounts accumulated in individual accounts. As of the end of 1998, this system covers 88 million participants, 23 million beneficiaries, with 57 billion yuan in basic accumulated amounts in the fund, 120 billion yuan in premium income (as of 1997), and total supplied amount in 108 billion yuan. Participation breakdown is: 95% for state-owned enterprises, more than 50% for group-managed enterprises, and about 30% for others (foreign-capital enterprises and private enterprises).
Endowment insurance programs for public officials are managed pursuant to the endowment insurance system for public officials, except some areas. Governmental organizations pay all necessary costs for benefits, without any premiums collected. Benefits are 60 to 90% of standard income in proportion to working hours.
Endowment insurance system for the people living in agricultural areas have not been developed due to its vulnerable economic infrastructure, with only 800 thousand participants in the mid 1980's. A "Five-S" system (mentioned below) has been developed as a social relief system. In 1991, the Ministry of Civil Affairs published the basic bill for "endowment insurance for agricultural societies." At present, based on this bill, the endowment insurance system for agricultural societies is underway by way of trial. As of the end of 1997, the system covers 8.2% of the population.
(2) Medical Insurance System
As regards medical insurance system for company employees, people working for or being retired from enterprises used to participate to some insurance programs established by those enterprises, and receive medical services at clinics or hospitals managed by or under contract with those enterprises. However, in the 1980's, development of the open economy reform caused difficulties such as 1) slack business of state-owned enterprises, 2) increase in the number of non state-owned enterprises, and 3) raise in medical expenses. To solve such difficulties, the system continued to be reformed in full scale in the 1990's. As a result of the reform, the policies were prepared to execute and diffuse a new nationwide medical insurance system for urban workers by the end of 1999.
In the basic medical insurance system for urban workers, employers pay 6% of total wage amount (30% of the amount will be transferred to workers' personal accounts) to the fund, and workers pay 2% of their wages to personal accounts. Administrative districts or larger districts (or cities with direct jurisdiction) are in principle responsible for managing personal accounts and the fund. If it is difficult, prefectures may also be in charge of management. Medical benefits are in principle supplied from personal accounts. However, in case of medical expenses exceeding 10% of average wages, the benefits are supplied from the fund up to the amount four times the average wages at maximum (the medical benefits in proportion to wages are changeable responding to the case of communities). In case of receiving benefits from the fund, patients are required to pay a certain amount.
Public-funded medical care system for public officials has a certain restriction in benefits. However, the government pays all necessary costs for benefits, without any premiums collected. When the basic medical insurance system for urban workers is put into effect, public service employees will also participate in the system with some assistance from public funds.
People may voluntarily participate in the medical insurance system for agricultural areas. It has a flexible structure that an implementing entity and benefits description are decided corresponding to regional conditions. Benefits supplied are generally low, and its diffusion rate is only about 10%.
(3) Health and Medical Services
Organizations responsible for public health include the Ministry of Health in the central government, as well as the Chinese Academy of Medical Science, the Chinese Academy of Preventive Medicine, hospitals directly managed by the Ministry of Health, and hospitals of medical colleges directly managed by the Ministry of Health. As regards local organizations, the Class 1 administrative districts (corresponding to prefectures in Japan) include 23 provinces, five autonomous wards, and four cities with direct jurisdiction (and Hong Kong, a special administrative district with an advanced autonomy). Under provinces, districts of the Class 2 administrative districts, prefectures of the Class 3 administrative districts, xiangs and zhens (municipalities) as the lowest administrative organizations, and then several villages without administrative authorities follow, serially. Administrations include the provincial health care agencies, district health care agencies, and then prefectural health care offices. In provinces, districts, and prefectures, health care services are provided in health care and epidemics control centers, mother-child health care centers, special disease prevention research institutes, provincial people's hospitals, provincial hospitals of medical colleges, district hospitals, prefectural hospitals. Xiangs and zhens are governed by the municipal authorities and provide health and medical care services through health care centers. Villages have residential committees that are autonomous organizations for residents and village clinics. The public sector occupies dominant portions for health care services, that is, about 50% of hospitals or 70% of beds. Average number of beds per thousand people is 2.4 for hospitals and health care centers, and average number of days of hospitalization (in hospitals in prefectures or larger governments) is 13.8 days.
Health care service system is less developed in agricultural areas than in urban areas. About 90% of villages have temporary medical care facilities (e.g. village clinics), and even those facilities can provide the minimum services. Thus, improvement of health and medical care services is an important issue. As regards the people engaging in medical services, there are 1,985 thousand doctors (including those finishing medical schools), that is, 1.65 doctor per one thousand people. Agricultural villages have 970 thousand doctors with one or two year education in medical schools. National certification had not been developed for doctors before establishment of the Medical Doctor Law in 1998. National examination system is to be carried out in 1999. The number of nurses is 1,198 thousand, that is, 0.99 person per one thousand people.
Although there are no official statistical figures for gross national medical expenses, those for workers account for 77.33 billion yuan, 28 times the figures of 1978, with the annual increase by 19%.
(4) Welfare Policies for the Elderly and Disabled
The population of the age 60 and older is 120 million in number (9.7% of the whole population), which is estimated to reach 130 million (over 10% of the whole population) in 2000, and then exceed 400 million in 2040, at the year which is regarded as the peak of the aging society. At the advent of such a full-scale aging society, the Elderly Human Rights Security Law was established in 1996, as the basic law for welfare policies for the elderly. This Law stipulates the obligations to maintain families, as well as basic provisions about social security, education for the elderly, personnel training, cultural lives, facility development, and social participation. Community organizations managed mainly by community people based on the spirit of autonomy, self-help, and mutual aid carries out welfare services for the elderly. These services include facility development, health and medical care services, and social education activities. There are 42 thousand residential facilities for the elderly (e.g. welfare facilities and elderly homes) with 785 thousand residents. 5,000 senior citizens' universities and schools are developed.
As regards welfare policies for the disabled, the Disabled Security Law was established in 1990. The Law stipulates basic provisions about the rights, governmental responsibilities, and rehabilitation, education, employment, cultural lives, welfare policies, social environment, and legal responsibilities for the disabled. The number of the disabled is estimated as about 60 million at present. Community organizations take the lead to provide welfare services for the disabled, with 10,469 regional rehabilitation centers and 5,646 welfare service facilities.
(5) Policy for Family Planning
The population of China reached 1,236 million at the end of 1997. Plowland area per capita is one quarter of the world average width. The population is increasing by about 13 million persons per year. It results in producing the surplus workforce of more than 100 million persons in agricultural areas. Under such circumstances, for the purpose of restraining such significant population growth, the national government stipulates in the current Constitution established in 1982 to promote family planning to adjust the population increase to the economic and social development plan, as well as imposing obligations to married couples to planned delivery. (so-called "only-one child policy").
Specific measures are provided pursuant to the regulations of local government authorities. Those regulations stipulate 1) the raise in the marrying age (from the age 22 for men and 20 for women provided in the Marriage Law), 2) preferential treatment for deliveries and raising of children pursuant to the policies, and 3) sanctions against infringement of the policies. Although married couples are allowed to have only one child in principle, there are some exceptional measures taking regional economic and social situations into consideration. It is strictly restricted to have only one child in big cities, but, in many agricultural areas, married couples are allowed to have the second child after a certain period of time since the birth of the first child if it is a girl, or to have the second child. In the minority tribe residential areas, it is also allowed to have the second child or thereafter.
As a result, natural population increase rate decreased to 10.06% in 1997, compared to 25.83% in 1970. Besides, this policy may induce rapid progress in aging. From 1994, this policy was combined with other policies including those for maternal and child health care to focus not only on the population restraint but also on improvement of daily living in agricultural areas, maternal and child health care, and women's social positions.
2. Summary of Public Assistance System (Social Relief)
There are wide differences between urban cities and agricultural areas in the social relief system to rescue the people, who are unable to maintain basic living standards due to old age, feebleness, sickness, disabilities, or loss of working abilities.
The social relief services in urban areas are provided pursuant to the local governmental regulations. They are mainly classified into two: that is, relief of the people with difficulties in daily lives, and relief of the elderly living alone and orphans. There are differences in specific requirements for beneficiaries, benefit descriptions, and certification among others. Increase in the number of the poor in urban areas according to the progress in economic reforms results in development of a nationwide minimum public assistance system for the people living in urban areas at present. This public assistance system is for the people, who have no fixed income, working abilities, or dependents, who have the average household income equivalent to or below the minimum public assistance limit amount with no possibilities to engage in any job after the period of the unemployment benefits supplied is to be finished. The government grants the certification for applicants and then supplies the amount deducting the actual income from the minimum public assistance limit. The minimum public assistance limit amount set as the standards for benefits varies according to living standards and economic situations, between about 100 yuan and 250 yuan per month. It is permitted to be wholly funded by the government or jointly funded by the government and companies, with the total annual investment of 1.2 billion yuan. This system is to be developed in all cities and zhens of prefectural capitals by the end of 1999. As of the end of 1998, it covers 2,337 thousand persons of 584 cities (87% of all cities) and 1,035 prefectures (61% of all prefectures).
Besides, the social relief services in agricultural areas are also provided pursuant to the local governmental regulations under several formulas. They vary in contents, however centered on the "Five-S" system. "Five-S" means to secure foods, clothing, residence, medical care, and funerals. Xiangs and zhens are responsible for enforcement of the system. It is a social relief service system for the elderly, disabled, and minor satisfying the conditions (e.g. loss of working abilities or fixed income, or absence of dependents) to provide foods, fuel, clothing, reasonable amount of money, residence qualifying basic conditions, medical or funeral services, and education for the minor. Specifications of benefits are decided with taking the regional living standards into consideration. Well-conditioned xiangs or zhens may admit the elderly to the elderly homes. Xiangs and zhens pay 1.7 billion yuan and the government 110 million yuan for its financial resources. The "Five-S" beneficiaries are 2,003 thousand persons with the average annual amount of 856.9 yuan per capita.
3. Challenges of the Social Security System
As regards the social security system, the government made decisions on the basic medical insurance system for the people working in urban areas, as well as the basic endowment insurance system for company employees, the minimum public assistance system for the people living in urban areas. Reforms in urban areas are spreading now. Current issues include to stably diffuse such a nationwide universal system in local areas in full scale, and to develop the legal system with establishment of regulations required for the social security system (e.g. social insurance, pension, and medical insurance). Preparation is underway.
In the meantime, for the people in agricultural areas, occupying about 70% of the whole population, reforms are still in an experimental stage. Standards in benefits are largely different from those in urban areas, and it is important to diffuse and develop social security systems in agricultural areas.
A problem in the medical insurance system is how to deal with the increasing medical expenses. The government endeavors to control medical expenses for the new basic medical insurance system for the people working in urban areas with opening personal accounts to motivate patients to be conscious of their own medical costs. Besides, reforms are underway for pharmaceutical and medical service systems. They include enhanced management of medical services with preparation of drug lists and standards for medical services covered by the insurance and other measures, promotion of competitiveness among medical institutions, and separation of dispensing from medical practice.
(Population: 70.72 million; Total area: 300,000km2; Aging rate: 4.0%; Total fertility rate: 3.6;1 peso = 3.7 yen)
* The population, aging rate, and total fertility rate are as of 1997, and the exchange rate is as of March 1999.
1. An Overview of the Social Security System
The Philippines has a social security system that includes a retirement pension plan, a medical insurance plan, welfare programs for the elderly, which support their social activities, as well as child welfare programs for the protection and care of children who are abandoned or neglected, and family policies to reduce the birthrate. In addition, in order to secure access to medical care for low-income people, free or inexpensive medical care services, in proportion to each patient's income, are provided through national and public medical institutions.
(1) Social Insurance System
The social insurance system in the Philippines is mainly classified as two systems: the social security system (SSS), which serves private sector employees, and the Government Service Insurance System (GSIS), which service public sector employees. While classified as two systems, the SSS and GSIS are similar in nature to one another.
The SSS and the GSIS both consist of a social security program, a medical insurance program, commonly known as Medicare (MCR), and a workmen's accident security program, commonly known as the Employees' Compensation Program (EC). Every worker (including domestic helpers and others who work for individual families) and the self-employed (including those engaging in the farming, lumber, and fishing related industries) under the age 60 with an income of a fixed amount (at least 1,000 pesos per month) as well as all employers, are required to enroll in the Social Security System. The SSS supplies illness and injury benefits, disability benefits, death benefits for the bereaved, retirement pensions, and maternity leave benefits.
The Philippine Health Insurance Council (PHIC) manages the medical insurance program, MCR. The MCR will for the inpatient medical expenses (i.e. accommodations, meals, and drugs) of the participants and their dependents at hospitals or surgical facilities that are certified by the Philippine Medical Care Committee (PMCC). However, the participants must pay for outpatient surgical operations, like those for cataracts, etc. A certain portion of a qualified patient's medical expenses, according to the type of illness or injury the patient has, as well as the category of the medical institution, are paid directly from the MCR, in the form of a fixed amount, to the doctors or hospitals involved. Should the mediacl fees be in excess of the fixed amount paid by the MCR, the patients is expected to pay the excess amount. The maximum period of hospitalization, with benefits paid, is 45 days per year.
They are roughly 15.9 million workers and 480,000 employers that participate in the SSS, while 1.3 million people participate in the GSIS. Presently, the SSS and GSIS medical insurance programs serve approximately 24 million participants and their dependents.
(2) Welfare Policy for Children
The Department of Social Welfare and Development leads other relevant organizations in handling welfare policies for children. The total percentage of the population of the Philippines that is under the age of 21 is 49%. And, the majority of these young people require every type of social assistance available.
If parents have difficulties in taking care of their children due to family problems, such as illness, poverty, or other reasons, there are health care programs available to them. These programs include counseling and assistance for guardians, an adoption system, a foster parent entrustment program, and a protection-oriented facilities program.
In addition, all barangays (i.e. villages: minimum administrative units) are obliged to have day-care centers for children under the age of six (before they begin elementary school) whose parents work and whose grandparents or other relatives are unable to care for them. It is also required, pursuant to the Labor Law that any workplace with women workers should have a day-care center for children of these female workers.
Furthermore, the social security systems provide maternity leave benefits to the SSS or GSIS participants in order to compensate them for lost income resulting from absences due to maternity leaves.
(3) Welfare Policy for the Elderly
In the Philippines, the percentage of the total population that is considered elderly (persons 65 years of age or older) is relatively small compared to that of Japan. In fact, the elderly account for just 4.0% of the total population of the Philippines (1997 estimate). Thus, the aging of society is not recognized as an urgent issue at this time.
Traditional values still remain strong among the people, and, as a result of this, the elderly are usually cared for by their families. However, there are programs that provide protection-oriented facilities for those elderly people with no family members to take care for them.
In this regard, people living with and taking care of the elderly are subject to favorable treatment in taxation. Furthermore, assistance is provided for daily living improvement activities, self-motivated group activities, and volunteer activities conducted for the elderly involving young people or women. The elderly are also qualified to receive 20% discount on public transportation, accommodation facilities, and pharmaceuticals.
(4) Public Health Policies
The national organization responsible for public health is the Department of Health. Local administration organizations include regional health offices, which are directly managed by the Department of Health; provincial health offices, which are managed by the provincial governments and guide local medical care; and municipal health offices, which are managed by the municipalities.
As a result of the establishment of the health and medical care system in 1979, public hospitals came to play the roles corresponding to their functions, and Regional Health Units (RHU) and Barangay Health Units (BHU) were setup by barangays as subordinate organizations to give primary care. Each RHU can service up to 10,000 people. Doctors, nurses, and midwives work regularly in RHUs to give simple treatment and perform vaccinations, as well as offer health counseling, nutritional guidance, and family planning services. BHUs support RHUs and can each serve up to 1,500 people. Midwives and volunteers ("barangay health workers") staff the BHUs and provide assistance during childbirth, administer vaccinations, and provide family planning and various other services. In addition, municipal and district hospitals provide secondary care, while provincial hospitals, regional general hospitals, and national hospitals, including special hospitals and medical centers, provide tertiary care.
The policies based on a national health and medical care plan include the expansive vaccination plan, the plans to restrain the breakout and spread of diseases like tuberculosis, malaria, schistosomiasis, and Hansen's disease, as well as the plans to supply vitamin A and iron supplements to children, and to provide family planning services to all adults.
(5) Sources of Revenue
Separate insurance premiums are set for social security programs (pensions and non-work related disabilities), the medical insurance system (MCR), and the workmen's accident security system (EC). The premiums are paid in this way: of all monthly wages, 8.4% (5.04% by employers and 3.36% by workers) is paid for social security programs, 2.5% (1.25% each by employers and workers) is paid for the MCR, and 1% (all by employers) is paid for the workmen's accident security system.
2. Summary of Public Assistance System
In the Philippines there is still a wide gap between the rich and the poor. According to the statistical data, last taken in 1997, roughly 40% of the population lives below the poverty line. This percentage is even higher in the country's rural and agricultural areas.
The government, however, only spends 1.2% of its GDP on social benefits for those living below the poverty line. Unemployed are not eligible to receive public services because the social security system is, in principle, only for the employed. There is no public assistance system like the one in Japan, which would secure the minimum living standards of all of the nation's citizens. However, the people of the Philippines respect blood relationships, and the poorest and the unemployed are provided for by their families.
At present, the Department of Social Welfare and Development determines the goal of public assistance policies, which are designed to alleviate poverty by improving the standard and the living environment of low-income people.
In order to promote independence among these low-income people, the services such as loans for the self-employed, occupational training, and job placement are provided. The loans for the self-employed are offered to businesses that can be conducted with a low-capital investment, such as stalls or peddler based businesses.
In addition, regional assistance is offered to the rapidly increasing number of "street children." The regional measures include admitting these children to special facilities, and the provision of day-care services at day-care centers and field schools. The government also provides under-nourished children with milk and nutritional supplements (vitamins and iron).
Other services offered to needy families include living standard improvement projects designed to support independence, such as monetary assistance (no-interest loans) and food assistance programs.
3. Challenges of the Social Security System
One of the most urgent issues in Philippines is the need to control the increase of the still high population increase rate, especially total fertility rate. The increase of working population, due to a raise in the population as a whole, adversely affects the national economy by inducing the increased potential for unemployment, of for incomplete employment, and by causing wage standards to deteriorate.
Therefore, it is important to reduce the birth rate and control population growth. In this regard, the Philippine government calls on the assistance of foreign countries, including Japan, and the United Nations Population Fund (UNFPA), of which Japan is the largest contributor, to distribute contraceptive kits (condoms and intrauterine contraceptive devices) and drugs (hormone medicines and oral contraceptive pills), free of charge, as well as give guidance in the areas of family planning and contraception for all its citizens, whether male of female.
It should be noted that the people living in provincial cities and agricultural area have the most limited access to social welfare and medical services. This is because social welfare and medical services, and the institutions that provide them, are mostly concentrated in and around the capital, Manila. It is also difficult for these less populated areas, with their already insufficient medical services, to appropriately staff their health care centers. This is due to the fact health care professionals also tend to be concentrated in more urban areas.
In general, economic growth and an increase in the average income level will raise the overall standard of living. Thus, the Philippine government must take measures to improve pension and medical insurance systems, as well as its system of taxation, in order to stimulate economic growth and thereby improve the standard of living of its people.
(Population: 203.48 million; Total area: 1,905,000 km2; Aging rate: 4.2%; Total fertility rate: 2.1; 1 rupiah = 0.017 yen)
* The population and total fertility rate are as of 1997, aging rate is as of 1996, and the exchange rate is as of March 1999.
1. An Overview of the Social Security System
A universal social security system, similar to the one in Japan, has not yet been established in Indonesia. Various systems and services exist and are operated independently. These include the health maintenance security system with governmental authorization, workmen's social security system (health insurance, workmen's accident compensation insurance, old-age benefits, and death benefits), medical security and pension systems covering national public service employees and military personnel, and social welfare services designed for the elderly, people with disabilities, the poor, etc. Medical care services have been inexpensively provided through national or public hospitals and health centers to secure medical care for the people, as well as free-of-charge medical care services for needy people.
As part of the social welfare program, the government also supports the social welfare activities conducted by NGOs.
(1) Health Maintenance Security System (JPKM)
Pursuant to the relevant law in 1992, the government, for the purpose of promoting this system, gives authorization to the organizations that engage in health maintenance services satisfying the standards provided by the government. Sixteen organizations have obtained the governmental authorization by 1997. JPKM participants pay a fixed amount pursuant to the agreement for the services provided, and they receive diverse services to recover, maintain, and improve their health (e.g. disease prevention, tests, and treatment). Service providers should not impose any restrictions on the age of participants or risks. Expenses necessary for health and medical care services are set pursuant to the agreement between service providers and health care and medical institutions in advance. Local governments have appropriate organizations give instruction and supervision on the services.
(2) Workmen's Social Security System (JAMSOSTEK)
The workmen's social security system covers workers and it used to comprise mainly workmen's accident compensation insurance and death benefits. It was revised into a new system through the enactment of a law on the workmen's social security system in 1992. The new system comprises health insurance, workmen's accident compensation insurance, old-age benefits and death benefits. All employers who have 10 or more employees or who pay total monthly wages of one million rupiahs or more must participate in this system. Other employers can voluntarily participate in it. The health insurance provides benefits in kind including outpatient care, inpatient care, maternity care and drug coverage to workers and their families. The old-age benefits are based on the full funding method, in which insurance premiums which have accumulated are pair back to individual workers in a form of an annuity or in a lump sum. Workers are eligible for pension benefits when they become 55 years old, the age of mandatory retirement age. The workmen's social security system is managed by a public corporation through 87 regional offices nationwide. Separate from this system, there are a health insurance system and pension system covering public service employees.
(3) Health Insurance System for Public Service Employees and the Retiree
Public service employees (including military personnel) and the retirees are obliged to participate in this system, which is managed by the national health insurance corporation. Health care and medical services are provided through national hospitals and health centers.
(4) Welfare Policy for the Elderly
People living in urban areas still have firm family bonds. The elderly are often taken care of their family members. Thus, welfare policy for the elderly focuses on those living alone or having disabilities.
Specific measures include admitting the elderly to the institutions (45 public institutions and 72 private institutions) to take care of them, and giving them assistance and benefits.
(5) Welfare Policy for Children
Governmental policy focuses on economic assistance for needy children. Several public organizations offer facility services associated with protection, nursery care, etc. to children with no family and other similar children. Thirty-three public facilities and 730 private facilities provide rehabilitation services such as mental education and technical training for six months. Adoption programs flourish vigorously.
Furthermore, daily living support services are provided to families with social or economic problems, as well as loans to improve their means of living among other services. However, there is no systematized allowance intended for the general public such as the child allowance.
(6) Public Health Policies
The Ministry of Health, as a national organization, is responsible for public health. The Ministry establishes 27 provincial offices in each province. Health care agencies are establishes in provinces, prefectures, and cities, respectively. As prefectural organizations, counties have at least one health center (puskesmas) and health center branches (sub-puskesmas), respectively.
In Indonesia, most of private medical institutions are concentrated in big cities for medical services for rich people. Most of health and medical services for general public are provided by public organizations. Health centers take the central role of primary care in Indonesia, and provide people with disease prevention activities, health education, and treatment. They also provide other kinds of training for medical staff. Establishment of village-level health organizations (posiandu) has been promoted by residents.
(7) Sources of Revenue
Health insurance, old-age benefits and death benefits under the workmen's social security system employ an income-related fixed ratio system. Health insurance and death benefits are fully funded by employees. Twice the rate of insurance is paid for married workers for health insurance. Old-age benefits are generally borne by employers and employees, with employers paying more than their employees.
2. Summary of Public Assistance System
Like many other developing countries, Indonesia faces larger difference between the rich and poor due to economic growth. Despite of gradual improvement, needy people occupy 15% of the whole population. About 40% of those needy people suffer from extreme poverty.
The government engages in social welfare promotion activities for the purpose of supporting improvement of needy people's living standards. These activities aim at improving the living attitudes and styles of the people without any income or satisfactory income for necessities, and creating their confidence and abilities. Specific measures include continuous daily living guidance, counseling for motivation, social training, technical training, and economic and productive assistance. As regards the economic and productive assistance, the government gives guidance and assistance; that is, to classify needy residents by village into several groups, supply equipment and raw materials for productive activities, and sell their products.
Medical expense exemption system is one of medical assistance for needy people or other people living in poor areas. If those people visit medical institutions, they are required to show the certificates called "health cards." There is a regional insurance fund (danasehat) for villages and counties. It is a medical insurance system for low-income people based on the idea of mutual aid (goton royon), the daily customs in communities. It is funded by residents' premiums as well as contributions from wealthy people.
3. Challenges of the Social Security System
In Indonesia, health insurance system is managed not by the government, but by public or private organizations. It is required in the future for the government to increase the number of participants and providers of health and medical insurance services, to which the government should give appropriate guidance and supervision. For instance, there is a difference in risk (e.g. the number of the elderly) among groups for health maintenance security system. It is necessary to make up the difference.
It is also required for other social security services to improve both quality and quantity. The current issue is how far the government can control the economic influence due to the decline in rupiah since 1997.
Furthermore, countermeasures should be prepared for the increase of the homeless due to the raise in the number of abandoned children.
* The population and aging rate are as of 1996, total fertility rate is as of 1991, and the exchange rate is as of March 1999 (medium price).
1. An Overview of the Social Security System
Thailand's social security system can be roughly divided into two areas: the social welfare system and social insurance system. The social welfare system is comprised of welfare services targeted at the poor, people with disabilities, children, the elderly, women, minority mountainous tribes and others. The social insurance system is relatively new. When the Social Security Law was enacted in 1990, it included benefits for sickness, maternity, disability, death, dependent child, old age and unemployment. This law propelled the social security system for private-sector employees in Thailand into a new era (benefits for sickness, maternity, disabilities, death, dependent child, and old age are currently implemented). The social security system that covers private-sector employees did not exist until then except for workmen's accident compensation benefits which were provided to employees of business establishments with 20 or more employees.
In addition to the above, there are, for example, medical security and pension systems for public service employees, employees of national enterprises and military personnel.
(1) Medical Service System
With regard to assistance in medical cost, the medical service system, which is targeted to poor individuals or households, the elderly and children, has been implemented from the viewpoint of ensuring the welfare of these people. In addition to these, benefits based on the Social Security Law have been provided since its enactment in April 1991. The beneficiaries of benefits were originally employees of business establishments with 20 or more employees and were expanded in September 1993 to those of business establishments with ten or more employees. With the later introduction of a voluntary participation system and other reasons, the participants numbered 5.57 million as of November 1998. The contents of the benefits include expenses for consultation, treatment, inpatient nursing care, drugs and transportation, sickness/injury and disability allowance, and funeral expenses. In principle, participants are supposed to receive medical services at hospitals with which their employers have registered in advance among hospitals that are designated by the government.
Public health and medical institutions include about 900 public hospitals (e.g. university hospitals, specialized hospitals, prefectural hospitals, and provincial hospitals) with health centers responsible for primary care. There are also about 10,000 private medical institutions such as hospitals and clinics.
(2) Pension System (Old-Age Pension)
The pension system is enacted at the end of 1998 pursuant to the Social Security Law. The payment of premiums for a period of 15 years or longer will be required to receive benefits, which are supplied when the beneficiary reaches the age 55. The benefit amount will be determined based on the amount of premiums paid and the length of premium payment period.
(3) Welfare Policy for the Elderly
Thailand's welfare measures for the elderly include a public assistance system targeted to poor individuals and households in general as well as provision of welfare services through establishment of homes for the elderly targeted to the poor elderly people without a home or relatives (16 homes for the elderly with about 2,600 users as of 1997). In light of the latter, establishment of social service centers started in 1979 (13 centers with about 470,000 users as of 1997). Social service centers provide medical care and physiotherapy as well as counseling, etc. and some of them offer temporary protection services in addition.
(4) Public Health Policies
The Ministry of Health is the national organization responsible for public health. Disease countermeasures include family planning, maternal and child care, as well as countermeasures against nutritional issues, and infectious diseases. Local public health organizations comprise prefectural health offices, provincial health offices, and quasi-provincial health offices, which provide primary care (simple outpatient treatment and preventive measures). Besides, voluntary staff called Village Health Volunteers (VHV) is trained to provide family planning help to residents and health education.
(5) Welfare Policy for Children
The government provides milk and necessities for neglected children, or other children and their families having causes that prevent those children from growing up healthily. Programs include introduction of foster family and adoption systems, as well as protection and support of abused children suffering from prostitution and human trading.
Welfare facilities include homes for infants, children's home, and other facilities for children with disabilities (as one of the policies for the disabled) (several facilities established, respectively, with about 8,000 users in total as of 1997). These facilities provide services that are not covered by other welfare programs. If anyone is admitted to these facilities after he/she finishes school education, occupational training is also provided. Private welfare facilities are monitored for appropriate management through certification or other measures.
As part of educational administration, kindergartens are rapidly diffusing for the purpose of giving children education prior to elementary schools.
(6) Sources of Revenue
The premiums pertaining to the portion that is already being provided or is being implemented based on the Social Security Law is set as an amount equivalent to 2% of each of employees' wages, to be borne by the government, employer and employee (total of 6%). Payments are made to the Social Security Funds managed by the government.
Premiums are to be increased upon examination, taking the future economic situations into consideration.
2. Summary of Public Assistance System
No system similar to public assistance programs in Japan is established for securing the minimum level of living to needy people. However, there are temporary facilities for the homeless to identify them and investigate whether they have any relatives (two facilities as of 1997 with about 4,000 persons admitted). Needy people without anyone they can depend upon are qualified to be admitted to the facilities, which cover basic living needs including daily meals and elementary occupational training (six facilities with about 4,000 persons admitted as of 1997). Besides, there are facilities providing information, referral to related organizations or hospitals, and support to find jobs, to needy people (two facilities with about 2,000 users as of 1997).
3. Challenges of the Social Security System
Public demand for improvements in the social security system is gradually growing due to the improved living standards of the people accompanying economic growth and other reasons. Qualitative and quantitative improvements and expansion of the social security system is the general issue. Current issues for the social insurance system include solving the shortage of manpower and improving the convenience for participants when receiving medical services. In addition, among benefits according to the Social Security Law, it will be demanded to ensure smooth implementation of benefits for unemployment, that is planned. As the number of employees in the secondary and tertiary industry increases in the future, the Social Security Law will play an increasingly important role. Thus the long-term issue for the government is to ensure stable management of measures under this Law.
With regard to welfare, it is necessary to watch how families and communities, which continue to fulfill many welfare-related functions, will change in the future in an environment of economic development and progressive population concentration in the cities among other phenomena, and how the government will meet the welfare needs that will change according to the changes in families and communities. The currently low aging rate is expected to rise overtime and eventually will be as one of major policy issue.
Thailand recently has an increasing number of patients suffering from diseases related with behavior and habits and mental disorders. New problems such as AIDS and traffic accidents are also emerging. The government has drafted a new plan and taken a number of countermeasures against these issues.
Since its economic crises, it has been increasingly important to improve public assistance system for needy people. Assistance measures for daily lives or independence should be further developed despite of its stagnant financial situation.
(Population: 18.53 million; Total area: 7,692,000 km2; Aging rate: 12.0%; Total fertility rate: 1.8; 1 Australian dollar = 77 yen)
* The population and aging rate are as of 1997, and the exchange rate is as of the end of March 1999.
1. An Overview and Recent Trends in the Social Security System
In Australia, the social security system is mainly classified into three components: that is, 1) the income security system including pension, family allowance, and public assistance; 2) the medical security system called "Medicare;" and 3) the social welfare system such as care for the elderly, and welfare policies for the elderly and children. Besides, the retirement pension fund system is an income security system after retirement provided by a private organization. It is a mandatory savings program for daily living after retirement funded by the reserve of employees themselves.
Characteristics of the social security system in Australia are as follows: 1 the income security system and medical security system are not pursuant to the social insurance formula, but funded by general financial resources, 2 the income security system gives individual and limited benefits in proportion to necessities measured by the screening of income or assets, while medical and welfare services cover all the citizens universally, and 3 diverse entities such as the federal government, state governments, municipalities, and private organizations, share their roles to provide services in parallel.
(1) Pension System
The Age Pension is supplied to citizens reaching the age 65 for men and the age 61 for women (to be raised to the age 65 by 2014). The pension amount may be decreased according to beneficiaries' income or assets. The pension is supplied to secure daily living of the elderly, in the targeted amount equivalent to 25% of the male average wages for single persons (i.e. A$9,000 per year) or 40% for married couples (i.e. A$15,000 per year). All the resources necessary for the pension is funded by the general financial resources without any social insurance premiums paid by citizens.
The retirement pension fund system is a savings program to secure income after retirement, funded by individual reserves. This system has been developed as employers fund a fixed portion of employees' salaries for the employees, which was required by labor unions as one of the conditions of employment. In the 1990's, the government regarded this retirement pension fund system as an important measure to secure the retiree's income and increase the citizen's savings for the purpose of complementing the Age Pension. To encourage individual savings, the government introduced the retirement pension security tax system in July 1992 to practically obligate employers to lay up reserves.
(2) Medical Security System
The Medicare system was established in February 1984 as a public medical security system. It comprises of 1) the Medicare benefits supplying a fixed portion of medical expenses paid by the government and 2) the government's contribution for all amounts of medical expenses for inpatient care at public hospitals. Medicare is funded by the general financial resources, and an earmarked tax (1.5% of taxable income) occupying about 30% of the expenditures.
For outpatient treatment, 85% of medical expenses (in the amount decided by the government) is covered by Medicare and 15% is paid by patients (maximum payment by patients per examination is A$50.10). If a patient treatment, if a patient receives public-expense treatment at public hospitals as an inpatient, treatment is given by the doctors designated by the hospital, and all the expenses for medical care and hospitalization (for beds and nursing care) are paid by the government. This means no payment is made by the patient. However, if the patient receives private-expense treatment at public hospitals, treatment is given by the doctors designated by the patient, and 75% of medical expenses are paid by the government, and 25% are paid by the patient (no hospitalization expenses are subject to benefits).
(3) Public Health and Medical Care Policies
For public health and medical care, the federal government manages and operates a medical security system called Medicare, as well as engaging in financial administration such as financial support. It also prepares and conducts medical care policies for disease prevention and health promotion including 1) securing safety of pharmaceuticals, 2) alcohol and drug control, and 3) countermeasures against AIDS.
State governments traditionally play the central role in providing and managing public health and medical care policies. They are responsible for planning, managing, and operating state medical service facilities (e.g. public hospitals and regional health and medical clinics), as well as providing relevant services. They are also in charge of regulating registration and management of doctors, dentists, and other medical staff. Each state government establishes its own regulations about public health pursuant to the standards provided by the federal government. Furthermore, state governments are responsible for control over waterworks, sewerages, air, and wastes.
Municipalities take the lead in practices of public health management and in-home or community health care services. Municipal health surveyors investigate and ensure compliance with environment and public health requirements. Municipalities are authorized to collect and transport wastes. They provide in-home or community health care services mainly for the disabled and elderly.
(4) Health Care and Welfare Policies for the Elderly and Disabled
(Long-term Care Policy for the Elderly)
In Australia, health care and welfare policies for the elderly are mainly classified into two fields; that is, facility care and community and in-home care.
Facilities for the elderly include nursing homes and hostels. In nursing homes, similar to special nursing homes for the elderly in Japan, staff specialized in nursing or long-term care take care of the elderly on an around-the-clock basis. In hostels, similar to care houses in Japan, domestic services such as meals, laundry, and cleaning are offered to the elderly, who do not require nursing care or long-term care. These facilities are granted subsidies mainly from the federal government.
As in-home and community care services, the Home and Community Care program (HACC) was established as a part of the aged care reform process which commenced in 1985. Under the HACC program, diverse entities including municipalities and private non-profit organizations provide a variety of services such as the home help service, home-visit nursing care service, meal service, and day-care service. HACC, which is regarded as the joint project of the federal and state governments, is granted subsidies. Furthermore, other programs have been initiated to cope with the increasing demand of entry into facilities for the elderly. These programs are the community option program (nursing home level care) and the community aged care option program (hostel level care), which are funded by government. Through these programs, community aged-care organizations attempt to provide home care services similar to those at facilities for the elderly.
(5) Welfare Policies for Children and Families
Welfare policies for children and families in Australia include child care services, family assistance services, and income security such as family allowance. The Child Care Act 1972 marked the beginning of the development of child care policies by the federal government. Under flourishing public consciousness for child welfare policies in the mid 1980's, the Commonwealth/State National Child Care Strategies were announced in 1988. Child care services under these strategies have been developing with subsidies from the federal or state governments.
2. Summary of the Public Assistance System
The public assistance system operates pursuant to the Social Security Act 1991. The system compensates for the minimum necessary daily living expenses to those, who can neither support themselves and their families, nor have applied to other income security systems, because they are unable to cope by themselves due to age, physical or mental disabilities. Therefore, most beneficiaries, (83%), consist of "recent immigrants," who are not qualified for residential requirements in Australia necessary for application to other income security systems. Other beneficiaries include those taking care of children or incompetent persons, young homeless people under the age 18, and pregnant women.
Centre Link, an executive organization of the Department of Community Services, provides public assistance services.
Benefits include basic benefits and rent assistance. Benefits standards are decided according to judgments made by the Department of Community Services. These benefits are based on and supplied in the amount not exceeding 1) the Newstart Allowance (for those unemployed aged 21 and older and under the age subject to Age Pension: the maximum amount for single persons without any children is 323.40A$ per fortnight) and 2) the Youth Allowance (for student aged between 16 and 24 with any jobs whether full time or part time, and the unemployed under the age of 21: the maximum amount for single persons living separate from their parents or other relatives is 265.50A$ per fortnight). Income tests are conducted so that the equivalent income, if any, of an individual beneficiary generates a corresponding reduction from the maximum benefit payable to that beneficiary. Assets test is also conducted by category (e.g. residence owners, and residence expense holders).
The public assistance system covers 10,413 persons, of which 63.6% are aged 65 years and over. The percentage of people receiving this benefit who were born overseas is 91.9%, compared to 8.1% who were born in Australia.
3. Challenges of the Social Security System
Like other developed countries, Australia has faced changes in economic environments and social situations from the 1980's. A serious depression in the early 1990's produced a number of the long-term unemployed, which has become a severe social problem. Furthermore, the aging population and a change in family composition brought about the straining of the social security system. Under such circumstances, Australia, like other developed countries, is obliged to carry out reforms necessary to secure stable management of the social security system in the long term. Thus revaluation of the social security system is crucial to respond to changing social needs.