Open Access

Using a life-cycle approach, we identify key gaps for social reform in Georgia. The reduction of informal work is the most pressing of these, since formal employment is the backbone of any robust and reliable social insurance scheme. At the same time, greater financial resources are required through taxation in order to enable systematic social reform in Georgia. Both interventions are needed in order to fill the gaps in the current social protection system, which include the limited scope of pension and health insurance, as well as the lack of permanent unemployment insurance and universal child benefits. Against the background of Germany’s long experience with social protection, we outline the main principles of the German welfare state and present the design of three main social insurance branches (pensions, health and unemployment). Based on the mixed experience that has emerged in Germany, in particular due to path dependencies and political deadlock, we derive lessons that inform a clear and coherent vision for social reform in Georgia.

We analyze short-term effects of free hospitalization insurance for the poorest quintile of the population in the province of Khyber Pakhtunkhwa, Pakistan. First, we exploit that eligibility is based on an exogenous poverty score threshold and apply a regression discontinuity design. Second, we exploit imperfect rollout and compare insured and uninsured households using propensity score matching. With both methods we fail to detect significant effects on the incidence of hospitalization. Whereas the program did not meaningfully increase the quantity of health care consumed, insured households more often choose private hospitals, indicating a shift towards higher perceived quality of care.