In middle-income Latin American and transition economies, social insurance systems which are mature, albeit limited in coverage, ensure coverage at the top of income distribution. In other regions, coverage for the better off is achieved mostly through private expenditure and self-insurance in the form of savings. These innovative instruments need to be complemented by more traditional transfers and support for those of working age who are unable to work and for the elderly, for whom employment generation and conditions aiming at improving human capital make less sense.