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National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

Himmelstein, David U.; Woolhandler, Steffie
Fonte: © American Journal of Public Health 2003 Publicador: © American Journal of Public Health 2003
Tipo: Artigo de Revista Científica
Publicado em /01/2003 EN
Relevância na Pesquisa
85.94%
Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost.

National Health Insurance or Incremental Reform: Aim High, or at Our Feet?

Himmelstein, David U.; Woolhandler, Steffie
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2008 EN
Relevância na Pesquisa
85.95%
Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost.

The evolution of Taiwan’s National Health Insurance drug reimbursement scheme

Hsu, Jason C; Lu, Christine Y
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
96.12%
Background: The rapid growth of health care expenditures, especially pharmaceutical spending, is a challenge for many countries. To control increasing pharmaceutical expenditures and to enhance rational use of drugs, Taiwan’s National Health Insurance drug reimbursement system has evolved over time since its introduction in 1995. This study reviewed Taiwan’s drug reimbursement scheme: its development and evolution in the last two decades, and implications and impacts of recent policies for drug pricing. We also provide recommendations for possible improvement. Methods: We conducted a review of Taiwan’s National Health Insurance drug reimbursement scheme. We focused on three major components of the scheme: (i) the scope of drug coverage; (ii) pricing system for pharmaceuticals under the scheme; and (iii) adjustment of drug reimbursement prices. We reviewed the literature and public policy documents. Results: The National Health Insurance delisted 176 and another 240 behind-the-counter products (e.g., antacids, vitamins) between 2005 and 2006 to reduce pharmaceutical expenditures. For the pricing of pharmaceuticals, policy evolution can be divided into four phases since 1995; the present system emphasizes stakeholder engagement...

National Health Insurance by Regulation: Mandated Employee Benefits

Phelps, Charles E.
Fonte: Rand Corporation Publicador: Rand Corporation
Tipo: Trabalho em Andamento
ENG
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85.94%
This paper was presented at the Conference on "National Health Insurance: What Now, What Later, What Never?" sponsored by the American Enterprise Institute on October 5, 1979. Subsequently published in the Rand Paper Series.

Europe and Central Asia - Health insurance and competition

World Bank
Fonte: World Bank Publicador: World Bank
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76.21%
Health financing systems in some Europe and Central Asia (ECA) countries are undergoing some major reforms. In parallel with the transition from central planning to develop market-based economies, countries in Central Europe have moved within a relatively short period of time from having health systems that were government managed and funded by taxes to single health insurance systems that are payroll-funded. The next chapter (chapter two) describes the insurance context in Austria, the Netherlands, Slovakia, and Switzerland. Chapter three examines risk selection in a multiple insurance system. Risk-adjusters and equalization schemes in different countries are discussed as well as the resulting incentives for insurance companies to develop cost containment strategies. Chapter four discusses whether and how insurers compete for providers, including the different forms of managed care contracts that have evolved under multiple insurance and the impact of such contracts on policy goals. Chapter five describes consumer choice in different health financing systems and whether consumers are exercising their choice to switch insurers and plans. Chapter six presents an overview of the different options for insurance reforms. The final chapter will identify the main lessons drawn from the preceding chapters and will present potential policy solutions for increasing the effectiveness of insurance systems...

Social Health Insurance for Developing Nations

Hsiao, William C.; Shaw, R. Paul
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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76.23%
Good health is necessary for well-being but also has another critical impact: it causes poverty, in that large health expenditures can bankrupt families. Many nations are now hoping that formally mandated social health insurance (SHI), involving payroll taxes, will provide a solution. This report examines the principles, design, and practices of SHI for low and middle-income nations and the necessary conditions for its viability and sustainability, with a focus on design and implementation issues. This volume presents five country case studies to provide evidence and greater detail on key issues that arise at different stages of implementation in low-income countries. They have been selected to reflect on a continuum and timeline of operational stages, beginning with the initial design and legislation of SHI, the first phase of implementation, the expansion to cover larger segments of the population, and on up to completion, whereby SHI becomes the predominant form of health care financing in a country. Accordingly...

The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries : A Systematic Review

Acharya, Arnab; Vellakkal, Sukumar; Taylor, Fiona; Masset, Edoardo; Satija, Ambika; Burke, Margaret; Ebrahim, Shah
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
76.2%
This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases...

Universal Health Coverage for Inclusive and Sustainable Development : Country Summary Report for Ghana

Otoo, Nathaniel; Awittor, Evelyn; Marquez, Patricio; Saleh, Karima
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
EN_US
Relevância na Pesquisa
76.21%
Ghana is a country in West Africa with a population of about 25 million. The country is a stable democracy and achieved lower middle-income status in 2011 with a per capita gross national income (GNI) of $1,410. The prevalence of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in Ghana is among the lowest in the Sub-Saharan Africa region, and this too makes its status related to life expectancy relatively better. The government made a commitment to universal health coverage when it passed the national health insurance scheme (NHIS) law, act 650, at the end of 2003. The law was revised in 2012 (act 852) to bring the district insurance schemes into a single pooled fund, thus eliminating fragmentation. Act 650 established the national health insurance authority (NHIA) to implement the NHIS and mandates that all residents of Ghana enroll in one of the accredited insurance schemes. The law does not specify consequences for failing to enroll, nor are residents automatically enrolled, so until now the NHIS has been operating as a de facto voluntary scheme. With the 2003 NHIS law...

Building Systems for Universal Health Coverage in South Korea

Na, Sanggon; Kwon, Soonman
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Trabalho em Andamento
EN_US
Relevância na Pesquisa
76.22%
This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). Health insurance agencies have improved the accountability and transparency of the health insurance system, thanks to the ICT-based centralized claim review and assessment. Lessons and challenges from Korea’s experiences and achievements on the road to UHC could provide valuable policy implications to low- and middle-income countries.

Extending Health Insurance: Effects of the National Health Insurance Scheme in Ghana

BRUGIAVINI, Agar; PACE, Noemi
Fonte: Instituto Universitário Europeu Publicador: Instituto Universitário Europeu
Tipo: Trabalho em Andamento Formato: application/pdf; digital
EN
Relevância na Pesquisa
86.04%
There is considerable interest in exploring the potential of health insurance to increase the access to, and the affordability of, health care in Africa. We focus on the recent experience of Ghana, where a National Health Insurance Scheme (NHIS) became law in 2003 and fully implemented from late 2005. Even though there is some evidence of large coverage levels, the effect of the NHIS on health care demand and out-of-pocket expenditures has still not been fully examined. This paper is an attempt to close this gap. Using nationally-representative household data from the Ghana Demographic and Health Survey, we find that the introduction of the NHIS has a positive and significant effect on the utilisation of health care services, although it does have only a weak effect on out-of-pocket expenditure.

Private Health Sector Assessment in Ghana

Makinen, Marty; Sealy, Stephanie; Bitrán, Ricardo A.; Adjei, Sam; Muñoz, Rodrigo
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH
Relevância na Pesquisa
76.19%
Most countries in Sub-Saharan Africa confront serious health challenges; however, Ghana has done beer than many of its neighbors. Ghana's life expectancy at birth is 60 years (versus 53 for all of Sub-Saharan Africa), the infant mortality rate is 73 per thousand (versus 79), and the maternal mortality ratio is 562 per 100,000 (versus 832) (World Bank 2009b). Ghana has worked hard to achieve the gains it has made, and it has benefited from substantial assistance from external development partners. Ghana has separated policy making the Ministry of Health, (MOH) from provision Ghana Health Service (GHS) in the public sector and decentralized health service management to the district level. In 2004, Ghana instituted its National Health Insurance Scheme (NHIS) to ease consumers' need to mobilize payment at the time of illness. The private health sector in Ghana is a large and important factor in the market for health-related goods and services. The size and configuration of private providers and their contribution to health sector outcomes. With beer information about the size...

Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation

Brunner, Greg; Gottret, Pablo; Hansl, Birgit; Kalavakonda, Vijayasekar; Nagpal, Somil; Tapay, Nicole
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research
EN_US
Relevância na Pesquisa
76.24%
Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular...

Republic of Uruguay Integrated National Health System : Analysis of the Governability of the SNIS Benefit Plan

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
76.22%
Today the health reform in Uruguay is a mature, ongoing process in which major progress has been consolidated. At the same time, like all systems, it faces challenges in the immediate, medium, and long term, and how they are resolved will not only shape the ultimate outcome of many of the processes currently under way, and but will also impact the sustainability of the accomplishments so far. The purpose of this study is to contribute to development of the integrated national health system (SNIS) by analyzing and identifying policy options aimed at improving its governance, equity, efficiency, and sustainability through the government's use of control variables in order to achieve and maintain conditions of governability and efficiency, which will contribute to the stability and sustainability of the results. The present study analyzes the main variables that Uruguay has at its disposal to manage a central aspect of regulating the sector namely, the plan of benefits that the population receives to cover their health needs. This plan has important consequences for both health and the economy. The specific objectives of the study were to analyze the following three aspects of the SNIS: (i) the conditions of governance and governability of its benefit plan...

Health Financing in Ghana

Schieber, George; Cashin, Cheryl; Saleh, Karima; Lavado, Rouselle
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH
Relevância na Pesquisa
76.21%
The report is divided into five chapters. This chapter provides background on demographic and epidemiological trends, the configuration of Ghana's health system, and health financing functions and health systems goals. It also describes Ghana's health financing system. Chapter two assesses the performance of Ghana's health system with respect to these goals through international comparisons of health outcomes, inputs, spending, and financial protection as well as time series comparisons of trends in other countries in Africa. Chapter three identifies the strengths and weaknesses of Ghana's health system, which determine Ghana's health reform baseline. Chapter four analyzes the sustainability of the National Health Insurance Scheme, or NHIS in the context of Ghana's future fiscal space, based on Ghana's new standing as a lower-middle-income country. Chapter five analyzes major structural and operational reform options that will help ensure the long-term efficacy and sustainability of the NHIS.

Health Insurance Handbook : How to Make It Work

Wang, Hong; Switlick, Kimberly; Ortiz, Christine; Zurita, Beatriz; Connor, Catherine
Fonte: World Bank Publicador: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH
Relevância na Pesquisa
76.21%
Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts...

Governing Mandatory Health Insurance : Learning from Experience

Savedoff, William D.; Gottret, Pablo
Fonte: Washington, DC : World Bank Publicador: Washington, DC : World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
ENGLISH; EN_US
Relevância na Pesquisa
76.23%
This book provides guidance to countries that want to reform or establish mandatory health insurance (MHI) by specifically addressing governance. It elucidates the role played by the social, political, and historical context in conditioning how MHI systems are governed and, in turn, how governance structures influence the health insurance systems' performance. The book describes the forms of governance that are associated with success, in particular, the regulatory institutions required to guide the system toward its social goals; the oversight mechanisms that monitor and correct the system; and the internal management of the health insurance institutions themselves. It highlights five governance dimensions: coherent decision making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability that influence the coverage, financial protection, and efficiency of MHI entities, and show how these operate in particular countries. Detailed analysis of governance arrangements in four countries: Chile...

Colombia Case Study : The Subsidized Regime of Colombia’s National Health Insurance System

Montenegro Torres, Fernando; Bernal Acevedo, Oscar
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
EN_US
Relevância na Pesquisa
96.24%
This case study provides an overview of the contribution of Colombia's compulsory health insurance, particularly its Subsidized Regime (SR), to universal health care coverage in the country, and the current challenges the SR faces. The case study is based on discussions with stakeholders from academia and the public and private sectors. The report is divided into four sections: (1) country context and health outcomes; (2) the SR within the institutional architecture of the national health insurance system; (3) the subsidized regime: considerations on equity in the context of the public debate on the right to health care in Colombia; and (4) policy decisions and key areas of the agenda for the short and medium term.

Costa Rica Case Study : Primary Health Care Achievements and Challenges within the Framework of the Social Health Insurance

Montenegro Torres, Fernando
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
EN_US
Relevância na Pesquisa
86.19%
The objective of this paper is to assess the key interventions Costa Rica has developed to expand health coverage for the poor and other vulnerable groups, with an emphasis on its approach to primary health care. Universal health coverage in Costa Rica is provided through a single national health insurance program. This program, which protects the poor without the pitfalls of a fragmented system, and the sustained policies that have enabled the building of a solid primary health care system, is broadly recognized as a success story. At the same, time new challenges are emerging to sustaining the success of Costa Rica's universal health coverage. Social Security of Costa Rica (Caja Costarricense de Seguridad Social, CCSS) faces increased production costs and demographic and epidemiological changes in a rapidly aging population. This report is divided into three broad sections: (1) objective of the case study and health system overview; (2) primary health care and the organization of health services within CCSS; and (3) agenda of key policy decisions for a renewed primary health care approach as part of a more responsive and sustainable health insurance system.

Philippines’ Government Sponsored Health Coverage Program for Poor Households

Chakraborty, Sarbani
Fonte: World Bank, Washington DC Publicador: World Bank, Washington DC
Tipo: Publications & Research :: Working Paper; Publications & Research
EN_US
Relevância na Pesquisa
76.22%
This is a nuts and bolts case study of the implementation of the government-financed health coverage program (HCP) for poor households in the Philippines. The data and information in this case study largely draws upon the 2011 World Bank Report 'Transforming the Philippine health sector: challenges and Future Directions' (Chakraborty et al. 2011), and technical work undertaken for World Bank support to the Government of the Philippines (GOP) for universal health coverage (UHC) in the Philippines.2 The aim of the case study is to understand how the HCP was implemented, what worked and did not work, and how it impacted expected results under the HCP. In 1996, similarly to many low- and middle-income countries, the Philippines introduced a demand-side program for poor households (the Sponsored Program). The objective was to improve access of poor households to needed health services without experiencing a financial burden. Unlike many countries, where such programs are stand alone, in the case of the Philippines it was integrated into the National Health Insurance Program (NHIP). This is a sound design feature from the perspective of providing optimal risk pooling and redistribution, and the Philippines is a model for other countries implementing similar schemes for poor households. The national government has included financing for poor households in the medium-term national expenditure program...

National Health Insurance in South Africa: Implications for Equity

Fraser, Kelsey
Fonte: Universidade Duke Publicador: Universidade Duke
Publicado em /12/2011 EN
Relevância na Pesquisa
96.06%
This project examines the African National Congress’ most recent proposal for national health insurance in South Africa. By analyzing its ability to build upon the successes and avoid the pitfalls of past policies, this project evaluates the current proposal’s potential to increase equity in access to health care services. Analysis of the current proposal reveals learning from previous policies, and despite its failure to address certain pitfalls, this policy is likely to increase equity in South Africa if implemented as described in the ANC’s September 2010 discussion document. However, implementation as planned is unlikely given the brevity of the timeline, insufficient data to inform policy formulation, and the lack of a concrete policy. In order to redress inequity in its health system, the South African government should continue to pursue a national health insurance plan based on the principles of universal coverage, social solidarity, and the right to healthcare, but must slow the implementation process to allow for sufficient data collection, capacity building, and the development of fully-informed, concrete policies.; Honors Thesis