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Europe and Central Asia - Health insurance and competition

World Bank
Fonte: World Bank Publicador: World Bank
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76.27%
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...

Private Voluntary Health Insurance in Development : Friend or Foe?

Preker, Alexander S.; Sheffler, Richard M.; Preker, Alexander S.
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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This volume presents findings of a World Bank review of the existing and potential role of private voluntary health insurance in low- and middle-income countries and is the third volume in a series of reviews of health care financing. Also, this volume is about managing risk. Not the risk of national or man-made disasters but the risk of illness. The developing world is plagued by many of the historical scourges of poverty: infectious disease, disability, and premature death. As countries pass through demographic and epidemiological transition, they face a new wave of health challenges from chronic diseases and accidents. In this respect, illness has both a predictable and an unpredictable dimension. Contributors to this volume emphasize that the public sector has an important role to play in the health sector, but they demonstrate that the private sector also plays a role in a context in which private spending and delivery of health services often composes 80 percent of total health expenditure. Managing risks in the private sector begins at the household level. Private voluntary health insurance is merely an extension of such nongovernmental ways to deal with the risk of illness and its impoverishing effects in low- and middle-income countries. The authors examine frameworks for analyzing health financing and health insurance. They conclude that most studies are hampered by lack of data on the impact of private voluntary health insurance on broad social goals...

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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96.26%
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...

Social Health Insurance Reexamined

Wagstaff, Adam
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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96.24%
Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where nonenrollment and evasion are commonplace, and that while SHI can cover the formal sector and the poor relatively easily...

Egypt Health Policy Note : Egypt Public Expenditure Review

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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76.27%
The public expenditures review (PER) of the health sector was prepared in response to a request from the government of Egypt as part of a broader PER work that covers other sectors. This policy note is intended to inform government policymakers of the key findings from the PER and recommend strategies for improving the efficiency, equity, and sustainability of public financing in the health sector, with a special emphasis on expanding the coverage of social health insurance - a major plank in the health reform strategy announced by President Mubarak in July 2005. There are four sections in the report. The first section provides background information. The second section presents a summary of health outcomes, trends, and financing in Egypt; an analysis of inequities in the allocation and utilization of health resources; and an assessment of the efficiency of the delivery of health services. The third section summarizes existing government policies toward the health sector. The fourth section proposes strategies and recommendations for expanding social insurance coverage and enhancing incentives to deliver health services more efficiently and effectively.

Solomon Islands : Health Financing Options

Somanathan, Aparnaa
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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The objective of this Policy Note is to provide an assessment of available options for financing health care in the Solomon Islands. In doing so, the analysis will factor in the country-specific economic, social and political factors, which will ultimately influence the performance of the health financing mechanisms. The Note was motivated by the Solomon Islands Government s (SIG) interest in knowing whether financing options other than general revenue financing would be feasible and sustainable in the context of the Solomon Islands. In particular, SIG wished to consider whether Social Health Insurance presents a better alternative to General Revenue financing. The Note therefore seeks to provide the evidence and information needed to guide the Solomon Islands Government (SIG) in making decisions about different health financing options.

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
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86.28%
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...

Global Marketplace for Private Health Insurance : Strength in Numbers

Preker, Alexander S.; Zweifel, Peter; Schellekens, Onno P.
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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76.27%
The development challenges of addressing health problems in low- and middle-income countries are daunting but not insurmountable. There are now known and affordable interventions to deal with many aspects of the HIV/AIDS crisis as well as the continued challenge posed by malaria and other major infectious diseases. Three major development objectives of health insurance in low- and middle income countries are highlighted in this volume: securing sustainable financing for health care providers that serve the health needs of vulnerable populations; providing financial protection against the impoverishing cost of illness; and reducing social exclusion from organized health financing and delivery systems. Private health insurance schemes can address the needs of the poor and other vulnerable populations with appropriate combinations of subsidies, risk pooling, household savings, and user charges. The authors of this book argue in favor of a multipillar approach to health care financing in low- and middle-income countries that combines these instruments in addressing the underlying development objectives described above, while putting a strong emphasis on private voluntary health insurance. In this way, private means can make a significant contribution to public ends.

Government Spending on Health in Lao PDR : Evidence and Issues

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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76.26%
The note analyzes overall trends in government health financing and expenditure patterns and discusses some of the efficiency and equity issues pertaining to current government health spending patterns. The policy note is one of a series of health financing analyses, complementing earlier policy notes focusing on out-of-pocket spending as well as community-based and social health insurance schemes in the country. This reliance on out-of-pocket payments represents a considerable financial barrier to utilization of health services. The prominence of out-of-pocket spending in the form of user fees and revolving drug funds (RDFs) also raises concerns over management of funds at health facility level and regarding the potential for over prescription. In contrast, social health insurance expenditures are very low in Lao PDR: social insurance schemes cover about 11.4 percent of the population but account for only about 2.8 percent of total health spending. The Lao government has committed to increasing government spending to 9 percent of the budget...

Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries

Bitran, Ricardo
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to quality and timely health care. ISWs are generally reluctant to enroll in insurance schemes...

Can Social Health Insurance Be Successfully Introduced and Expanded in Papua New Guinea?

World Bank Group
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Brief
EN_US
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Cross-country comparisons have identified several enabling conditions required to ensure the sustainability of payroll tax-based systems. These are: (i) a large formal labour market; (ii) a growing economy; (iii) an administrative capacity for collection; and (iv) good regulatory and oversight structures. Political willingness is another important factor. The brief below discusses in detail the technical enabling conditions in the context to introduce and expand social health insurance in Papua New Guinea (PNG). Successful introduction of social health insurance (SHI) financing in PNG will, in part, depend on the feasibility of expanding coverage to the entire population, including the informal sector. A second important factor is how an increase in contribution rates will affect labour and capital markets. Expanding SHI coverage to the informal sector will be challenging in almost all contexts. The population in the formal sector is relatively easy to enrol and collect contributions from due to the availability of employment earnings records. The population in the informal sector is typically not affiliated with any organisation from which to enrol and collect premiums. They are also poorer and less able to afford premiums.

Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECD

Wagstaff, Adam
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
ENGLISH
Relevância na Pesquisa
96.26%
This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression-based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country's health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3-4 percent, reduces the formal sector share of employment by 8-10 percent, and reduces total employment by as much as 6 percent. For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause-breast cancer among women-social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost.

Effects of Interventions to Raise Voluntary Enrollment in a Social Health Insurance Scheme : A Cluster Randomized Trial

Capuno, Joseph J.; Kraft, Aleli D.; Quimbo, Stella; Tan, Carlos R., Jr.; Wagstaff, Adam
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
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A cluster randomized controlled trial was undertaken, testing two sets of interventions to encourage enrollment in the Philippines' Individual Payer Program. Of 243 municipalities, 179 were randomly assigned as intervention sites and 64 as controls. In early 2011, 2,950 families were interviewed; unenrolled Individual Payer Program-eligible families in intervention sites were given an information kit and a 50 percent premium subsidy until the end of 2011. In February 2012, the "non-compliers" had their voucher extended, were re-sent the enrollment kit, and received Short Message Service (SMS) reminders. Half were told that in the upcoming end-line interview the enumerator could help complete the enrollment form, deliver it to the insurer, and have identification cards mailed. The control and intervention sites were balanced at baseline. In the control sites, 9.9 percent (32/323) of eligible individuals had enrolled by January 2012, compared with 14.9 percent (119/801) in intervention sites. In the sub-experiment...

Social Health Insurance and Labor Market Outcomes : Evidence from Central and Eastern Europe, and Central Asia; Adv Health Econ Health Serv Res

Wagstaff, A.; Moreno-Serra, R.
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Journal Article; Journal Article
EN
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OBJECTIVE: The implications of social health insurance (SHI) for labor markets have featured prominently in recent debates over the merits of SHI and general revenue financing. It has been argued that by raising the nonwage component of labor costs, SHI reduces firms' demand for labor, lowers employment levels and net wages, and encourages self-employment and informal working arrangements. At the national level, SHI has been claimed to reduce a country's competitiveness in international markets and to discourage foreign direct investment (FDI). The transition from general revenue finance to SHI that occurred during the 1990s in many of the central and eastern European and central Asian countries provides a unique opportunity to investigate empirically these claims. METHODOLOGY/APPROACH: We employ regression-based generalizations of difference-in-differences (DID) and instrumental variables (IV) on country-level panel data from 28 countries for the period 1990-2004. FINDINGS: We find that, controlling for gross domestic product (GDP) per capita, SHI increases (gross) wages by 20%, reduces employment (as a share of the population) by 10%, and increases self-employment by 17%. However, we find no significant effects of SHI on unemployment (registered or self-reported)...

Sustaining Universal Health Coverage in France : A Perpetual Challenge

Barroy, Helene; Or, Zeynep; Kumar, Ankit; Bernstein, David
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
76.25%
While universal health coverage (UHC) offers a powerful goal for a nation, all countries-irrespective of income are struggling with achieving or sustaining UHC. France is a high-income country where HC is in effect universal. Health-related costs are covered by a mix of mandatory social health insurance (SHI) and private complementary schemes, while benefit packages are comprehensive, uniform, and of good quality. France provides some of the highest financial protection among countries in the Organization for Economic Co-operation and Development (OECD). Still, under pressure to sustain UHC without compromising equity of access, the system has been fine-tuned continually since inception. Much can be learned from France's experience in its reforms toward better fiscal sustainability, equity, and efficiency. The main purpose of the study is to assess major challenges that France has faced for sustaining UHC, and to share its experiences and lessons in addressing system bottlenecks to benefit less developed countries as they embark on the path to UHC.

Moving toward Universal Coverage of Social Health Insurance in Vietnam : Assessment and Options

Somanathan, Aparnaa; Tandon, Ajay; Dao, Huong Lan; Hurt, Kari L.; Fuenzalida-Puelma, Hernan L.
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication
ENGLISH; EN_US
Relevância na Pesquisa
96.25%
To address the growth in resultant out-of-pocket (OOP) payments and associated problems of financial barriers to access, the government issued several policies aimed at expanding coverage throughout the 1990s and 2000s, particularly for the poor and other vulnerable groups. Universal coverage (UC) can be an elusive concept and is about three objectives: (a) equity (linking care to need, and not to ability to pay); (b) financial protection (ensuring that health care use does not lead to impoverishment); (c) effective access to a comprehensive set of quality services (ensuring that providers make the right diagnosis and prescribe a treatment that is appropriate and affordable; and (d) to ensure that the financing needed to achieve UC is mobilized in a fiscally sustainable manner, and is used efficiently and equitably. The objective of this report is to assess the implementation of Vietnam social health insurance (SHI) and provide options for moving toward UC, with a view to contributing to the law revision process. It analyzes progress to date on the two major goals of the master plan. The report assesses Vietnam's readiness to meet these goals...

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
76.29%
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...

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
86.24%
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.

Europe and Central Asia's Great Post-Communist Social Health Insurance Experiment : Impacts on Health Sector and Labor Market Outcomes

Wagstaff, Adam; Moreno-Serra, Rodrigo
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH
Relevância na Pesquisa
96.22%
The post-communist transition to social health insurance in many of the Central and Eastern European and Central Asian countries provides a unique opportunity to try to answer some of the unresolved issues in the debate over the relative merits of social health insurance and tax-financed health systems. This paper employs a regression-based generalization of the difference-in-differences method and instrumental variables on panel data from 28 countries for the period 1990-2004. The authors find that, controlling for any concurrent provider payment reforms, adoption of social health insurance increased national health spending and hospital activity rates, but did not lead to better health outcomes. The authors also find that adoption of social health insurance reduced employment in the economy as a whole and increased unemployment, although it did not apparently increase the size of the informal economy.

Biased selection within the social health insurance market in Colombia

Castaño Yepes, Ramon Abel; Zambrano Riveros, Jorge Andrés
Fonte: Facultad de Economía Publicador: Facultad de Economía
Tipo: info:eu-repo/semantics/book; info:eu-repo/semantics/acceptedVersion Formato: application/pdf
Publicado em //2005 ENG
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Las regulaciones como primaje comunitario, paquetes estandarizados y afiliación abierta, orientadas a reducir el impacto de las fallas en los mercados de seguros, tienen un efecto limitado puesto que abren espacio a la selección sesgada. A partir de 1993, el sistema de seguridad social en salud en Colombia fue reformado hacia un enfoque de mercado con la expectativa de mejorar el desempeño de los monopolios preexistentes exponiéndolos a la competencia de nuevos entrantes. La hipótesis que se maneja en el trabajo es que las fallas de mercado pueden llevar a selección sesgada favoreciendo a los nuevos entrantes. Se analizaron dos encuestas de hogares utilizando el estado de salud auto reportado y la presencia de enfermedad crónica como indicadores prospectivos del riesgo de los afiliados. Se encuentra que hay selección sesgada, llevando a selección adversa entre los aseguradores preexistentes, y a selección favorable entre los nuevos entrantes. Este patrón se observa en 1997 y se incrementa en el 2003. Aunque las entidades preexistentes son entidades públicas, y su tamaño disminuyó sustancialmente entre estos años, se analizan sus implicaciones fiscales en términos de financiación adicional por parte del gobierno.; Reducing the impact of insurance market failures with regulations such as community-rated premiums...