Scaling Up Affordable Health Insurance PDF
Preview Scaling Up Affordable Health Insurance
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Rights and Permissions This work is available under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0) http://creativecommons.org/licenses/by/3.0. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions: Attribution—Please cite the work as follows: Preker, Alexander S., Marianne E. Lindner, Dov Cher- nichovsky, and Onno P. Schellekens, eds. 2013. Scaling Up Affordable Health Insurance: Staying the Course. Washington, DC: World Bank. doi: 10.1596/978-0-8213-8250-9. License: Creative Commons Attribution CC BY 3.0. Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an offi cial World Bank translation. The World Bank shall not be liable for any content or error in this translation. All queries on rights and licenses should be addressed to the Offi ce of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: [email protected]. ISBN (paper): 978-0-8213-8250-9 ISBN (electronic): 978-0-8213-8579-1 DOI: 10.1596/978-0-8213-8250-9 Library of Congress Cataloging-in-Publication Data Scaling up affordable health insurance : staying the course / editors, Alexander S. Preker, Marianne E. Lindner, Dov Chernichovsky, and Onno P. Schellekens. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8213-8250-9 (pbk. : alk. paper) — ISBN 978-0-8213-8579-1 (electronic) I. Preker, Alexander S., 1951– editor of compilation. II. Lindner, Marianne E., editor of compilation. III. Chernichovsky, Dov, editor of compilation. IV. Schellekens, Onno P., 1964– editor of compilation. V. World Bank, issuing body. [DNLM: 1. Insurance, Health. 2. Developing Countries. 3. Health Services Accessibility—economics. W 100] RA412.3 368.38'2—dc23 2013009642 Contents Foreword xix Preface xxi Acknowledgments xlix Abbreviations and Acronyms li 1. Introduction: Public Options, Private Choices 1 Alexander S. Preker, Marianne E. Lindner, Dov Chernichovsky, and Onno P. Schellekens Introduction 1 Key Issues 4 References 9 PART 1 MAJOR POLICY CHALLENGES: PRECONDITIONS FOR SCALING UP 11 2. Health Protection: More Than Financial Protection 13 Xenia Scheil-Adlung Introduction 13 Social Health Insurance: Concepts, Defi nitions, and Observations 14 Current Trends and Developments in Social Health Insurance 22 Experiences in Scaling Up Social Health Insurance 26 Achieving Universal Coverage by Scaling Up Social Health Insurance 36 Conclusion 44 Notes 45 References 46 3. Making Health Insurance Affordable: Role of Risk Equalization 49 Wynand P.M.M. van de Ven Introduction 49 Why Are Out-of-Pocket Health Expenses So Common? 50 Subsidies for Health Insurance 54 Mandatory Community Rating: Does One Premium Fit All? 61 v vi Contents Economic Motives for Mandatory Health Insurance 63 Conclusions and Discussion 65 References 67 4. Reaching the Poor: Transfers from Rich to Poor and from Healthy to Sick 71 Sherry Glied and Mark Stabile What Is Social Health Insurance? 71 Design Considerations 75 Financing Mechanisms 84 Notes 90 References 90 5. Binding Constraints on Public Funding: Prospects for Creating “Fiscal Space” 91 Peter S. Heller What Are the Sources of “Fiscal Space”? 91 Issues That Arise in the Creation of “Fiscal Space” 95 Concluding Remarks 98 Notes 99 References 99 6. Universal Coverage: A Global Consensus 101 Guy Carrin, Inke Mathauer, Ke Xu, and David B. Evans Introduction 101 Shifting to Prepayment 102 Policy Norms in Health Financing 103 Key Questions 103 Factors to Consider 106 Toward a Comprehensive Framework 107 Conclusion 110 Note 110 References 110 PART 2 FROM THEORY TO PRACTICE: EVIDENCE FROM THE GROUND 113 7. The French Connection in Francophone Africa 115 Yohana Dukhan, Alexander S. Preker, and François Diop Introduction 115 Current Status of Health Financing and Health Insurance 116 Key Factors in the Development of Health Insurance 131 Prospects for the Development of Health Insurance 137 Conclusions 139 Annex 7A Statistical Annex 141 Notes 142 References 143 Contents vii 8. “Big-Bang” Reforms in Anglophone Africa 147 Caroline Ly, Yohana Dukhan, Frank G. Feeley, Alexander S. Preker, and Chris Atim Introduction 147 Health Coverage and Insurance Arrangements 151 Factors Underlying Resistance to Reform and Implementation 156 Targeted Areas for Scaling Up Health Insurance Development 171 Annex 8A Health Insurance Arrangements in Anglophone Africa, by Country 177 Notes 185 References 185 9. Moving from Intent to Action in the Middle East and North Africa 191 Bjorn O. Ekman and Heba A. Elgazzar Introduction 191 Health Financing in MENA: Trends and Patterns 192 Health Insurance in MENA 199 Conclusions and Recommendations 208 Annex 9A MENA: National Health Expenditure, 1995–2008 217 Annex 9B MENA: Health Financing and Insurance, Selected Countries 221 Notes 227 References 228 10. One-Step, Two-Step Tango in Latin America and the Caribbean 231 Ricardo Bitrán Introduction 231 Overview of the LAC Region 232 Policy Challenges That Arise When Extending Coverage 234 Strategies for Extending Health System Coverage: Social Insurance and Other Approaches 241 Summary and Conclusions 264 Notes 269 References 270 11. Orient Express in South, East, and Pacifi c Asia 273 William C. Hsiao, Alexis Medina, Caroline Ly, and Yohana Dukhan Introduction 273 Overview of Socioeconomic, Demographic, and Health Conditions 275 Role of Private Insurance in Scaling Up 282 Barriers to Scaling Up 283 Factors Enabling Developed Asian Countries to Scale Up 290 viii Contents Scaling Up in Five Low- and Lower-Middle-Income Asian Countries 293 Lessons and Conclusions 309 Notes 310 References 310 12. Bismarck’s Unfi nished Business in Western Europe 313 Hans Maarse, Alexander S. Preker, Marianne E. Lindner, and Onno P. Schellekens The “Logic” of Health Insurance 313 The Social Origins of Health Insurance 315 The Extension of State Involvement in Health Insurance 316 The Doctors’ Struggle 320 Broadening Coverage 322 Deepening Coverage 324 The Structure of the Health Insurance Market 325 Economy and Governance 326 Conclusions and Policy Lessons 328 Annex 12A Socioeconomic Data on Health Insurance, Selected West European Countries 331 Annex 12B Overview of Health Financing and Social Health Insurance, Selected West European Countries 334 Annex 12C The Conceptualization of Good Governance 336 Notes 337 References 337 13. From Cradle to Grave in the United Kingdom, Canada, Australia, and Elsewhere 341 Alexander S. Preker and Mark C. Bassett Introduction 341 Past Achievements 342 Major Outstanding Issues 344 Two Different Reform Processes to Universal Access 345 Legal Entitlement and Dimensions of Access 348 Nature of Participation 350 Financing Mechanisms 350 Relevance of OECD Experience to the Developing World 351 Revisiting Universal Entitlement 355 Note 355 References 356 14. Great Post-Communist Experiment in Eastern Europe and Central Asia 357 Adam Wagstaff and Rodrigo Moreno-Serra Introduction 357 Europe and Central Asia’s SHI Reforms and Hypothesized Effects 359 Methods 364
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