Scaling Up Affordable Health Insurance

781 Pages·2014·4.54 MB·English

by  World Bank Group

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Scaling Up Affordable Health Insurance

Scaling Up Affordable Health Insurance
Staying the Course
Editors
Alexander S. Preker, Marianne E. Lindner,
Dov Chernichovsky, and Onno P. Schellekens
© 2013 International Bank for Reconstruction and Development/The World Bank
1818 H Street NW, Washington, DC 20433
Telephone: [phone]; Internet: www.worldbank.org
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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
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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