Scaling Up Affordable Health Insurance

Public Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure Authorized Public Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure AuthorizedPublic Disclosure Authorized 77909 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: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 16 15 14 13 This work is a product of the staff of The World Bank with external contributions. Note that The World Bank does not necessarily own each component of the content included in the work. The World Bank therefore does not warrant that the use of the content contained in the work will not infringe on the rights of third parties. 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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: pubrights@worldbank.org. 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 v 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 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 [...]... Group and Region, 2000 Intracountry U-5 Mortality Inequality Health Expenditures, by Income Group and Region Japan: Timeline of Historical Development of Social Health Insurance Korea, Rep.: Timeline of Insurance Expansion Taiwan, China: Timeline of Insurance Expansion Thailand: Timeline of Historical Development of Social Health Insurance China: Timeline of Historical Development of Social Health Insurance. .. Development of Social Health Insurance Philippines: Timeline of Health Insurance Development Indonesia: Timeline of Historical Development of Social Health Insurance The Economy Health Care Expenditure, 2004 Health Care Expenditure as Percentage of GDP Health Care Expenditure per Capita Health Indicators, 2004 Overview of Health Financing/Social Health Insurance Scheme, Selected West European Countries Landmark... Challenges: Preconditions for Scaling Up Major policy challenges and preconditions for scaling up health insurance coverage in low- and middle-income countries are explored in the first part of this book In chapter 2, Health Protection: More Than Financial Protection,” Xenia Scheil-Adlung describes how scaling up is more than just insurance coverage She uses a broader definition of social health protection as... result from ill health Social health insurance is a key element of social health protection, and an integral way of achieving universal and affordable coverage through coordinating pluralistic health financing mechanisms Social health insurance is seen as a necessary element in achieving both social health protection and social security The author stresses that the ultimate objective of scaling up is to achieve... van de Ven describes how mandatory health insurance can be used as a tool to achieve the goal of making health insurance affordable, even for high-risk and low-middle-income populations, irrespective of whether this is in the context of a voluntary or mandatory health insurance The rationale for doing so is that, if health insurance is not affordable for certain groups of individuals, it makes no sense... make health insurance affordable, is a mandate to buy such health insurance really necessary? Free competitive health insurance markets tend to gravitate toward riskadjusted premiums, leading, over time, to risk selection To counter this effect, sooner or later governments introduce regulations to make such health insurance accessible to high-risk groups and low-income populations by forcing private health. .. to, scaling up health insurance in Africa’s English-speaking countries This group of countries inherited a publicly run health care system from their colonial days, in addition to a disconnected group of mission-based and other modern and traditional health care providers Often modeled after the British National Health Service, the public systems were set up with a belief that government-provided health. .. How Did Universal Health Systems Grow? Why Does the Process Work Differently in Development Settings? Clients An Alternative Model for Health Systems: Beyond the Three Laws of Health Economics Conclusions Notes References 539 542 545 Appendixes A Theory of Social Health Insurance Peter Zweifel 1 Introduction and Overview 2 The Demand for Social Health Insurance 3 The Supply of Health Insurance 4 The... to Social Health Insurance Tanzania: Providers Fight Managed Care South Africa: National Health Insurance Stirs More Debate Than Action Insuring the Informal Sector: Lessons from the International Experience Main Design Features of Colombia’s Generalized Health Social Security System Highlights in National Health Insurance Legislation Social Health Insurance Coverage Limitations of Major Health Care... nongovernmental district mutual health organizations In Rwanda, community-level health insurance has reached coverage rates higher than 80 percent in some areas These are a few of the many examples provided in this book that challenge common myths about the limited potential role of health insurance in developing countries Building on Past Reviews Scaling Up Affordable Health Insurance: Staying the Course, . AuthorizedPublic Disclosure AuthorizedPublic Disclosure Authorized 77909 Scaling Up Affordable Health Insurance Scaling Up Affordable Health Insurance Staying the Course Editors Alexander S. Preker, Marianne. 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. 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