Description : Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.
Description : Over the past two decades Vietnam has made enormous progress towards achieving universal coverage (UC) for its population. Significant challenges remain, however, in terms of improving equity with continuing low rates of enrollment. Ensuring financial protection also remains an elusive goal. The Master Plan for Universal Coverage approved in 2012 by the Prime Minister directly addresses both these deficiencies in coverage. The objective of this report is to assess the implementation of Vietnam SHI and provide options for moving towards UC. This is a joint assessment with development partners, World Health Organization, United Nations Children's Fund (Unicef) and Rockefeller Foundation. Expanding breadth of coverage, particularly for those hard to reach groups such as the near-poor and informal sector would require substantially increasing general revenue subsidies and fully subsidizing the premiums for the near-poor. High enrollment rates would, however, have little impact on financial protection and equity if OOP costs remain high. Achieving UC will require sustained efforts to improve efficiency in the system, and gain better value for money from available budgetary resources; without these efforts, any further progress towards UC would be financially unsustainable. There is considerable scope for improving efficiency in Vietnam. Fragmentation in the pooling of funds gives rise to unnecessary costs. Inefficiencies in resource allocation and purchasing arrangements include: (i) an overly generous benefits package; (ii) provider payment mechanisms and the mix of incentives facing providers which result in an oversupply of services; (iii) high prices, overconsumption and inappropriate use of pharmaceuticals; and (iv) the structure and incentives embedded within the delivery system. The organization, management and governance of SHI are fragmented and often dysfunctional. The present institutional setting for SHI needs to be assessed and changed.
Description : This study examines and explains the relationship between social health insurance (SHI) participation and out-of-pocket expenditures (OOP) as well as the mediating role the institutional arrangement of SHI plays in this relationship in China. Embracing a new institutionalist approach, it develops two analytical perspectives: determination, which identifies the mechanisms of social health insurance, and strategic interaction, which explores the interaction among social health insurance agencies, healthcare providers, patients, and institutions. It reveals the poor performance of social health insurance in decreasing out-of-pocket health expenditures caused by a trade-off between the reimbursement, behavior management, and purchasing mechanisms of social health insurance programs. Further, it finds that the inequitable allocation of healthcare resources and patients’ concerns regarding the benefits offset the strategies used by social health insurance agencies to manage care-seeking behavior. It also discovers that the complex interactions between insurance agencies, doctors, patients and a larger disenabling institutional surrounding restricts the purchasing efficiency of social health insurance. This book is characterized by its unique synthesis of the role of the institutional arrangement of social health insurance in China, the interaction between the stakeholders in health sectors, and of the relationship between healthcare institutions, actors, and policy outcomes. Providing a comprehensive overview, it enables scholars and graduate students to understand the ongoing process of social health insurance reform as well as the dynamics of health cost inflation in China. It also benefits policymakers by recommending a single-payer model based on an evidence-based investigation.
Description : There is growing international evidence that the effectiveness of health services stems primarily from the extent to which the incentives facing providers and consumers are aligned with "better health" objectives. Efficiency in health service provision requires that providers and consumers have incentives to use healthcare resources in ways that generate the maximum health gains. Equity in at least one sense requires that consumers requiring the same care are treated equally, irrespective of their ability to pay. Efficiency in the use of health services requires that consumers are knowledgeable about the services on offer and which are most appropriate to their needs. Although these principles are enshrined in the design of every health system in the world, they have proven extremely difficult to apply in practice. Healthcare providers have financial obligations to their families as well as professional obligations to their patients. Health service consumers generally lack information about both their health and health services so that they under-consume or over-consume healthcare.
Description : This report discusses several different approaches that support reforming health care services in developing countries. For some time now, health care services have been supported by government funds. As demands for improving health care services continue to increase additional demands will be placed on governments to respond. This, however, will not be easy. Slow economic growth and record budget deficits in the 1980's have forced reductions in public spending. Alternative approaches to finance health care services are needed. Such possible changes could involve: decentralization of federal government involvement; the promotion of nongovernment involvement; the imposition of user fees; and, establishing health insurance. Finally, the role of the Bank in pursuing new financing strategies is discussed.
Description : Private voluntary health insurance already plays an important role in the health sector of many low and middle income countries. The book reviews the context under which private insurance could contribute to an improvement in the financial sustainability of the health sector, financial protection against the costs of illness, household income smoothing, access to care, and market productivity. This volume is the third in aseries of in-depth reviews of the role of health care financing in providing access for low-income populations to needed healthcare, protecting them from the impoverishing effects of illness, and addressing the important issues of social exclusion in government financed programs.
Description : World Bank Discussion Paper No. 308. A major obstacle in creating secure banks in transitional economies is the absence of political will and the lack of traditions and techniques for governing and regulating financial intermediaries. This paper provides a comprehensive, annotated model contract for policymakers and bank executives to help them discipline troubled banks.