Financial protection against the cost of illness and inclusion of vulnerable groups will require better mobilization and use of private means. Private voluntary health insurance already plays an important role in mobilizing additional resources to the health sector and protecting against the catastrophic cost of illness in some countries. This review explores the context under which private voluntary health insurance could contribute to an improvement in the sustainability of the health sector and financial protection in other countries.
Author(s): Alexander S. Preker, Peter Zweifel, Onno Schellekens
Year: 2009
Language: English
Pages: 600
Contents......Page 7
Foreword......Page 19
Preface......Page 21
Acknowledgments......Page 33
Abbreviations and Acronyms......Page 35
Introduction......Page 37
1.1 Strength in Numbers under a Multipillar Approach......Page 40
1.3 Multipillar System for Financing Health Care......Page 48
Implementation Challenges......Page 56
References......Page 59
PART 1 EMPIRICAL AND ECONOMIC UNDERPINNINGS......Page 63
Introduction......Page 65
2.2 Health Care Financing Systems......Page 69
Evidence of PHI in Low- and Middle-Income Countries......Page 74
Outlook......Page 121
Annex 2A WHO Data on Health Care Expenditure between 1998 and 2002......Page 124
Annex 2B Country Groups according to 2005 World Bank Classification......Page 128
Annex 2C PHI Spending, by Country Group......Page 130
Annex 2D Non–Life and Life Insurance around the World......Page 131
Notes......Page 134
References......Page 135
Introduction......Page 143
Review of the Theoretical Predictions......Page 144
3.10 Factors Affecting Intensity of Health Insurance Regulation......Page 157
Conclusions and Outlook......Page 167
3A.1 Overview of Hypotheses and Results of Tests......Page 169
References......Page 175
PART 2 EVIDENCE FROM THE PAST......Page 177
Introduction......Page 179
4.2 Chile: VHI Components......Page 182
4.3 Chile: Household Decision Tree regarding Health Insurance......Page 185
4.6 Chile: Nonmedical Consumption, Health Shock Magnitude, and Family Risk Factors......Page 189
4A.2 Chile: Simulation of Choice 3......Page 191
4A.13 Chile: NMC Informal Workers with Secondary Education and Risk Factor = 1......Page 198
Introduction......Page 199
Health Financing in Egypt......Page 201
5.1 Egypt: Total Public Expenditures on Health, 1996–2004......Page 202
Key Issues and Major Constraints related to Health Care Financing in Egypt......Page 208
Assessing the Potential for VHI......Page 209
Conclusions and Recommendations......Page 215
5A.1 Egypt: Total Health Expenditures, Fiscal Years 1996–2004......Page 220
5A.3 Health Insurance Types, by Socioeconomic Characteristics......Page 223
References......Page 224
Introduction......Page 225
Situational Analysis of Health Financing in South Africa......Page 226
The Private Sector......Page 229
6.3 South Africa: Medical Scheme Membership, by Expenditure Quintile, 2000......Page 235
6.3 South Africa: Standard Deviation of Out-of-Pocket Health Expenditure, by Household Income Quintile......Page 238
Health Reform in South Africa......Page 242
References......Page 243
Introduction......Page 247
On Private Health Insurance......Page 248
7.2 Thailand: Cost of Most Recent Medical Service relative to Household and Individual Income......Page 252
7.4 Thailand: Flow of Health Expenditure, 1998......Page 254
Problems and Constraints in Health Care Financing......Page 255
Quantitative Analyses......Page 257
7.11 Thailand: The Results of the Regression Analysis of the Determinants of Enrolment with Voluntary Health Insurance at Household Level......Page 266
References......Page 267
Introduction......Page 269
Data and Methodology......Page 274
8.6 Turkey: Regression Results from Estimation of Two-Part Model......Page 279
Conclusions and Policy Implications......Page 286
References......Page 287
Introduction......Page 289
Methods......Page 290
Results......Page 291
Conclusions......Page 295
References......Page 296
PART 3 OPPORTUNITIES FOR THE FUTURE......Page 297
Introduction......Page 299
Background of China’s Health Care Financing System......Page 302
10.4 China: Health/Life Insurance Industry Revenue, 1999–2004......Page 304
Key Issues of Health Care Financing in China......Page 307
Determinants of Private Health Insurance Enrolment......Page 308
Demand for Private Health Insurance: Willingness to Pay and Ability to Pay......Page 314
10.14 China: Predicted Probability for Private Insurance Coverage in Private Sector, by Age, Education, and Income......Page 320
10.21 China: Predicted Probabilities for Private Insurance Coverage, by Education and Income, for Private Employees......Page 324
References......Page 326
The Brazilian Context......Page 329
11.5 Health Expenditure Financing Sources, 2002......Page 340
Policy Options......Page 344
11.15 Brazil: Best- and Worst-Case Scenarios......Page 355
11A.1 Financial Flows in the Brazilian Health Sector......Page 357
11B.1 Regression Results for Access, Labor Productivity, and Enrolment......Page 358
Notes......Page 359
References......Page 360
Introduction......Page 363
Overview......Page 364
12.4 India: Barriers to Health Insurance Development......Page 371
12.6 India: Health Financing through Insurance......Page 378
Conclusions......Page 379
Notes......Page 380
References......Page 383
Introduction......Page 385
Research Methodology......Page 387
Results......Page 391
Discussion......Page 400
References......Page 401
Introduction......Page 405
The Slovenian Context......Page 406
14.7 Slovenia: Use of Inpatient Services and Hospital Performance, 2006......Page 413
Issues Raised in the Development of VHI in Slovenia......Page 416
14.12 Slovenia: Risk-Equalization Flows for Two Insurers with Differing Age Structures and Average Claims Cost of the Two Age Groups, but with Same Average Claims Cost for Individual Age Groups......Page 428
Conclusions: The Future and the Reforms Needed in Slovenia’s Voluntary Health Insurance......Page 431
14.1 Slovenia: The Health Insurance System......Page 434
References......Page 435
Introduction......Page 437
15.1 Korea: Classification of Social Health Care Coverage, 2006......Page 438
NHI Financial Distress......Page 441
15.5 Korea: NHI Reimbursement and OOPS......Page 444
The Evaluation Study......Page 447
15.13 Korea: Financial Protection for Insured with Fixed Type vs. Indemnity Type......Page 455
15.15 Korea: Government Subsidy to NHI, 2010–50......Page 458
References......Page 459
Methodology Used in Companion Volume, Friend or Foe......Page 463
Methodology Used in Global Marketplace for Private Health Insurance: Strength in Numbers......Page 469
References......Page 476
B. Glossary of Terms......Page 479
Note......Page 495
Coeditors......Page 497
Other Contributing Authors......Page 498
Index......Page 507
1.1 The Global Health Financing Challenge......Page 38
1.2 Types of Private Voluntary Health Insurance......Page 41
2.1 Prepaid Medicine Programs in Latin America......Page 81
2.2 Managed Care in Latin America......Page 82
2.3 Medisave Program in Singapore......Page 85
2.4 PHI in India......Page 93
2.5 Private Health Insurance in South Africa......Page 97
2.6 Mutual Health Insurance in Sub-Saharan African Countries......Page 99
11.1 Brazil: Typical Models of Health Plan Organizations......Page 337
15.1 Korea: A Chronology of Health Care Reform......Page 440
1.2 Low-Income Countries Have Less Insurance Coverage than High-Income Countries......Page 43
1.4 Changes in Financing Mechanisms, 2005–15......Page 49
1.5 Shift Traditional Subsidies to Cover Premiums for the Poor, 2005–15......Page 50
1.6 Subsidize Cost of Basic Package for Everyone......Page 52
1.7 Subsidize Expanded Insurance Benefits for the Poor......Page 53
1.8 Add Supplemental Insurance Coverage for Infrequent High-Cost Events......Page 54
1.10 Match Variance and Risk with Instruments......Page 55
2.1 Private Health Insurance in WHO Countries......Page 67
2.3 Relative Importance of Commercial Insurance Markets, 2003......Page 75
2.4 Regional Split of Non–Life Insurance Premiums in the Developing World......Page 76
2.3 Total Health Expenditure and Gini Coefficient......Page 77
2.6 PHI Spending relative to Total Health Expenditure in the Latin America and Caribbean Region......Page 84
2.7 PHI Spending relative to Total Health Expenditure in the East Asia and Pacific Region......Page 91
2.8 Expenditure for Health Care through Financial Intermediaries in Eastern and Southern Africa, 1997–98......Page 98
2.9 PHI Spending Relative to Total Health Expenditure in the Sub-Saharan Africa Region......Page 102
2.10 PHI Spending Relative to Total Health Expenditure in Eastern Europe and Central Asia......Page 108
2.11 PHI Spending Relative to Total Health Expenditure in the Middle East and North Africa Region......Page 114
4.1 Three Modalities of Health Insurance Coverage......Page 181
4.5 Chile: Nonmedical Consumption, Health Shock Magnitude, and Income......Page 188
5.3 Egypt: Compared with Global Trends in per Capita Health Expenditure, 2002......Page 203
6.1 South Africa: Monthly Employment Income, 2004......Page 227
6.2 South Africa: Financial Vulnerability, by Household Income......Page 237
6.4 South Africa: Mean Annual Disposable Income, by Income Quintile......Page 239
7.1 Thailand: Monthly Household Income of the Insured, Quartiles 1 to 3......Page 251
7.3 Thailand: The Health Insurance System......Page 253
11.4 Brazil: Health Facility Network......Page 333
11.2 Brazil: Production of Health Services by Type of Facility and Clientele......Page 334
11.4 VHI Coverage, by Employment Status......Page 338
11.6 Brazil: Main Determinants of VHI Enrolment and Health Spending......Page 347
12.1 India: Public Expenditures on Curative Care, by Income Quintile......Page 365
12.2 India: Distribution of the Insured......Page 373
12.3 India: Distribution of Members and Claims, by Age......Page 374
12.5 India: Treatment Cost per Individual, by City......Page 375
15.1 Korea: Per Capita Health Expenditure, Three Age Cohorts......Page 456
A.1 Proximal and Distal Determinants......Page 465
2.1 OOP Spending in WHO Countries......Page 71
2.2 Typology of Private Health Insurance in Low- and Middle-Income Countries......Page 73
2.4 Private Health Insurance in LCR Countries......Page 79
2.5 Private Health Insurance in the East Asia and Pacific Region......Page 86
2.6 Private Health Insurance, Selected South Asian Countries......Page 92
2.7 Private Health Insurance in Sub-Saharan African Countries......Page 96
2.9 MHI Target Groups in Western and Central African Countries......Page 100
2.10 Private Health Insurance in East European and Central Asian Countries, 2002......Page 103
2.11 Private Health Insurance in MENA Countries......Page 109
3.1 Factors Affecting Demand for Health Insurance (Yes/No Decision)......Page 145
3.2 Factors Affecting Demand for Health Insurance (Amount of Coverage)......Page 146
3.3 Factors Affecting Demand for Health Insurance (Guaranteed Renewability)......Page 147
3.4 Factors Affecting the Size of the Benefits Package......Page 148
3.5 Factors Affecting Risk-Selection Effort......Page 150
3.6 Factors Affecting the Net Price of Insurance (Loading)......Page 151
3.7 Factors Affecting Insurer-Driven Vertical Integration......Page 153
3.8 Factors Affecting Provider-Driven Vertical Integration......Page 155
3.9 Factors Affecting the Degree of Seller Concentration of Health Insurance......Page 156
4.1 Chile: Private and Public Insurance Characteristics......Page 180
4A.4 Chile: Simulation of Choice 4......Page 192
4A.6 Chile: Simulation of Choice 1......Page 193
4A.7 Chile: Logit Model of the Probability of Seeking Care for a Health Problem......Page 194
4A.9 Chile: Second Simulation of Probability of Seeking Care for a Health Problem......Page 195
4A.10 Chile: Financial Protection by Insurance Type in the Formal and Informal Sectors, 2000......Page 196
4A.12 Chile: NMC Formal Workers with Secondary Education and Risk Factor = 1......Page 197
5.1 Egypt: Enrolment in VHI Organizations, 2002......Page 204
5.2 Egypt: Types of Insurance in Egypt Household Health Utilization and Expenditures Survey, 2002......Page 210
5A.2 Health Insurance Types, by Background Characteristics......Page 222
6.2 South Africa: Distribution of Medical Schemes, by Type, Size, and Number of Beneficiaries, 2003......Page 233
6.4 South Africa: Determinants of Health Care–Seeking Behavior......Page 240
7.2 Thailand: Evolution of Private Health Insurance......Page 249
7.3 Thailand: Insurance Coverage, 1998......Page 250
7.4 Thailand: Non–Life Insurance Business Premiums, 2003......Page 256
7.5 Thailand: The Results of Logit Regression Analysis of Voluntary Insurance Impacts on Access to Health Care......Page 259
7.6 Thailand: The Results of Log-Linear Regression Analysis of Voluntary Insurance Impacts on Access to Health Care......Page 260
7.7 Thailand: The Results of the Regression Analysis of Labor Productivity of Household Members......Page 262
7.8 Thailand: The Results of the Regression Analysis......Page 263
7.9 Thailand: Cross-Tabulation of Labor Force Participation and PHI Status......Page 264
7.10 Thailand: The Results of the Regression Analysis of the Determinants of Enrolment with Voluntary Health Insurance at Individual Level......Page 265
8.1 Turkey: Health and Economic Indicators......Page 270
8.2 Turkey: Insurance Coverage, Two Sets of Estimates, end-2000......Page 273
8.3 Turkey: Economic Status of Surveyed Population, by Rural, Urban, and Metropolitan Areas......Page 275
8.4 Turkey: Health Care Utilization and Expenditure, by Care Type and Region, 2002–03......Page 276
8.5 Turkey: Utilization Rates and OOP Expenditure per Visit/Stay, by Insurance Status and Service Type, 2002–03......Page 277
8.7 Turkey: Probit Regressions on Utilization of Inpatient and Outpatient Services......Page 281
8.8 Share of Private Providers in Total Outpatient Care Utilization, by Insurance Status......Page 284
8.9 Predictions of Outcomes due to Expansion of Private Insurance......Page 285
9.1 United States: Out-of-Pocket Spending on Health Care by the Privately Insured and the Uninsured Overall, and by Income......Page 292
9.2 United States: Out-of-Pocket Spending on Health Care by the Privately Insured and the Uninsured Overall, by Age and Gender......Page 294
10.2 China: National Health Expenditures, 1980–2000......Page 300
10.3 China: Health Insurance Coverage Distribution, 2003......Page 301
10.5 China: Market Share of Life/Health Insurance Industry, 2004......Page 305
10.6 China: Health Insurance Industry......Page 306
10.7 China: Definition of Variables......Page 309
10.8 China: Individual Characteristics, by Health Insurance Group......Page 310
10.9 China: Health Insurance Coverage Rate, by Group......Page 312
10.10 China: Random Effects Logistic Regression of Private Health Insurance Coverage......Page 313
10.11 China: Definitions of Variables (Logistic Model for WTP)......Page 315
10.12 Means and Standard Deviations of Variables......Page 317
10.13 China: Random Effects Logistic Regression of WTP for Each Program......Page 318
10.16 China: Urban Employment, 2002......Page 321
10.18 China: Estimated Population Distribution between Income and Education......Page 322
10.20 China: Predicted Probabilities for Private Insurance Coverage, by Education and Income, for Private Employees......Page 323
11.1 Brazil: 10-Year Trend in Socioeconomic Indicators......Page 330
11.2 Brazil: Health and Socioeconomic Indicators, 2003......Page 331
11.3 Brazil: Trends in Health Indicators......Page 332
11.6 Brazil: Private Health Plans, 2003......Page 335
11.8 Brazil: Financial Protection—Results for Individual OOPS......Page 348
11.9 Brazil: Financial Protection—Results by Income Quintile......Page 349
11.11 Brazil: Macroeconomic Trends—Base Case......Page 351
11.12 Brazil: Health Expenditure Trends—Base Case......Page 352
11.13 Brazil: VHI Trends—Base Case......Page 353
11.14 Brazil: Total Health Care Costs—Base Case......Page 354
12.1 India: Typology of Risk-Pooling Schemes......Page 367
12.2 India: Employees Covered under Different Systems......Page 369
12.3 India: Types of Medical Benefits Provided for Different Insured Groups......Page 370
12.5 India: Projecting the Size of the Health Insurance Market......Page 377
13.2 Nigeria: Willingness to Join and Pay for Employees’ PVHI......Page 392
13.3 Nigeria: Acceptability and Willingness to Enroll in Health Insurance, by Size of Organization......Page 393
13.4 Nigeria: Mechanisms Used to Pay and Cope with Health Care Payments......Page 394
13.6 Nigeria: Preferences for Different Health Insurance Strategies......Page 395
13.7 Nigeria: Willingness to Enroll and Pay for PVHI......Page 396
13.8 Nigeria: Geographic Differences in Willingness to Enroll and to Pay for PVHI......Page 397
13.9 Nigeria: SES Differences in Rating of Perceived Benefits of Health Insurance......Page 398
13.11 Nigeria: Level of Willingness to Pay, by Occupation......Page 399
14.1 Slovenia: Basic Macroeconomic Indicators......Page 407
14.3 Slovenia: Health Status Indicators compared with Other New EU Member States, 2003......Page 408
14.4 Slovenia: Household Final Consumption Expenditure, by Purpose......Page 410
14.6 Slovenia: Basic Hospital Care Indicators......Page 412
14.8 Slovenia: Financial Results of Compulsory and Voluntary Insurance Companies......Page 417
14.10 Slovenia: Risk-Equalization Flows for Two Insurers with Differing Age Structures and the Same Average Claims Cost for the Two Age Groups......Page 426
14.11 Slovenia: Risk-Equalization Flows for Two Insurers with Differing Age Structures and the Same Average Claims Cost for the Two Age Groups......Page 427
15.2 Korea: Contributions and Benefits under NHI Programs......Page 439
15.3 Korea: Fiscal Status of the National Health Insurance, 1995–2006......Page 442
15.4 Korea: Medical Fee Index and Consumer Price Index, 1990–2005......Page 443
15.6 Korea: Private Health Insurance Market Size......Page 445
15.7 Korea: Definitions of Variables, Evaluation Study......Page 448
15.8 Logit Model for Testing Determinants of PHI Enrolment......Page 450
15.9 Characteristics of the Sample......Page 452
15.10 Korea: OLS Models Testing Moral Hazard and Other Effects, Any Private Coverage......Page 453
15.12 Korea: Financial Protection for the Insured vs. Uninsured......Page 454
15.14 Korea: Total Health Expenditure, 2010–50......Page 457
A.1 Implementation Arrangements for Strategic Purchasing of Health Care......Page 470
A.2 Market Indicators for Benefits of Voluntary Health Insurance......Page 471
