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.
Author(s): William Hsiao
Edition: 1
Year: 2007
Language: English
Pages: 145
Contents......Page 5
Foreword......Page 9
Acknowledgments......Page 11
Abbreviations......Page 13
1. Introduction, Context, and Theory......Page 15
Context......Page 18
1.2. Factors Contributing Positively to an Enabling Environment for SHI......Page 26
References......Page 33
Design......Page 35
Implementation......Page 47
2.2. Hypothetical Plan to Reduce Subsidies to Public Hospitals......Page 53
References......Page 54
Background......Page 57
3.3. The NSHIF Gradual Implementation Scenario, 2004–12......Page 61
Implementation Issues......Page 66
References......Page 73
Background......Page 75
Evolution of Health Financing Mechanisms......Page 79
Design Issues......Page 85
Implementation Issues......Page 89
4.4. Employment by Category, Selected Years......Page 91
References......Page 93
Background......Page 95
Delivery of Health Services......Page 100
5.8. Health Professionals Registered by the Department of Health, 2004......Page 104
Impact of SHI......Page 117
References......Page 118
Background......Page 119
Health Care Reform......Page 122
Design......Page 124
6.4. Toward Universal Health Coverage, 1993–2001......Page 127
6.8. Reasons for Not Using Health Care by Income Quintile, 1992 and 1997......Page 138
6.9. Percentage of Respondents Who Had a Health Problem Who Were Seen by a Doctor by Enrollment Status and Area, 1997 and 2003......Page 139
References......Page 145
Background......Page 147
Health Insurance Development before Universal Coverage......Page 154
7.7. Trends in Coverage by Health Insurance Schemes, Selected Years......Page 160
Lessons Learned from Universal Coverage......Page 165
Challenges......Page 167
References......Page 168
8. Lessons Learned and Policy Implications......Page 169
The Development Context Matters......Page 172
8.1. Selected Characteristics of Country Groupings by Income Level, 2000......Page 173
Major Challenges Inherent in Implementation......Page 176
Policy Implications......Page 179
Conclusions......Page 184
References......Page 186
1.1. Terms......Page 31
8.1. Traditional Responses to Poor Health Sector Performance......Page 171
1.1. Sources of Health Care Financing, Selected Low- and Middle-Income Nations, 2000......Page 20
1.2. Out-of-Pocket Payments as a Percentage of Total National Health Expenditures, 2002......Page 21
1.3. Average Tax Revenues by Country Income Level, 2000......Page 22
1.4. Share of Total National Health Spending Derived from External Sources, Selected Countries, 2000......Page 24
2.1. Progress Toward Universality, Selected Countries, 1990–2014......Page 51
3.1. Map of Kenya......Page 58
3.2. Administrative Structure of the NSHIF......Page 64
4.1. Map of Ghana......Page 76
4.2. Interaction between Administrative Entities......Page 86
5.1. Map of the Philippines......Page 96
5.2. Milestones in the Development of the NHIP......Page 99
5.3. PhilHealth's Financial Position, 1997–2004......Page 105
5.9. PhilHealth Financial Statement, March 31, 2004, and March 31, 2005......Page 106
5.5. Enrollment in the NHIP, 1972–2005......Page 107
5.7. Estimated Coverage Rates by Member Sector, 2004......Page 110
5.8. Cross-Subsidization across Member Categories, 2004......Page 115
5.10. Average Value of Claims by Member Category, 2002–2005......Page 116
6.1. Map of Colombia......Page 120
6.2. Managed Competition Model for National Health Insurance......Page 123
6.3. Administrative Structure of the Health Care System......Page 125
6.6. Insurance Coverage by Urban and Rural Residence and Regime, 2003......Page 128
6.7. Insurance Coverage by Income Quintiles, 1992–2003......Page 129
6.10. Public Hospitals' Incomes and Expenditures, 1993–99......Page 141
7.1. Map of Thailand......Page 148
7.2. Poverty Trend, 1988–2004......Page 150
7.3. Health Expenditure as a Percentage of GDP, 1994–2004......Page 151
7.5. Share of National Spending on Health by Spending Category, 2001......Page 152
7.6. Development of Health Insurance Schemes, 1975–2002......Page 157
8.1. Percentage of Total Public Expenditures on Health by Income Quintile Ghana, 1992 and 1998......Page 170
1.1. Government and External Donors' Expenditures on Health, Selected Sub-Saharan African Countries, 1995 and 2000......Page 23
1.3. Country Characteristics, Selected Countries, 2000–2004......Page 27
1.4. Selected Characteristics of SHI Compared with Other Forms of Health Insurance......Page 30
2.1. Working Population by Employment Status and Income, Uganda, 1999–2000......Page 37
2.2. Design Issues, Selected Countries, as of 2005......Page 42
3.1. Background Statistics, Kenya......Page 59
3.2. Shares of Health Expenditures by Provider, 2000–2002......Page 60
3.4. Projected NSHIF Expenditures and Revenues, 2004–10......Page 63
3.6. Sources of NSHIF Funding......Page 68
3.7. Implementation Scenarios, 2004–12......Page 71
3.9. Required Government Contribution to Balance the Fund, Selected Years......Page 72
4.1. Background Statistics, Ghana......Page 77
4.2. Chronological Development of Health Financing......Page 80
4.3. Distribution of Membership, Four Largest MHOs, 2002......Page 82
5.1. Background Statistics, Philippines......Page 97
5.4. Hospital Bed Distribution in Department of Health Licensed Hospitals by Ownership and Level, 2003......Page 101
5.6. Hospital Bed Distribution in PhilHealth Accredited Hospitals by Ownership and Level, 2005......Page 102
5.7. Facility Accreditation for New PhilHealth Benefit Packages, December 2004......Page 103
5.10. PhilHealth Member Benefits and Cost Ceilings, 1999......Page 113
6.1. Background Statistics, Colombia......Page 121
6.2. Scenarios for Expanding Coverage by the Subsidized Regime as of December 2004......Page 130
6.3. Comparison of the Contributory and Subsidized Regime Benefits Packages as of December 2004......Page 131
6.4. Payment Method Used by Health Plans in the Contributory Regime......Page 135
6.5. Solidarity and Guarantees Fund Balances, 1998–2002......Page 136
6.6. Total Resources and Sources of Funding for the Subsidized Regime, 1995–2002......Page 137
6.7. Sources of Public Hospital's Sales Revenues by Level of Care, 2003......Page 142
6.8. Ratio of Total Health Expenditures to Total Income from Premiums 2003 and 2004......Page 144
7.1. Background Statistics, Thailand......Page 149
7.2. Numbers and Use of Public and Private Health Facilities 2003......Page 153
7.3. The Four Main SHI Schemes before Universal Coverage, 1999......Page 155
7.4. Insurance Schemes and Utilization of Services, 1996......Page 159
7.5. The Three SHI Schemes after Universal Coverage, 2004......Page 163
7.6. Breakdown of the Universal Coverage Scheme Capitation Rate and Payment Methods, 2004......Page 166
