Social Health Insurance for Developing Nations

Good health is necessary for well-being but also has another critical impact: it causes poverty, in that large health expenditures can bankrupt families. Many nations are now hoping that formally mandated social health insurance (SHI), involving payroll taxes, will provide a solution. This report examines the principles, design, and practices of SHI for low and middle-income nations and the necessary conditions for its viability and sustainability, with a focus on design and implementation issues. This volume presents five country case studies to provide evidence and greater detail on key issues that arise at different stages of implementation in low-income countries. They have been selected to reflect on a continuum and timeline of operational stages, beginning with the initial design and legislation of SHI, the first phase of implementation, the expansion to cover larger segments of the population, and on up to completion, whereby SHI becomes the predominant form of health care financing in a country. Accordingly, Kenya has been selected for illustration of the design stage, Ghana for initiation, the Philippines for extension of population coverage, Colombia for SHI and reform of health care delivery, and Thailand for universal coverage and reform of health care delivery. This sequencing and implied timeline of case studies allows this report to reflect on two questions. First, where can a country expect to be in relation to designing and implementing SHI in, say, 10 years? Second, as countries gain experience with SHI, what can they expect to offer or achieve in terms of variations in benefit design, who administers SHI, and how providers are contracted and paid?

Bibliographic Details

Main Authors:	Hsiao, William C., Shaw, R. Paul
Other Authors:	Fraker, Andrew
Format:	Publication biblioteca
Language:	English en_US
Published:	Washington, DC: World Bank 2007
Subjects:	ABILITY TO PAY, ACCESS TO HEALTH SERVICES, ACCOUNTING, ADMINISTRATIVE COSTS, ADMINISTRATIVE SUPPORT, ADVERSE SELECTION, ANNUAL CONTRIBUTIONS, APPLICABLE LAW, BANKS, BASIC HEALTH CARE, BASIC HEALTH SERVICES, BENEFICIARIES, BENEFIT ENTITLEMENTS, BENEFITS SCHEME, BUDGET ALLOCATION, CAPITAL INVESTMENTS, CAPITATION, CERTIFICATION, CHILD HEALTH, CHILD HEALTH SERVICES, CHOICE OF PROVIDERS, CITIES, CLINICAL INFORMATION, CLINICAL QUALITY, CLINICS, COMMODITIES, COMMUNITY HEALTH, COMPETITION AMONG INSURERS, COMPETITION AMONG PROVIDERS, COMPETITIVE INSURANCE MARKET, COMPULSORY CONTRIBUTIONS, CONTRIBUTION, CONTRIBUTION RATE, CONTRIBUTION SYSTEM, CONTRIBUTIONS, COST RECOVERY, COST SHARING, COST-EFFECTIVENESS, CUSTOMER SERVICE, DEATH DECISIONS, DELIVERY OF HEALTH SERVICES, DELIVERY SYSTEM, DELIVERY SYSTEMS, DETERMINATION OF ELIGIBILITY, DEVELOPMENT BANK, DIAGNOSIS, DISABILITY, DISASTERS, DIVERSIFICATION, DOCTORS, DRUGS, ECONOMIC DEVELOPMENT, ECONOMIC REVIEW, EMPLOYMENT, ENROLLEES, EQUILIBRIUM, EQUITABLE ACCESS TO HEALTH CARE, FAMILIES, FEE-FOR-SERVICE, FEE-FOR-SERVICE BASIS, FINANCIAL LOSS, FINANCIAL POSITION, FINANCIAL RISKS, FINANCIAL SUPPORT, HEALTH BUDGETS, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE DELIVERY, HEALTH CARE FINANCING, HEALTH CARE PROVISION, HEALTH CARE REFORM, HEALTH CARE SPENDING, HEALTH CARE SYSTEM, HEALTH CARE SYSTEMS, HEALTH CENTERS, HEALTH COVERAGE, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH EXPERTS, HEALTH FACILITIES, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INSURANCE FUND, HEALTH INSURANCE PLAN, HEALTH INSURANCE PROGRAM, HEALTH INSURANCE SCHEMES, HEALTH INSURER, HEALTH ORGANIZATION, HEALTH ORGANIZATIONS, HEALTH PLANS, HEALTH POLICY, HEALTH PROFESSIONALS, HEALTH PROGRAMS, HEALTH PROJECT, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HOSPITAL CARE, HOSPITAL SERVICES, HOSPITALS, HOUSEHOLD EXPENDITURE, HOUSEHOLD INCOME, HUMAN RESOURCES, HYGIENE, ILLNESS, IMMUNIZATION, IMPERFECT INFORMATION, INCOME, INCOME COUNTRIES, INCOME GROUP, INCOME HOUSEHOLDS, INCOME LEVEL, INCOME LEVELS, INCOMES, INDUCED DEMAND, INFANT MORTALITY, INFANT MORTALITY RATE, INFLATION, INFORMAL SECTOR, INFORMAL SECTOR WORKERS, INFORMATION SYSTEMS, INSURANCE COVERAGE, INSURANCE FUNDS, INSURANCE MARKETS, INSURANCE PLAN, INSURANCE PLANS, INSURANCE POLICY, INSURANCE PREMIUM, INSURANCE PREMIUMS, INSURANCE SYSTEMS, LABOR MARKET, LARGE ENTERPRISES, LEGAL REMEDIES, LIABILITY, LOW INCOME, LOW-INCOME, LOW-INCOME COUNTRIES, LOW-INCOME PEOPLE, MANAGED CARE, MANDATORY CONTRIBUTIONS, MARKET CONDITIONS, MARKETING, MEDICAL ASSOCIATION, MEDICAL BENEFITS, MEDICAL CARE, MEDICAL EXPENSES, MEDICAL FACILITIES, MEDICAL RECORDS, MEDICAL SERVICES, MEDICARE, MINIMUM BENEFITS, MORAL HAZARD, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH EXPENDITURE, NATIONAL HEALTH EXPENDITURES, NATIONAL HEALTH INSURANCE, NATIONAL HEALTH SPENDING, NATIONAL INSURANCE, NONGOVERNMENTAL ORGANIZATIONS, NUTRITION, PATIENT, PATIENTS, PHARMACIES, PHYSICIANS, POCKET PAYMENTS, POVERTY RATE, PREMIUM RATES, PREPAYMENT SCHEMES, PRICE RATIONING, PRIMARY CARE, PRIVATE HOSPITALS, PRIVATE INSURANCE, PRIVATE SECTOR, PRIVATE SECTORS, PRODUCTIVITY, PROVISION OF HEALTH CARE, PUBLIC EXPENDITURE, PUBLIC EXPENDITURES, PUBLIC HEALTH, PUBLIC HEALTH SERVICES, PUBLIC HOSPITAL, PUBLIC HOSPITALS, PUBLIC PROVIDERS, PUBLIC PROVISION, PUBLIC PROVISION OF INSURANCE, PUBLIC SECTOR, PUBLIC SPENDING, PURCHASES, PURCHASING POWER, QUALITY OF HEALTH, QUALITY OF HEALTH CARE, RECURRENT COSTS, REFORM OF HEALTH CARE, REMEDIES, RESPONSIBILITIES, SALARIES, SALES, SMALL EMPLOYERS, SOCIAL DEVELOPMENT, SOCIAL HEALTH INSURANCE, SOCIAL INSURANCE, SOCIAL SECURITY, STAKEHOLDERS, TEACHING HOSPITALS, WAGE, WAGES, WORKERS,
Online Access:	http://documents.worldbank.org/curated/en/2007/01/8517127/social-health-insurance-developing-nations http://hdl.handle.net/10986/6860
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