Scaling Up Affordable Health Insurance

This book presents an in-depth review on the role of health care financing in improving access for low-income populations to needed care, protecting them from the impoverishing effects of illness, and addressing the important issues of social exclusion in government financed programs.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populationsand if so, how to do itor to serve them through other means.

Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection.

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Healthcare for all at affordable prices is still a major but universally elusive goal. Everyone spends money on healthcare, and it is the most impoverishing consumption item. Thus, most governments (and the United Nations) promote Universal Health Coverage — each country's unique blend of tools for healthcare financing, including taxes, subsidies and market controls.Most people in low- and middle-income countries (LMICs) have no health insurance of any kind. And most LMIC governments lack the political will, information, or resources to require their citizens to buy health insurance themselves or to subsidize insurance for all who cannot afford the price. This book deals with financing voluntary and contributory health insurance for resource-poor and rural groups in LMICs.This book addresses three issues. The first is how to catalyse demand for health insurance and develop insurance literacy among the largely illiterate and innumerate target population, using training programs to build an enabling consensus, allowing locals to create and administer such schemes. The second involves the process of developing simplified methods for risk assessment, which can help to underwrite risks, price the micro health insurance schemes, and ensure proper implementation. The third issue is formulating a compelling business case which would make this health insurance affordable, financially sustainable, and operationally scalable.This book develops insurance education and financial literacy for students of economics, business administration, insurance, development studies, and social work to prepare them for practical work as implementers, policymakers, or evaluators. A supplementary section for teachers and students includes comprehension questions.

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.

This book aims to help countries design and implement a legal framework for a viable private health insurance market, with rationale for insurance regulation, institutions involved, and standards and protections used in regulating private health insurance.

This Handbook covers major topics in global health economics and public policy and provides a timely, systematic review of the field. Edited by Richard M Scheffler, Distinguished Professor of Health Economics and Public Policy and Director of the Global Center for Health Economics and Policy Research at the University of California, Berkeley, the Handbook features academics and practitioners from more than a dozen countries. Contributors are from the London School of Economics and Political Science, Pompeu Fabra University in Barcelona, University of York, University of Oslo, London School of Hygiene and Tropical Medicine, University of California - Berkeley, Stanford University, Johns Hopkins University, University of Toronto, University of Oxford, Harvard Medical School, OECD, the World Health Organization and the World Bank, many of whom have also acted as economic and policy advisors to government and non-governmental organizations across the world. Experts in these areas who provide critical analyses and relevant data for further exploration and research include: Thomas E Getzen, Executive Director of the International Health Economics Association (iHEA); Douglas E Hough, Associate Scientist and Associate Director of the Master in Healthcare Management programme at the Bloomberg School of Public Health of John Hopkins University; Guillem López-Casasnovas, former President of iHEA and member of the Advisory Council of the Spanish Health and Social Welfare Ministry and of the Advisory Council of the Catalan Health Ministry since 1984; Alistair McGuire, Professor of Health Economics at the London School of Economics and Political and advisor to a number of governments and governmental bodies across Europe; Tor Iversen, Research Director at the Health Economics Research Programme at the University of Oslo and former member of the iHEA Arrow Award Committee 2007-2011; William H Dow, Professor and Associate Dean for Research at University of California ,Berkeley and former Senior Economist for the Council of Economic Advisors (White House); Audrey Laporte, the Director of the Canadian Centre for Health Economics; Alexander S Preker, President and CEO of Health Investment & Financing Corporation; Ayda Yurekli, who initiated and developed the World Health Organization TaXSiM simulation model that has been used by many Ministries of Finance around the world for the development of tax policies; Marko Vujicic, Managing Vice President of the Health Policy Resources Center at the American Dental Association; Mark Sculpher, Director of the Programme on Economic Evaluation and Health Technology Assessment at the University of York and former President of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) (2011-2012); and Peter Berman, who has had almost 40 years of experience in global health and was formerly a Lead Health Economist at the World Bank. The Handbook spans across three volumes. The chapters deal with key global issues in health economics, are evidence-based, and offer innovative policy alternatives and solutions. The Handbook's approach toward global health economics and public policy will make it a useful resource for health economists, policymakers, private sector companies, NGOs, government decision-makers and those who manage healthcare systems.