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Sustainability of Healthcare Financing in the Western Balkans : An Overview of Progress and ChallengesThis paper explores the major challenges
 to the sustainability of health sector financing in the
 countries of the Western Balkans - Albania, Bosnia and
 Herzegovina, the Former Yugoslav Republic of Macedonia,
 Montenegro, Serbia and the province of Kosovo. It focuses on
 how the incentives created by the different elements of the
 healthcare financing system affect the behavior of
 healthcare providers and individuals, and the resulting
 inefficiencies in revenue collection and expenditure
 containment. The paper analyzes patterns of healthcare
 expenditure, finding that there is some evidence of cost
 containment, but that current expenditure levels - while
 similar to that in EU countries as a share of GDP - are low
 in per capita terms and the fiscal space to increase
 expenditures is extremely limited. It also examines the key
 drivers of current healthcare expenditure and the most
 significant barriers to revenue generation, identifying some
 key health reforms that countries in the sub-region could
 consider in order to enhance the efficiency and
 sustainability of their health systems. Data are drawn from
 international databases, country institutions, and household surveys.
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Private Voluntary Health Insurance : Consumer Protection and Prudential RegulationHealth care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance.
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Matching Contributions for Pensions : A Review of International ExperienceEstablishing robust, equitable, and
 effective social protection is essential to reducing poverty
 and boosting prosperity at all levels of development. The
 demographic transition that has already transformed most
 high-income societies will exert similar and growing
 pressures on others, reinforcing the role of pensions and
 savings for old age as a central pillar of social protection
 systems. One possible solution that has emerged in recent
 years that offers the potential to overcome this challenge
 is the provision of contribution matches to provide an
 immediate and powerful incentive for participation in
 pension saving systems. Originating in several high-income
 settings there are now a number of innovations and
 substantial experience in low-income countries in using this
 design to stimulate coverage and savings. This experience
 now provides a rich opportunity for learning, not just from
 the longer experience of a few high-income countries but
 also the more meaningful South-South learning across
 developing countries.This volume, which reviews
 the experience with matching pension contributions across
 the range of countries that have used the design, makes an
 initial, but critically important investment in this
 learning process. The description and analysis of this
 experience which is the product of partnership and
 collaboration across many public and private institutions
 provide an invaluable early assessment of the design to
 inform policy makers and practitioners as well as serve as a
 model for the kind of cooperation that will be required to
 address this difficult challenge. At the World Bank, we look
 forward to being part of this learning process of how to
 best provide old-age security for all.