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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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Integrating the Poor into Universal Health Coverage in VietnamThis case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.
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Evidence on Cost-sharing in Health Care : Applications to Hungary : Executive SummaryThis study, done at the request of the Hungarian government, presents evidence on cost-sharing in the health sector, and its application in Hungary. It presents results on the impact of cost-sharing on revenues in health facilities and insurance, financial sustainability, informal payments, overall service use, and equity in access. Five keyfindings emerge: cost-sharing could lead to a reduction in unnecessary care provided to insured patients who do not have to pay the full price of care; cost-sharing could help reduce informal payments and keep patient payments in the system; cost-sharing with exemption policies are a prerequisite to provide equity in access to care; cost-sharing could support cost containment strategies; experience from OECD countries provides examples of successful cost-sharing policies. Based on these findings. the study recommends that Hungary continues to monitor and evaluate the impact of cost-sharing on access, to identify possible negative effects on equity in service use. In Hungary, financial incentives through the provider payment system could eventually support the effect of the government supply-side strategy. Such financial incentives could be set to providers through capitation payment to reward better quality of care, and Diagnosis Related Group (DRG) payments with expenditure ceilings with strict utilization review and quality assurance control to set an incentive for efficient provision of care.