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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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Enhancing Efficiency and Equity : Challenges and Reform Opportunities Facing Health and Pension Systems in the Western BalkansThis collection of papers explores the
 major challenges to the sustainability of health and pension
 system 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 financing arrangements affect the
 behavior of providers and individuals, and the resulting
 inefficiencies in revenue collection and expenditure
 containment. The volume commences with an analysis of
 healthcare financing, exploring patterns of healthcare
 expenditure, and examining the key drivers of current
 healthcare expenditure and the most significant barriers to
 revenue generation. Subsequent chapters give special
 attention to provider payment mechanisms and the
 pharmaceutical sector. Equity considerations are highlighted
 in a chapter that explores the protection that is offered
 against the financial impact of health expenditures. With
 respect to the pension sector, the volume provides an
 overview of national pension systems and outlines the main
 challenges to achieving a sustainable balance between
 pension benefits and costs. The analyses of the health and
 pension reform process are placed within the context of the
 labor market challenges in the sub-region, especially as
 they relate to the ability to raise revenue for health and
 pensions through payroll contributions. All chapters
 conclude by identifying some reforms that countries in the
 sub-region could consider in order to enhance the efficiency
 and sustainability of their systems. Data are drawn from
 international databases, country institutions, and household surveys.
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Private Voluntary Health Insurance in Development : Friend or Foe?This volume presents findings of a World Bank review of the existing and potential role of private voluntary health insurance in low- and middle-income countries and is the third volume in a series of reviews of health care financing. Also, this volume is about managing risk. Not the risk of national or man-made disasters but the risk of illness. The developing world is plagued by many of the historical scourges of poverty: infectious disease, disability, and premature death. As countries pass through demographic and epidemiological transition, they face a new wave of health challenges from chronic diseases and accidents. In this respect, illness has both a predictable and an unpredictable dimension. Contributors to this volume emphasize that the public sector has an important role to play in the health sector, but they demonstrate that the private sector also plays a role in a context in which private spending and delivery of health services often composes 80 percent of total health expenditure. Managing risks in the private sector begins at the household level. Private voluntary health insurance is merely an extension of such nongovernmental ways to deal with the risk of illness and its impoverishing effects in low- and middle-income countries. The authors examine frameworks for analyzing health financing and health insurance. They conclude that most studies are hampered by lack of data on the impact of private voluntary health insurance on broad social goals, such as financial protection. They find no overall consensus on the impact of voluntary health insurance on public health activities or on the quality, innovation, and efficiency of personal health services.