Health Insurance Reform in Four Latin American Countries : Theory and Practice
The author examines public economics rationales for public intervention in health insurance markets, draws on the literature of organizational design to examine alternative intervention strategies, and considers health insurance reforms in four Lat...
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
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World Bank, Washington, DC
2014
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| Online Access: | http://documents.worldbank.org/curated/en/2000/11/729384/health-insurance-reform-four-latin-american-countries-theory-practice http://hdl.handle.net/10986/19776 |
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okr-10986-19776 |
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| recordtype |
oai_dc |
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Digital Repository |
| institution_category |
Foreign Institution |
| institution |
Digital Repositories |
| building |
World Bank Open Knowledge Repository |
| collection |
World Bank |
| language |
English en_US |
| topic |
ADVERSE SELECTION PROBLEMS ASSETS ASYMMETRIC INFORMATION BUDGET CONSTRAINTS CLINICS COMPENSATION CONSUMER CHOICE CONSUMER PROTECTION CONSUMERS CONTRACTUAL ARRANGEMENTS COVERAGE CROWDING CROWDING OUT DEBT DEVELOPMENT INDICATORS DISTORTIONARY EFFECTS ECONOMIC MODELS ECONOMICS ELASTICITIES ELASTICITY ELASTICITY OF DEMAND EMPLOYMENT EQUILIBRIUM EQUILIBRIUM ANALYSIS EXTERNALITY FINANCIAL RESOURCES FINANCIAL RISK FORMAL LABOR MARKET GDP GDP PER CAPITA HEALTH CARE HEALTH CARE SERVICES HEALTH DELIVERY SYSTEM HEALTH INSURANCE HEALTH NEEDS HEALTH OUTCOMES HEALTH SECTOR HEALTH STATUS IMPERFECT COMPETITION IMPERFECT INFORMATION INCOME INCOME GROUPS INCOME INEQUALITY INCOME LEVELS INCREASING RETURNS INDEMNITY INEFFICIENCY INFANT MORTALITY INFORMAL SECTOR INFORMATION ASYMMETRIES INFORMATION IMPERFECTIONS INSURANCE COMPANIES INSURANCE CONTRACTS INSURANCE COVERAGE INSURANCE MARKETS INSURANCE POLICIES INSURANCE PRICING INSURANCE REGULATION INSURANCE SYSTEM INSURERS LIFE EXPECTANCY LIFE-TIME INSURANCE MARKET FAILURES MARKET MECHANISM MARKET POWER MEDICAL CARE MEDICAL COSTS MEDICAL SERVICES MORAL HAZARD OPTIMIZATION ORGANIZATIONAL STRUCTURE ORGANIZATIONAL STRUCTURES PHYSICIANS POLICY RESEARCH POLLUTION POSITIVE EFFECTS PREMIUMS PRICE DISCRIMINATION PRIVATE GOODS PRIVATE INSURANCE PRIVATE INSURANCE COMPANIES PRIVATE INSURANCE SYSTEMS PRIVATE SECTOR PRODUCT DIFFERENTIATION PRODUCTION EFFICIENCY PRODUCTIVE ASSETS PUBLIC GOODS PUBLIC HEALTH PUBLIC INSURANCE RATES REDISTRIBUTIVE TAXATION RISK AVERSE RISK MANAGEMENT RISK REDUCTION SAVINGS SERVICE DELIVERY SOCIAL SECURITY SOCIAL WELFARE SOFT BUDGET CONSTRAINTS TAXATION UNDERLYING PROBLEM VOTERS WAGES WELFARE EFFECTS WILLINGNESS TO PAY |
| spellingShingle |
ADVERSE SELECTION PROBLEMS ASSETS ASYMMETRIC INFORMATION BUDGET CONSTRAINTS CLINICS COMPENSATION CONSUMER CHOICE CONSUMER PROTECTION CONSUMERS CONTRACTUAL ARRANGEMENTS COVERAGE CROWDING CROWDING OUT DEBT DEVELOPMENT INDICATORS DISTORTIONARY EFFECTS ECONOMIC MODELS ECONOMICS ELASTICITIES ELASTICITY ELASTICITY OF DEMAND EMPLOYMENT EQUILIBRIUM EQUILIBRIUM ANALYSIS EXTERNALITY FINANCIAL RESOURCES FINANCIAL RISK FORMAL LABOR MARKET GDP GDP PER CAPITA HEALTH CARE HEALTH CARE SERVICES HEALTH DELIVERY SYSTEM HEALTH INSURANCE HEALTH NEEDS HEALTH OUTCOMES HEALTH SECTOR HEALTH STATUS IMPERFECT COMPETITION IMPERFECT INFORMATION INCOME INCOME GROUPS INCOME INEQUALITY INCOME LEVELS INCREASING RETURNS INDEMNITY INEFFICIENCY INFANT MORTALITY INFORMAL SECTOR INFORMATION ASYMMETRIES INFORMATION IMPERFECTIONS INSURANCE COMPANIES INSURANCE CONTRACTS INSURANCE COVERAGE INSURANCE MARKETS INSURANCE POLICIES INSURANCE PRICING INSURANCE REGULATION INSURANCE SYSTEM INSURERS LIFE EXPECTANCY LIFE-TIME INSURANCE MARKET FAILURES MARKET MECHANISM MARKET POWER MEDICAL CARE MEDICAL COSTS MEDICAL SERVICES MORAL HAZARD OPTIMIZATION ORGANIZATIONAL STRUCTURE ORGANIZATIONAL STRUCTURES PHYSICIANS POLICY RESEARCH POLLUTION POSITIVE EFFECTS PREMIUMS PRICE DISCRIMINATION PRIVATE GOODS PRIVATE INSURANCE PRIVATE INSURANCE COMPANIES PRIVATE INSURANCE SYSTEMS PRIVATE SECTOR PRODUCT DIFFERENTIATION PRODUCTION EFFICIENCY PRODUCTIVE ASSETS PUBLIC GOODS PUBLIC HEALTH PUBLIC INSURANCE RATES REDISTRIBUTIVE TAXATION RISK AVERSE RISK MANAGEMENT RISK REDUCTION SAVINGS SERVICE DELIVERY SOCIAL SECURITY SOCIAL WELFARE SOFT BUDGET CONSTRAINTS TAXATION UNDERLYING PROBLEM VOTERS WAGES WELFARE EFFECTS WILLINGNESS TO PAY Jack, William Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| geographic_facet |
Latin America & Caribbean ARGENTINA Brazil Chile Colombia |
| relation |
Policy Research Working Paper;No. 2492 |
| description |
The author examines public economics
rationales for public intervention in health insurance
markets, draws on the literature of organizational design to
examine alternative intervention strategies, and considers
health insurance reforms in four Latin American countries --
Argentina, Brazil, Chile, and Colombia -- in light of the
theoretical literature. Equity has been the main reason for
large-scale public intervention in the health insurance
sector, despite the well-known failures of insurance and
health care markets associated with imperfect information.
Recent reforms have sought less to make private markets more
efficient than to make public provision more efficient,
sometimes by altering the focus and function of existing
institutions (such as the obras sociales in Argentina) or by
encouraging the growth of new ones (such as Chile's
ISAPREs). Generally, these four Latin American countries
have reformed the ways insurance and care are organized and
delivered, have tried to extend formal coverage to
previously marginalized groups, and have tried to finance
this extension fairly. Colombia instituted an implicit
two-tiered voucher scheme financed through a proportional
wage tax. Chile's financing mechanism is similar but
the distribution of benefits is less progressive, so the net
effect is less redistributive. Argentina's remodeled
obras system went halfway: the financing base is similar and
there is some implicit redistribution from richer to poorer
obras, but the quality of insurance increases with income.
On the face of it, Brazil's health insurance system is
less redistributive than those of the other three countries,
as no tax is earmarked for financing health insurance. But
taxes paid by higher-income taxpayers are not reduced when
they choose private insurance, highlighting the problem of
examining the health sector independent of the general tax
and transfer system. |
| format |
Publications & Research :: Policy Research Working Paper |
| author |
Jack, William |
| author_facet |
Jack, William |
| author_sort |
Jack, William |
| title |
Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| title_short |
Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| title_full |
Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| title_fullStr |
Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| title_full_unstemmed |
Health Insurance Reform in Four Latin American Countries : Theory and Practice |
| title_sort |
health insurance reform in four latin american countries : theory and practice |
| publisher |
World Bank, Washington, DC |
| publishDate |
2014 |
| url |
http://documents.worldbank.org/curated/en/2000/11/729384/health-insurance-reform-four-latin-american-countries-theory-practice http://hdl.handle.net/10986/19776 |
| _version_ |
1764440617667002368 |
| spelling |
okr-10986-197762021-04-23T14:03:44Z Health Insurance Reform in Four Latin American Countries : Theory and Practice Jack, William ADVERSE SELECTION PROBLEMS ASSETS ASYMMETRIC INFORMATION BUDGET CONSTRAINTS CLINICS COMPENSATION CONSUMER CHOICE CONSUMER PROTECTION CONSUMERS CONTRACTUAL ARRANGEMENTS COVERAGE CROWDING CROWDING OUT DEBT DEVELOPMENT INDICATORS DISTORTIONARY EFFECTS ECONOMIC MODELS ECONOMICS ELASTICITIES ELASTICITY ELASTICITY OF DEMAND EMPLOYMENT EQUILIBRIUM EQUILIBRIUM ANALYSIS EXTERNALITY FINANCIAL RESOURCES FINANCIAL RISK FORMAL LABOR MARKET GDP GDP PER CAPITA HEALTH CARE HEALTH CARE SERVICES HEALTH DELIVERY SYSTEM HEALTH INSURANCE HEALTH NEEDS HEALTH OUTCOMES HEALTH SECTOR HEALTH STATUS IMPERFECT COMPETITION IMPERFECT INFORMATION INCOME INCOME GROUPS INCOME INEQUALITY INCOME LEVELS INCREASING RETURNS INDEMNITY INEFFICIENCY INFANT MORTALITY INFORMAL SECTOR INFORMATION ASYMMETRIES INFORMATION IMPERFECTIONS INSURANCE COMPANIES INSURANCE CONTRACTS INSURANCE COVERAGE INSURANCE MARKETS INSURANCE POLICIES INSURANCE PRICING INSURANCE REGULATION INSURANCE SYSTEM INSURERS LIFE EXPECTANCY LIFE-TIME INSURANCE MARKET FAILURES MARKET MECHANISM MARKET POWER MEDICAL CARE MEDICAL COSTS MEDICAL SERVICES MORAL HAZARD OPTIMIZATION ORGANIZATIONAL STRUCTURE ORGANIZATIONAL STRUCTURES PHYSICIANS POLICY RESEARCH POLLUTION POSITIVE EFFECTS PREMIUMS PRICE DISCRIMINATION PRIVATE GOODS PRIVATE INSURANCE PRIVATE INSURANCE COMPANIES PRIVATE INSURANCE SYSTEMS PRIVATE SECTOR PRODUCT DIFFERENTIATION PRODUCTION EFFICIENCY PRODUCTIVE ASSETS PUBLIC GOODS PUBLIC HEALTH PUBLIC INSURANCE RATES REDISTRIBUTIVE TAXATION RISK AVERSE RISK MANAGEMENT RISK REDUCTION SAVINGS SERVICE DELIVERY SOCIAL SECURITY SOCIAL WELFARE SOFT BUDGET CONSTRAINTS TAXATION UNDERLYING PROBLEM VOTERS WAGES WELFARE EFFECTS WILLINGNESS TO PAY The author examines public economics rationales for public intervention in health insurance markets, draws on the literature of organizational design to examine alternative intervention strategies, and considers health insurance reforms in four Latin American countries -- Argentina, Brazil, Chile, and Colombia -- in light of the theoretical literature. Equity has been the main reason for large-scale public intervention in the health insurance sector, despite the well-known failures of insurance and health care markets associated with imperfect information. Recent reforms have sought less to make private markets more efficient than to make public provision more efficient, sometimes by altering the focus and function of existing institutions (such as the obras sociales in Argentina) or by encouraging the growth of new ones (such as Chile's ISAPREs). Generally, these four Latin American countries have reformed the ways insurance and care are organized and delivered, have tried to extend formal coverage to previously marginalized groups, and have tried to finance this extension fairly. Colombia instituted an implicit two-tiered voucher scheme financed through a proportional wage tax. Chile's financing mechanism is similar but the distribution of benefits is less progressive, so the net effect is less redistributive. Argentina's remodeled obras system went halfway: the financing base is similar and there is some implicit redistribution from richer to poorer obras, but the quality of insurance increases with income. On the face of it, Brazil's health insurance system is less redistributive than those of the other three countries, as no tax is earmarked for financing health insurance. But taxes paid by higher-income taxpayers are not reduced when they choose private insurance, highlighting the problem of examining the health sector independent of the general tax and transfer system. 2014-08-27T20:14:34Z 2014-08-27T20:14:34Z 2000-11 http://documents.worldbank.org/curated/en/2000/11/729384/health-insurance-reform-four-latin-american-countries-theory-practice http://hdl.handle.net/10986/19776 English en_US Policy Research Working Paper;No. 2492 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research Latin America & Caribbean ARGENTINA Brazil Chile Colombia |