Social Health Insurance Reexamined

Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so....

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Bibliographic Details
Main Author:	Wagstaff, Adam
Format:	Policy Research Working Paper
Language:	English
Published:	World Bank, Washington, DC 2012
Subjects:	ABILITY TO PAY ADMINISTRATIVE COSTS ADVERSE SELECTION BREAST CANCER CANCER PATIENTS CENTRAL FUND COMPETITION AMONG INSURERS CONSUMPTION TAXES CONTRIBUTION RATE CONTRIBUTION RATES CONTRIBUTORY SYSTEM CORPORATE INCOME TAXES COST OF CARE COST OF HEALTH CARE CUMULATIVE TURNOVER DELIVERY OF HEALTH CARE DELIVERY SYSTEM EARNING ECONOMIC GROWTH ECONOMIES OF SCALE EMPLOYEE EMPLOYMENT EFFECTS EQUALIZATION EVASION FAMILIES FEMALE LABOR FEMALE LABOR FORCE FINANCIAL RESOURCES FINANCING HEALTH CARE FINANCING OF HEALTH CARE FORMAL SECTOR WORKER GOVERNMENT SPENDING HEALTH CARE HEALTH CARE COSTS HEALTH CARE DELIVERY HEALTH CARE REFORM HEALTH CARE SPENDING HEALTH CARE SYSTEMS HEALTH FINANCE HEALTH FINANCING HEALTH FINANCING MECHANISM HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH INSURERS HEALTH NEEDS HEALTH POLICY HEALTH REFORM HEALTH REFORMS HEALTH SECTOR HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEM FINANCING HEALTH SYSTEMS HOSPITALS HOUSING INCOME GROUPS INCOME HOUSEHOLDS INCOME TAXES INFORMAL ECONOMY INFORMAL EMPLOYMENT INFORMAL EMPLOYMENT ARRANGEMENTS INFORMAL PAYMENTS INFORMAL SECTOR INFORMAL SECTOR WORKERS INFORMATION SYSTEM INSURANCE COVERAGE INSURERS JOBS LABOR COSTS LABOR DEMAND LABOR FORCE PARTICIPATION LABOR MARKET LABOR SUPPLY LATIN AMERICAN LIFE EXPECTANCY LOCAL GOVERNMENT REVENUES LOW INCOME MARGINAL COST MEDICAL INSURANCE MUNICIPALITIES NONGOVERNMENTAL ORGANIZATIONS OCCUPATION PATIENTS PAYROLL TAX PAYROLL TAXES PHARMACY POCKET PAYMENTS POLICY RESEARCH PRIMARY CARE PRIMARY HEALTH CARE PRIVATE ENTERPRISES PRIVATE INSURANCE PRIVATE PROVIDERS PRIVATE SECTOR PRIVATE SECTOR EMPLOYEES PUBLIC PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SPENDING PURCHASER- PROVIDER SPLIT PURCHASER-PROVIDER SPLIT REAL WAGES RESOURCE ALLOCATION REVENUE COLLECTION SAFETY NET SCREENING SERVANTS SICKNESS FUNDS SOCIAL HEALTH INSURANCE SOCIAL INSURANCE SOCIAL INSURANCE CONTRIBUTIONS SOCIAL INSURANCE SYSTEM SOCIAL SECURITY SOCIAL SECURITY SYSTEMS STATE-OWNED ENTERPRISE SUPPLIERS SURVIVAL RATES TAX TAX COLLECTION TAX RATES TAX REVENUE TAX REVENUES TAXATION TREASURY UNEMPLOYED UNEMPLOYMENT UNEMPLOYMENT RATES WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2007/01/7311064/social-health-insurance-reexamined http://hdl.handle.net/10986/6886

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Summary:	Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where nonenrollment and evasion are commonplace, and that while SHI can cover the formal sector and the poor relatively easily, it fares badly in terms of covering the nonpoor informal sector workers until the economy has reached a high level of economic development. The paper also argues that SHI can have negative labor market effects.

Social Health Insurance Reexamined

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