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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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

id	okr-10986-6886
recordtype	oai_dc
spelling	okr-10986-68862021-04-23T14:02:32Z Social Health Insurance Reexamined Wagstaff, Adam 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 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. 2012-06-01T17:53:20Z 2012-06-01T17:53:20Z 2007-01 http://documents.worldbank.org/curated/en/2007/01/7311064/social-health-insurance-reexamined http://hdl.handle.net/10986/6886 English Policy Research Working Paper; No. 4111 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank World Bank, Washington, DC Publications & Research :: Policy Research Working Paper Publications & Research
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English
topic	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
spellingShingle	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 Wagstaff, Adam Social Health Insurance Reexamined
relation	Policy Research Working Paper; No. 4111
description	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.
format	Publications & Research :: Policy Research Working Paper
author	Wagstaff, Adam
author_facet	Wagstaff, Adam
author_sort	Wagstaff, Adam
title	Social Health Insurance Reexamined
title_short	Social Health Insurance Reexamined
title_full	Social Health Insurance Reexamined
title_fullStr	Social Health Insurance Reexamined
title_full_unstemmed	Social Health Insurance Reexamined
title_sort	social health insurance reexamined
publisher	World Bank, Washington, DC
publishDate	2012
url	http://documents.worldbank.org/curated/en/2007/01/7311064/social-health-insurance-reexamined http://hdl.handle.net/10986/6886
_version_	1764401253958287360

Social Health Insurance Reexamined

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