Social Health Insurance Reexamined

Wagstaff, Adam

World Bank, Washington, DC

关键词: ABILITY TO PAY;    ADMINISTRATIVE COSTS;    ADVERSE SELECTION;    BREAST CANCER;    CANCER PATIENTS;   

DOI  :  10.1596/1813-9450-4111
RP-ID  :  WPS4111

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Social health insurance (SHI) isenjoying something of a revival in parts of the developingworld. Many countries that have in the past relied largelyon tax finance (and out-of-pocket payments) have introducedSHI, or are thinking about doing so. And countries with SHIalready in place are making vigorous efforts to extendcoverage to the informal sector. Ironically, this revival isoccurring at a time when the traditional SHI countries inEurope have either already reduced payroll financing infavor of general revenues, or are in the process of doingso. This paper examines how SHI fares in health caredelivery, revenue collection, covering the formal sector,and its impacts on the labor market. It argues that SHI doesnot necessarily deliver good quality care at a low cost,partly because of poor regulation of SHI purchasers. Itsuggests that the costs of collecting revenues can besubstantial, even in the formal sector where nonenrollmentand evasion are commonplace, and that while SHI can coverthe formal sector and the poor relatively easily, it faresbadly in terms of covering the nonpoor informal sectorworkers until the economy has reached a high level ofeconomic development. The paper also argues that SHI canhave negative labor market effects.