Health Insurance Reform in Four Latin American Countries : Theory and Practice

Jack, William

World Bank, Washington, DC

关键词: ADVERSE SELECTION PROBLEMS;    ASSETS;    ASYMMETRIC INFORMATION;    BUDGET CONSTRAINTS;    CLINICS;   

DOI  :  10.1596/1813-9450-2492
RP-ID  :  WPS2492

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

The author examines public economicsrationales for public intervention in health insurancemarkets, draws on the literature of organizational design toexamine alternative intervention strategies, and considershealth insurance reforms in four Latin American countries --Argentina, Brazil, Chile, and Colombia -- in light of thetheoretical literature. Equity has been the main reason forlarge-scale public intervention in the health insurancesector, despite the well-known failures of insurance andhealth care markets associated with imperfect information.Recent reforms have sought less to make private markets moreefficient than to make public provision more efficient,sometimes by altering the focus and function of existinginstitutions (such as the obras sociales in Argentina) or byencouraging the growth of new ones (such as Chile'sISAPREs). Generally, these four Latin American countrieshave reformed the ways insurance and care are organized anddelivered, have tried to extend formal coverage topreviously marginalized groups, and have tried to financethis extension fairly. Colombia instituted an implicittwo-tiered voucher scheme financed through a proportionalwage tax. Chile's financing mechanism is similar butthe distribution of benefits is less progressive, so the neteffect is less redistributive. Argentina's remodeledobras system went halfway: the financing base is similar andthere is some implicit redistribution from richer to poorerobras, but the quality of insurance increases with income.On the face of it, Brazil's health insurance system isless redistributive than those of the other three countries,as no tax is earmarked for financing health insurance. Buttaxes paid by higher-income taxpayers are not reduced whenthey choose private insurance, highlighting the problem ofexamining the health sector independent of the general taxand transfer system.