Scaling Up Affordable Health Insurance : Staying the Course

Preker, Alexander S. ; Lindner, Marianne E. ; Chernichovsky, Dov ; Schellekens, Onno P.

Washington, DC:World Bank

关键词: Health Financing;    Health Insurance;    Mandatory Health Insurance;    Private Health Insurance;    Social Health Insurance;   

DOI  :  10.1596/978-0-8213-8250-9
RP-ID  :  77909

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

As the world recently turned itsattention to the struggle of expanding health insurancecoverage for 40 million people in the United States, it isimportant not to forget the 4 billion people in low- andmiddle-income countries that face the same hardship.Millions of the poor have already fallen back into povertyas a result of the ongoing global financial crisis. Millionsmore are at risk before full recovery. It is the poor andmost vulnerable that are at greatest risk due to lack ofprotection against the impoverishing effects of illness. Theresearch for this volume shows that, when properly designedand coupled with public subsidies, health insurance cancontribute to the well-being of poor and middle-classhouseholds, not just the rich. And it can contribute todevelopment goals such as improved access to health care,better financial protection against the cost of illness, andreduced social exclusion. Opponents vilify health insuranceas an evil to be avoided at all cost. To them, healthinsurance leads to overconsumption of care, escalatingcosts-especially administrative costs-fraud and abuse,shunting of scarce resources away from the poor, creamskimming, adverse selection, moral hazard, and aninequitable health care system. Today many low-andmiddle-income countries are no longer listening to thisdichotomized debate between vertical and horizontalapproaches to health care. Instead, they are experimentingwith new and innovative approaches to health care financing.Health insurance is becoming a new paradigm for reaching theMillennium Development Goals (MDGs). They emphasize the needto combine several instruments to achieve three majordevelopment objectives in health care financing: 1)sustainable access to needed health care; 2) greaterfinancial protection against the impoverishing cost ofillness; and 3) reduction in social exclusion from organizedhealth financing instruments. The use of insurance wasrecommended to pay for less frequent, higher-cost risks andsubsidies to cover affordability for poorer patients tohigher-frequency, lower-cost health problems.