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Social health insurance reexamined

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  • Adam Wagstaff

    (Development Research Group, The World Bank, Washington, DC, USA)

Abstract

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 non-enrollment 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 non-poor 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. Copyright © 2009 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1492
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 19 (2010)
Issue (Month): 5 ()
Pages: 503-517

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Handle: RePEc:wly:hlthec:v:19:y:2010:i:5:p:503-517

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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Citations

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Cited by:
  1. Tenbensel, Tim & Eagle, Samantha & Ashton, Toni, 2012. "Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity," Health Policy, Elsevier, vol. 106(1), pages 29-36.
  2. Galina Besstremyannaya & Jaak Simm, 2014. "Multi-payer health insurance systems in Central and Eastern Europe: lessons from the Czech Republic, Slovakia, and Russia," Working Papers w0203, Center for Economic and Financial Research (CEFIR).
  3. Härpfer, Marco & Cacace, Mirella & Rothgang, Heinz, 2009. "And fairness for all? Wie gerecht ist die Finanzierung im deutschen Gesundheitssystem? Eine Berechnung des Kakwani-Index auf Basis der EVS," Working papers of the ZeS 04/2009, University of Bremen, Centre for Social Policy Research (ZeS).
  4. Raymundo M. Campos-Vazquez & Melissa A. Knox, . "Social Protection Programs and Employment: The Case of Mexico's Seguro Popular Program," Working Papers UWEC-2011-10, University of Washington, Department of Economics.
  5. Galina Besstremyannaya, 2014. "Urban inequity in the performance of social health insurance system: evidence from Russian regions," Working Papers w0204, Center for Economic and Financial Research (CEFIR).
  6. Götze, Ralf & Schmid, Achim, 2012. "Healthcare financing in OECD countries beyond the public-private split," TranState Working Papers 160, University of Bremen, Collaborative Research Center 597: Transformations of the State.
  7. Owen Smith & Son Nam Nguyen, 2013. "Getting Better : Improving Health System Outcomes in Europe and Central Asia," World Bank Publications, The World Bank, number 13832, October.

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