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Health insurance reform in four Latin American countries : theory and practice

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  • Jack, William

Abstract

The author examines public economics rationales for public intervention in health insurance markets, draws on the literature of organizational design to examine alternative intervention strategies, and considers health insurance reforms in four Latin American countries -- Argentina, Brazil, Chile, and Colombia -- in light of the theoretical literature. Equity has been the main reason for large-scale public intervention in the health insurance sector, despite the well-known failures of insurance and health care markets associated with imperfect information. Recent reforms have sought less to make private markets more efficient than to make public provision more efficient, sometimes by altering the focus and function of existing institutions (such as the obras sociales in Argentina) or by encouraging the growth of new ones (such as Chile's ISAPREs). Generally, these four Latin American countries have reformed the ways insurance and care are organized and delivered, have tried to extend formal coverage to previously marginalized groups, and have tried to finance this extension fairly. Colombia instituted an implicit two-tiered voucher scheme financed through a proportional wage tax. Chile's financing mechanism is similar but the distribution of benefits is less progressive, so the net effect is less redistributive. Argentina's remodeled obras system went halfway: the financing base is similar and there is some implicit redistribution from richer to poorer obras, but the quality of insurance increases with income. On the face of it, Brazil's health insurance system is less redistributive than those of the other three countries, as no tax is earmarked for financing health insurance. But taxes paid by higher-income taxpayers are not reduced when they choose private insurance, highlighting the problem of examining the health sector independent of the general tax and transfer system.

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Bibliographic Info

Paper provided by The World Bank in its series Policy Research Working Paper Series with number 2492.

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Date of creation: 30 Nov 2000
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Handle: RePEc:wbk:wbrwps:2492

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Keywords: Health Economics&Finance; Environmental Economics&Policies; Insurance&Risk Mitigation; Insurance Law; Economic Theory&Research;

References

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Citations

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Cited by:
  1. Bosch, Mariano & Goni, Edwin & Maloney, William, 2007. "The determinants of rising informality in Brazil : Evidence from gross worker flows," Policy Research Working Paper Series 4375, The World Bank.
  2. Ronald Eduardo Gómez Suárez, 2007. "Cream-Skimming And Risk Adjustment in Colombian Health Insurance System:: The Public Insurer Case," ARCHIVOS DE ECONOMÍA 004295, DEPARTAMENTO NACIONAL DE PLANEACIÓN.
  3. Martha Bottia & Lina Cardona-Sosa & Carlos Medina, 2012. "El SISBEN como mecanismo de focalización individual del régimen subsidiado en salud en Colombia: ventajas y limitaciones," REVISTA DE ECONOMÍA DEL ROSARIO, UNIVERSIDAD DEL ROSARIO.
  4. Tabor, Steven R., 2005. "Community-based health insurance and social protection policy," Social Protection Discussion Papers 32545, The World Bank.
  5. Bosch, Mariano & Goñi-Pacchioni, Edwin & Maloney, William, 2012. "Trade liberalization, labor reforms and formal–informal employment dynamics," Labour Economics, Elsevier, vol. 19(5), pages 653-667.
  6. Martha Bottia & Lina Cardona & Carlos Medina, . "Bondades y Limitaciones de la Focalización con Proxy Means Tests: El Caso del Sisben en Colombia," Borradores de Economia 539, Banco de la Republica de Colombia.

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