Health insurance reform in four Latin American countries : theory and practice
AbstractThe 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 InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 2492.
Date of creation: 30 Nov 2000
Date of revision:
Health Economics&Finance; Environmental Economics&Policies; Insurance&Risk Mitigation; Insurance Law; Economic Theory&Research;
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- Miguel Gouveia, 1997.
"Majority rule and the public provision of a private good,"
Springer, vol. 93(3), pages 221-244, December.
- Gouveia, Miguel, 1997. " Majority Rule and the Public Provision of a Private Good," Public Choice, Springer, vol. 93(3-4), pages 221-44, December.
- Bengt Holmstrom, 1997.
"Moral Hazard and Observability,"
Levine's Working Paper Archive
1205, David K. Levine.
- Uri Ronnen, 1991. "Minimum Quality Standards, Fixed Costs, and Competition," RAND Journal of Economics, The RAND Corporation, vol. 22(4), pages 490-504, Winter.
- Le Grand, Julian, 1991. "Quasi-markets and Social Policy," Economic Journal, Royal Economic Society, Royal Economic Society, vol. 101(408), pages 1256-67, September.
- Hammer, Jeffrey S, 1997.
"Economic Analysis for Health Projects,"
World Bank Research Observer, World Bank Group,
World Bank Group, vol. 12(1), pages 47-71, February.
- David M. Cutler & Richard J. Zeckhauser, 1998.
"Adverse Selection in Health Insurance,"
in: Frontiers in Health Policy Research, Volume 1, pages 1-32
National Bureau of Economic Research, Inc.
- Rothschild, Michael & Stiglitz, Joseph E, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, MIT Press, MIT Press, vol. 90(4), pages 630-49, November.
- Chalkley, Martin & Malcomson, James M., 2002.
"Cost sharing in health service provision: an empirical assessment of cost savings,"
Journal of Public Economics,
Elsevier, vol. 84(2), pages 219-249, May.
- Chalkley, M. & Malcomson, J.M., 2001. "Cost Sharing in Health Service Provision: An Empirical Assessment of Cost Savings," Economics Series Working Papers 9969, University of Oxford, Department of Economics.
- Andrei Shleifer, 1985. "A Theory of Yardstick Competition," RAND Journal of Economics, The RAND Corporation, vol. 16(3), pages 319-327, Autumn.
- Mathias Dewatripont & Jean Tirole, 1994. "The prudential regulation of banks," ULB Institutional Repository 2013/9539, ULB -- Universite Libre de Bruxelles.
- Tirole, Jean, 1994.
"The Internal Organization of Government,"
Oxford Economic Papers,
Oxford University Press, vol. 46(1), pages 1-29, January.
- Rubinstein, Ariel & Yaari, Menahem E., 1983. "Repeated insurance contracts and moral hazard," Journal of Economic Theory, Elsevier, vol. 30(1), pages 74-97, June.
- David M. Cutler & Sarah J. Reber, 1998.
"Paying For Health Insurance: The Trade-Off Between Competition And Adverse Selection,"
The Quarterly Journal of Economics, MIT Press,
MIT Press, vol. 113(2), pages 433-466, May.
- David M. Cutler & Sarah Reber, 1996. "Paying for Health Insurance: The Tradeoff between Competition and Adverse Selection," NBER Working Papers 5796, National Bureau of Economic Research, Inc.
- Dixit, Avinash, 1997. "Power of Incentives in Private versus Public Organizations," American Economic Review, American Economic Association, vol. 87(2), pages 378-82, May.
- Feldstein, Martin S, 1973. "The Welfare Loss of Excess Health Insurance," Journal of Political Economy, University of Chicago Press, University of Chicago Press, vol. 81(2), pages 251-80, Part I, M.
- Jack, W., 1998. "Controlling Risk Selction Incentives when Health Insurance Contracts are Endogenous," Papers, Australian National University - Department of Economics 341, Australian National University - Department of Economics.
- Akerlof, George A, 1970. "The Market for 'Lemons': Quality Uncertainty and the Market Mechanism," The Quarterly Journal of Economics, MIT Press, MIT Press, vol. 84(3), pages 488-500, August.
- Zeckhauser, Richard, 1970. "Medical insurance: A case study of the tradeoff between risk spreading and appropriate incentives," Journal of Economic Theory, Elsevier, vol. 2(1), pages 10-26, March.
- Wilson, Charles, 1977. "A model of insurance markets with incomplete information," Journal of Economic Theory, Elsevier, vol. 16(2), pages 167-207, December.
- 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.
- Martha Bottia & Lina Cardona & Carlos Medina, .
"Bondades y Limitaciones de la FocalizaciÃ³n con Proxy Means Tests: El Caso del Sisben en Colombia,"
Borradores de Economia
539, Banco de la Republica de Colombia.
- Martha Bottia & Lina Cardona & Carlos Medina, 2008. "Bondades y Limitaciones de la FocalizaciÃ³n con Proxy Means Tests: El Caso del Sisben en Colombia," BORRADORES DE ECONOMIA 005185, BANCO DE LA REPÃšBLICA.
- Martha Bottia & Lina Cardona-Sosa & Carlos Medina, 2012. "El SISBEN como mecanismo de focalizaciÃ³n individual del rÃ©gimen subsidiado en salud en Colombia: ventajas y limitaciones," REVISTA DE ECONOMÃA DEL ROSARIO, UNIVERSIDAD DEL ROSARIO.
- 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.
- Bosch, Mariano & Goni, Edwin & Maloney, William F., 2007. "The Determinants of Rising Informality in Brazil: Evidence from Gross Worker Flows," IZA Discussion Papers 2970, Institute for the Study of Labor (IZA).
- Ronald Eduardo GÃ³mez SuÃ¡rez, 2007. "Cream-Skimming And Risk Adjustment in Colombian Health Insurance System:: The Public Insurer Case," ARCHIVOS DE ECONOMÃA 004295, DEPARTAMENTO NACIONAL DE PLANEACIÃ“N.
- Tabor, Steven R., 2005. "Community-based health insurance and social protection policy," Social Protection Discussion Papers 32545, The World Bank.
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