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Developing health insurance in transitional Asia


  • Ensor, Tim


Many European and Asian economies are currently undergoing a process of economic transition away from state based command systems to market led economies. The impact of transition, such as a decline in public expenditure, break up of state enterprises and economic recession, has affected levels of funding available for social sectors. In the health sector, health insurance is being introduced as a way of alleviating the decline in funding arising from these processes. Most of the Former Soviet Union and a number of other Asian transition economies are currently introducing, extending or considering payroll based systems of health insurance. Comparisons with many Latin American countries, where social security based insurance has been encouraged since the first World War, can be illuminating. Experience suggests that, various factors have impeded or permitted development in these countries. General processes of economic change (transition factors) tend to affect all economies attempting to change the basis for public funding of services. Structural factors, such as urbanisation and the level of state or industrial employment, act as longer term inhibitors to the extension of coverage. These factors vary considerably across transition economies. This suggests that while a social security base for insurance may be a viable option for smaller industrialised European transitional economies, this is not the case for many of larger less industrialised economies. It is unclear how insurance will develop in the future. If a separate insurance fund is maintained it is important that its' purchasing function is developed. Otherwise it is not clear what value is added to the current health system. If entitlement is to be based on contribution, with the fund based on geographic or employment groups, systems for ensuring access for those not in employment and not classified as socially protected must be developed.

Suggested Citation

  • Ensor, Tim, 1999. "Developing health insurance in transitional Asia," Social Science & Medicine, Elsevier, vol. 48(7), pages 871-879, April.
  • Handle: RePEc:eee:socmed:v:48:y:1999:i:7:p:871-879

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    Cited by:

    1. Matthew Jowett & Anil Deolalikar & Peter Martinsson, 2004. "Health insurance and treatment seeking behaviour: evidence from a lowÔÇÉincome country," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 845-857, September.
    2. Kelley Lee, 2014. "Health Policy in Asia and the Pacific: Navigating Local Needs and Global Challenges," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 1(1), pages 45-57, January.
    3. Kutzin, Joseph, 2001. "A descriptive framework for country-level analysis of health care financing arrangements," Health Policy, Elsevier, vol. 56(3), pages 171-204, June.
    4. Habtom, GebreMichael Kibreab & Ruys, Pieter, 2007. "Traditional risk-sharing arrangements and informal social insurance in Eritrea," Health Policy, Elsevier, vol. 80(1), pages 218-235, January.
    5. Matthew Jowett, 2004. "Theoretical insights into the development of health insurance in low-income countries," Working Papers 188chedp, Centre for Health Economics, University of York.
    6. Mathauer, Inke & Nicolle, Emmanuelle, 2011. "A global overview of health insurance administrative costs: what are the reasons for variations found?," Health Policy, Elsevier, vol. 102(2), pages 235-246.
    7. Poletti, Tim & Balabanova, Dina & Ghazaryan, Olga & Kocharyan, Hasmik & Hakobyan, Margarita & Arakelyan, Karen & Normand, Charles, 2007. "The desirability and feasibility of scaling up community health insurance in low-income settings--Lessons from Armenia," Social Science & Medicine, Elsevier, vol. 64(3), pages 509-520, February.
    8. Veronica Vargas & Sayem Ahmed & Alayne M Adams, 2018. "Factors enabling comprehensive maternal health services in the benefits package of emerging financing schemes: A cross-sectional analysis from 1990 to 2014," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-15, September.
    9. Fernando Ruiz & Liliana Amaya & Stella Venegas, 2007. "Progressive segmented health insurance: Colombian health reform and access to health services," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 3-18, January.


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