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Health Insurance Handbook : How to Make It Work


  • Hong Wang
  • Kimberly Switlick
  • Christine Ortiz
  • Beatriz Zurita
  • Catherine Connor


Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.

Suggested Citation

  • Hong Wang & Kimberly Switlick & Christine Ortiz & Beatriz Zurita & Catherine Connor, 2012. "Health Insurance Handbook : How to Make It Work," World Bank Publications, The World Bank, number 5913, April.
  • Handle: RePEc:wbk:wbpubs:5913

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    References listed on IDEAS

    1. Dong, Keyong, 2009. "Medical insurance system evolution in China," China Economic Review, Elsevier, vol. 20(4), pages 591-597, December.
    2. Winnie Yip & Adam Wagstaff & William C. Hsiao, 2009. "Economic analysis of China's health care system: turning a new page," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 3-6, July.
    3. John C. Langenbrunner & Cheryl Cashin & Sheila O’Dougherty, 2009. "Designing and Implementing Health Care Provider Payment Systems : How-To Manuals," World Bank Publications, The World Bank, number 13806, April.
    4. Basinga, Paulin & Gertler, Paul J. & Binagwaho, Agnes & Soucat, Agnes L.B. & Sturdy, Jennifer R. & Vermeersch, Christel M.J., 2010. "Paying primary health care centers for performance in Rwanda," Policy Research Working Paper Series 5190, The World Bank.
    5. Eklund, Per & Stavem, Knut, 1990. "Prepaid financing of primary health care in Guinea-Bissau : an assessment of 18 village health posts," Policy Research Working Paper Series 488, The World Bank.
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    Cited by:

    1. World Bank, 2015. "Bulgaria Health Financing," World Bank Other Operational Studies 22964, The World Bank.


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