Governing Mandatory Health Insurance : Learning from Experience

This book provides guidance to countries that want to reform or establish mandatory health insurance (MHI) by specifically addressing governance. It elucidates the role played by the social, political, and historical context in conditioning how MHI systems are governed and, in turn, how governance structures influence the health insurance systems' performance. The book describes the forms of governance that are associated with success, in particular, the regulatory institutions required to guide the system toward its social goals; the oversight mechanisms that monitor and correct the system; and the internal management of the health insurance institutions themselves. It highlights five governance dimensions: coherent decision making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability that influence the coverage, financial protection, and efficiency of MHI entities, and show how these operate in particular countries. Detailed analysis of governance arrangements in four countries: Chile, Costa Rica, Estonia, and the Netherlands, provide nuanced lessons for establishing health insurance systems that can truly serve the social goals of improved health, reduced financial insecurity, and greater equity.