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Social health insurance reexamined

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  • Wagstaff, Adam

Abstract

Social health insurance (SHI) is enjoying something of a revival in parts of the developing world. Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced SHI, or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so. This paper examines how SHI fares in health care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where nonenrollment and evasion are commonplace, and that while SHI can cover the formal sector and the poor relatively easily, it fares badly in terms of covering the nonpoor informal sector workers until the economy has reached a high level of economic development. The paper also argues that SHI can have negative labor market effects.

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  • Wagstaff, Adam, 2007. "Social health insurance reexamined," Policy Research Working Paper Series 4111, The World Bank.
  • Handle: RePEc:wbk:wbrwps:4111
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    Cited by:

    1. Asuming, Patrick Opoku & Kim, Hyuncheol Bryant & Sim, Armand, 2017. "Long-Run Consequences of Health Insurance Promotion: Evidence from a Field Experiment in Ghana," IZA Discussion Papers 11117, Institute for the Study of Labor (IZA).
    2. Galina Besstremyannaya & Jaak Simm, 2014. "Multi-payer health insurance systems in Central and Eastern Europe: lessons from the Czech Republic, Slovakia, and Russia," Working Papers w0203, Center for Economic and Financial Research (CEFIR).
    3. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, vol. 52(2), pages 480-518, June.
    4. Götze, Ralf & Schmid, Achim, 2012. "Healthcare financing in OECD countries beyond the public-private split," TranState Working Papers 160, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    5. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2017. "Nudging Households to Take Up Health Insurance: Evidence from a Randomized Experiment in Burkina Faso," IZA Discussion Papers 10744, Institute for the Study of Labor (IZA).
    6. Raymundo M. Campos-Vázquez & Melissa A. Knox, 2013. "Social Protection Programs and Employment: The Case of Mexico's Seguro Popular Program," Economía Mexicana NUEVA ÉPOCA, , vol. 0(2), pages 403-448, July-Dece.
    7. Härpfer, Marco & Cacace, Mirella & Rothgang, Heinz, 2009. "And fairness for all? Wie gerecht ist die Finanzierung im deutschen Gesundheitssystem? Eine Berechnung des Kakwani-Index auf Basis der EVS," Working papers of the ZeS 04/2009, University of Bremen, Centre for Social Policy Research (ZeS).
    8. Mitenbergs, Uldis & Brigis, Girts & Quentin, Wilm, 2014. "Healthcare financing reform in Latvia: Switching from social health insurance to NHS and back?," Health Policy, Elsevier, vol. 118(2), pages 147-152.
    9. Khaled Makhloufi & Bruno Ventelou & Mohammad Abu-Zaineh, 2015. "Have health insurance reforms in Tunisia attained their intended objectives?," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 29-51, March.
    10. Sheinman, Igor & Terentieva, Svetlana, 2015. "International comparison of the effectiveness of fiscal and insurance models of healthcare financing," Economic Policy, Russian Presidential Academy of National Economy and Public Administration, vol. 6, pages 171-193.
    11. repec:ris:apltrx:0315 is not listed on IDEAS
    12. Rhee, Jong Chul & Done, Nicolae & Anderson, Gerard F., 2015. "Considering long-term care insurance for middle-income countries: comparing South Korea with Japan and Germany," Health Policy, Elsevier, vol. 119(10), pages 1319-1329.
    13. Owen Smith & Son Nam Nguyen, 2013. "Getting Better : Improving Health System Outcomes in Europe and Central Asia," World Bank Publications, The World Bank, number 13832, January.
    14. Liu, Kai & Wu, Qiaobing & Liu, Junqiang, 2014. "Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement," Social Science & Medicine, Elsevier, vol. 113(C), pages 95-103.
    15. Bowser, Diana M. & Mahal, Ajay, 2011. "Guatemala: The economic burden of illness and health system implications," Health Policy, Elsevier, vol. 100(2), pages 159-166.
    16. Tenbensel, Tim & Eagle, Samantha & Ashton, Toni, 2012. "Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity," Health Policy, Elsevier, vol. 106(1), pages 29-36.
    17. Galina Besstremyannaya, 2014. "Urban inequity in the performance of social health insurance system: evidence from Russian regions," Working Papers w0204, Center for Economic and Financial Research (CEFIR).
    18. World Bank, 2014. "Assessment of Health Financing Options : Papua New Guinea," World Bank Other Operational Studies 21118, The World Bank.
    19. Liu, Jun-Qiang, 2011. "Dynamics of social health insurance development: Examining the determinants of Chinese basic health insurance coverage with panel data," Social Science & Medicine, Elsevier, vol. 73(4), pages 550-558, August.
    20. Abrigo, Michael R.M. & Paqueo, Vicente B., 2017. "Social Protection and Access to Health Care among Children in the Philippines," Discussion Papers DP 2017-36, Philippine Institute for Development Studies.
    21. repec:bla:glopol:v:8:y:2017:i::p:110-116 is not listed on IDEAS

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    Keywords

    Health Monitoring&Evaluation; Health Economics&Finance; Public Sector Economics; Labor Markets; Health Systems Development&Reform;

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