Social Re Insurance A New Approach to Sustainable Community Health Financing

Kitap : Social Re Insurance A New Approach to Sustainable Community Health Financing

Yazar : * David M.Dror * Alexander S.Preker

Dil : İngilizce

Bölüm : Sosyal Güvenlik

Yayın Yeri : Geneva

ISBN : 0-8213-5041-2

Yayın Tarihi : 2002

Yayıncı : International Labour Office (ILO)

Tür : Kitap

Kitap No : 2587

İÇİNDEKİLER


Contents
Foreword Acknowledgments Abbreviations and Acronyms
Introduction
Definition of Community-Based Health Financing
Objective and Scope of this Volume
Target Audience
Background to Research
Roadmap for Volume
Conclusions
PART 1 DEVELOPMENT CHALLENGES IN HEALTH CARE FINANCING
1. Rich-Poor Differences in Health Care Financing
Alexander S. Preker, Jack Langenbmnner, and Melitta Jakab Achieving Financial Protection against the Cost of Illness Exclusion of Low-Income Rural Populations and Informal Workers Understanding the Origins of Rich-Poor Differences in Health Care
Financing Key Obstacles in Extending Financial Protection through Formal
Arrangements
2. The Role of Communities in Combating Social Exclusion
David M. Dror, Alexander S. Preker, and Melitta Jakab
Origins of Social Exclusion from Formal Health Care Financing
Role of Communities in Providing Financial Protection against Illness
Recent Evidence of Communities' Role in Combating Social Exclusion
Conclusions
PART 2 INSURANCE, MICROINSURANCE, AND REINSURANCE
3. Introduction to Insurance and Reinsurance Coverage
/. Francois Outreville
What Does Reinsurance Do?
What Are the Traditional Reinsurance Methods?
What Is Nontraditional (Financial) Reinsurance?
What Principles Govern a Reinsurance Program?
What Do Community-Based Health Insurance Funds Need?
How Does a Reinsurance Program Work?
Summary
4. From Microfinance to Micro Health Insurance
Bernd Balkenhol and Craig Churchill
The Evolution of Microfinance
Understanding Microfinance Today
Microfinance Subsidies
Microinsurance as Part of Microfinance
Some Lessons for Microinsurance
Conclusions 1
5. Health Insurance and Reinsurance at the Community Level
David M. Dror
Insurance 1
Reinsurance of Health Insurance for the Informal Sector
6. To Insure or Not to Insure? Reflections on the Limits of Insurability
Michel Vate and David M. Dror
The Problem of Insurability
Multiplying Criteria or Dividing the Concept
Actuarial Limits
Economic Limits
Political Limits
A Practical Delimitation of the Scope of Insurance
Conclusions
Annex 6A Dual Theory of Risk and the Safety Coefficient
7. A Model of Microinsurance and Reinsurance
Stephane Bonnevay, David M. Dror, Gerard Duru, and Michel Lamure
The Problem
The Principles Underlying the Reinsurance Model
Formulation of the Model
Simulation of the Relationship between Microinsurers and Reinsurer
Simulation Results
Conclusions
Annex 7A A Mathematical Model
Annex 7B Calculating the Reinsurance PremiumAnnex 7C Calculating the Mean Benefit Expenditure and Its Variance Annex 7D Calculating the Effects of Reinsurance
8. Local Consensus and Estimates of Medical Risk
Jean P. Auray and Robert Fonteneau
Local Consensus at the Community Level
From Consensus to Methodical Estimates
Estimating the Probability p of an Unknown Event
Estimates Based on Consensual Expert Opinions: NGT or Delphi
Methods Estimates Based on Nonconsensual Expert Opinions: "Maximum
Likelihood" and Bayesian Methods Conclusions Annex 8A
9. Insurance and Market Failure at the Microinsurance Level
Axel Weber
Typical Challenges of Microinsurers
Solutions to Typical Challenges of Microinsurers
Conclusions
Annex 9A Insurance Problem Solving, Selected Countries
PARTS IMPLEMENTATION ISSUES
10. Building Capacity and Strengthening Implementation at the Community Level
Sara Bennett and George Gotsadze
Capacity Concepts
Experience Designing and Implementing Microinsurance
Learning from Experience
Building Capacity for Microinsurance Schemes-The Role of
Reinsurance Conclusions
11. Role of Central Governments in Furthering Social Goals through Microinsurance Units
M. Kent Ranson and Sara Bennett
Conceptual Framework
Potential and Actual Mechanisms for Influencing Microinsurance
Schemes
Summary, Discussion, and Conclusions Annex 11A Five Case Studies
12. Regulatory Environment for Microinsurance and Reinsurance
Frank G. Feeley
Basic Regulations that May Apply
Additional Regulations that May Apply13. Role of Subsidies in Microinsurance: Closing the "Recovery Gap"
Reinhard Busse
Whence the Recovery Gap?
Closing the Recovery Gap: A Model
Closing the Recovery Gap: Europe's Experience
Do More Subsidies Mean More Equity?
Conclusions
14. Linking Ability and Willingness to Contribute to Microinsurance
Logon Brenzel and William Newbrander
The Application of Willingness to Pay to Microinsurance Units
The Affordability of Microinsurance Units
Willingness to Pay and Reinsurance
Conclusions
15. Creating a Favorable Market Environment for Microinsurance at the Community Level
William Newbrander and Logan Brenzel
Link between Market Factors and Development of Microinsurance
Units
Creating a Favorable Environment for Growth in Microinsurance Protection against Financial Insolvency The Need for Reinsurance for Microinsurers Reinsurance Options for Microinsurance Units Possible Formats for Reinsurance for Microinsurance Units Factors Facilitating Reinsurance for Microinsurers
16. Minimum Accounting and Statistical Framework
David M. Dror
Data Needs
Identification of the Benefit Package and Its Cost
Establishing the Income Side
Balance between Income and Expenditure
Other Information Needed to Calculate Variance
General Management Information
Data Template
Conclusions
PART 4 TOWARD A REINSURANCE PILOT IN THE PHILIPPINES
17. Social Health Insurance in the Philippines: A Review of the Context
Jonathan Flavier, M.D., Elmer S. Soriano, M.D., and Anne Nicolay
Health Care Delivery
Health Services Financing and SpendingHealth Insurance
Household Income, Ability to Pay, and Health Expenditures The Community-Based Health Care Organization Market CBHCOs: What Type of Partnership in Health Care Financing and
Delivery?
Selected Survey Results Risks and Opportunities Conclusions
18. Epidemiological Data on Health Risks in the Philippines
Jeannie Haggerty and Tracey Reid
The Contribution of Epidemiology
First Impressions: Demographics
Profiling Health Needs: The Epidemiological Snapshot
Profiling Future Health Needs: Health Risk Factors
Predicting Health Care Demand at the Local Level
Conclusions
19. Attitudes toward Solidarity, Risk, and Insurance in the Rural Philippines
Elmer S. Soriano, M.D., David M. Dror, Erwin Alampay, and Yolanda Bayugo
A Brief Overview of Philippine Social History
Salient Cultural Traits
Perspectives on Organizational Behavior in Microinsurance Units
Evidence from Philippine Rural Microinsurers
Spiral Evolution of Microinsurers
Sectoral Cultures and Risk
Stakeholder Interest and Risk
Conclusions
20. Structuring Demand and Supply in Community Health in Philippine Insurance
Avi Kupferman and Aviva Ron
Environment Conducive to Microinsurance Development
Demand Issues Linked to the Target Population
Demand Issues Linked to Scheme Design
Supply Factors
Conclusions
21. Actuarial Assessment of the ORT Health Plus Scheme in the Philippines
Hiroshi Yamabana
Coverage
Medical Facilities and Personnel
Benefits
FinancingEconomic and Demographic Context
Financial and Actuarial Assessment of the Scheme
Conclusions
22. Assessment of Piloting Social Reinsurance in the Philippines
Frank G. Feeley, Donato J. Gasparro, and Katherine Snowden
Social Re: The Concept, the Questions, the Assumptions
Method of Analysis
Assessing the Market in the Philippines
Structuring the Pilot
Implementation Plan
The Financial Model
Scenarios Tested
Results
Critical Uncertainties and Risks
Annex 22A
APPENDIXES
A. Data Template: A Framework for Accounting and Statistics
David M. Dror and Rakesh Rathi
The Social Re Project
Overview of the Data Template: Options and Navigation
How the Data Template Works
Platform
B. Toolkit Users' Manual
Stephane Bonnevay, Gerard Duru, and Michel Lamure How to Launch a Simulation Displaying the Results An Interactive Window
C. Glossary of Terms
Glossary of Terms, General Glossary of Terms, Data Template Sources
About the Coeditors and Contributors
The Coeditors The Contributors
INDEXBOXES
1.1 Flow of Funds through the Health System
1.2 Different Approaches to Sharing Risks
1.3 What To Buy Using Public Funds, in Which Form, How Much
to Buy, and How to Pay for It? 3.1 The World Reinsurance Market
4.1 Why Don't Commercial Insurers Serve the Low-Income Market?
4.2 Charging the Poor High Interest Rates?
4.3 The Role of Donors in Expanding Microinsurance
4.4 Micro Care: Using a Partner-Agent Model to Deliver Health Insurance
4.5 Cambodia: Should Microfinance Institutions Offer Health Insurance?
4.6 Lessons for Reinsurance from Microfinance Guarantee Schemes
4.7 Integrating Insurance with Other Financial Services
8.1 Getting a Confidence Interval When k = 0
8.2 NGT or Delphi Methods
8.3 Nonconsensual Methods
8.4 Beta Distribution
9.1 How Do Microinsurers Deal with Classical Insurance Problems?
10.1 Georgia: Situational Analyses for Rural Schemes
10.2 Rwanda: Monitoring and Evaluation in a Pilot Microinsurance
Scheme
11.1 Guinea-Bissau: Participant Responsibilities
13.1 Calculating a Microinsurer's Premium or Contribution Rate
16.1 Finding the Most Suitable Composition for the Benefit Package
17.1 The Value of the Philippine Peso
17.2 Need versus Demand for Hospitals
17.3 Doctors per Capita-Income Related?
17.4 Insuring Prevalent Risks
17.5 Group Size Affects Benefit Package
17.6 Information: (Almost) as Important as Money
22.1 Regulatory Considerations
FIGURES
1.1 Spending and Risk-Sharing Arrangements
1.2 Determinants of Outcome: Health and Financial Protection
1.3 Low-Income Countries Have Weak Capacity to Raise Revenues
1.4 Revenue Pooling Equalizes Inequities
1.5 Cost-Risk Concentration Curve
2.1 Schematic Description: Interaction of Needs, Demand, and Supply
2.2 Subsidizing Supply
2.3 Subsidizing Demand
2.4 Enhancing Overlap2.5 Pro-Rich Bias of Public Subsidies
4.1 NHHP/FINCA Uganda Health Financing Product
5.1 Group Size Affects Distribution
5.2 Variance of Claim and Group Size
5.3 Distribution of Unit Costs
5.4 Impact of Error in Estimating Risk
5.5 Reinsurance Compared with Higher Contributions
6.1 Insurability Analysis Grid
6.2 Safety Coefficient p and Number of Insureds
6.3 Safety Loading Rate a and Number of Insureds
6.4 Cost/Benefit of Insurance
6.5 Truncated Elasticity and Other Cases
6.6 Factors Contributing to Insurability
6.7 Dual Theory of Risk
7.1 The Dual Advantage of Reinsurance
7.2 Risk of Insolvency as a Function of Available Resources 7.3A Failure Rate of Microinsurance Units
7.3B Bankruptcy Rate of Microinsurance Units with and without Reinsurance
7.4 Levels of Reinsurance Premium Securing 95 Percent Survival of Reinsurer
7.5 Effect of Group Size on Premium
7.6 Reinsurance Premiums for a Heterogeneous Pool of Microinsurers
7.7 Comparison of the Premium to the Safety Margin
7.8 Discretionary Budget
7.9A Reinsurer's Balance, Pool of Five Microinsurers
7.9B Reinsurer's Balance, Pool of 20 Microinsurers
7.10 Reinsurer's Solvency
7.11 Subsidy Needed to Limit the Premium to Q = 0.5 10.1 Key Steps in Designing and Implementing Microinsurance Schemes 11.1 Government Goals for Microinsurers, Obstacles to Achieving Them, and Corrective Mechanisms
13.1 Tax Subsidies in Dutch Social Health Insurance, 1980-2000
13.2 Role of Taxes and Tax-Financed Subsidies in Financial Flows under Social Health Insurance or in Community-Financed Microinsurance Units
14.1 Factors Affecting Contributions to Microinsurance Units
16.1 Average and Specific Risk Profiles
16.2 Inpatient Admission, 1997-2000
16.3 ORT Membership Information
16.4 Contributions and Expenditure
16.5 Alternative Composition of Benefit Package
17.1A Correlating Physicians and Income (without CAR and NCR)
17.1B Correlating Physicians and Income (Provinces and Manila)
17.2 Health Expenditure, by Use of Funds, 1999
17.3 Health Expenditure, by Source of Funding, 1999
18.1 Philippines: Population Pyramid, 1998
19.1 Stages and Alternatives in Development of Consciousness in
Microinsurance Units
21.1 Income/Expenditure Balance and Reserves
22.1 Funding Needs of Social Re
A.1 Screen 1
A.2 Screen 2
A.3 Screen 3
A.4 Screen 4
A.5 Screen 5
A.6 Screen 6
B.1 Window 1
B.2 Window 2
B.3 Window 3
B.4 Window 4
B.5 Window 5
TABLES
2.1 Conceptual Underpinnings of Community-Financing Schemes
3.1 The Functions of Reinsurance
3.2 Community Health Insurance and the Four Functions of Reinsurance
4.1 Typology of Microfinance Institutions
4.2 Performance Indicators for Microfinance Institutions, by Size and Region
6.1 "External" Risk Analysis
6.2 Public Interventions and Their Effect on Insurable Risks
7.1 Reinsurance Results under Two Scenarios
7.2 Microinsurers' Characteristics in the Simulation
7.3 Distribution of the Benefit Cost
7.4 Premium and Discretionary Budget for Different Microinsurers
8A.1 Table of Critical Values n(a, n)
10.1 Common Design Shortcomings and Their Results
10.2 Rwanda: Use of Management Tools and Systems Employed
10.3 Ghana: Proposed Indicators for Monitoring Mutual Health Organizations
10.4 Objectives and Methods Employed by Three "Typical" Evaluations
10.5 Financial Instability and Capacity Constraints
11.1 Government Mechanisms in Use
13.1 Tax Financing in West European Social Health Insurance
Systems, 1999-2000 17.1 Household Income, 1998
17.2 Family Out-of-Pocket Health Expenditures, 1994
17.3 Benefit Packages
18.1 Philippines: Key Demographic Trends, 1970-99
18.2 Philippines: Deaths from and Cases of AIDS, 1996
18.3 Philippines: Trend of Five Leading Causes of Mortality, 1975-95
18.4 Philippines: Ten Leading Causes of Morbidity, 1999
18.5 Tarlac Health Maintenance Plan, Philippines: 13 Leading Causes of Morbidity, Outpatients and Inpatients, September to December 1999
18.6 Variables Commonly Used for Regression Modeling of Health
Care Demand
19.1 Microinsurers'Spiral Learning Process 22A.1 Cost Factors Used on Financial Model 22A.2 Salary Schedule for Manila Office