Social Re Insurance A New Approach to Sustainable Community Health Financing
İÇİNDEKİLERContents 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  |
