Without insurance, good health care for the poor is unaffordable. Mobilizing resources for needed health services, protecting populations against financial risk, and spending wisely on providers are the central topics of the new World Bank publication Scaling Up Affordable Health Insurance: Staying the Course. The book, edited by Alexander Preker, Marianne E. Lindner, Dov Chernichovsky and Onno P. Schellekens, was launched at the World Bank Conference Scaling up Health Insurance and Financial Protection in Health at the International Finance Corporation in Washington D.C.
At the book launch, Alexander Preker, the retiring head of Health Industry and Investment Policy at the World Bank Group, announced that a previous publication –Global Market Place for Private Insurance: Strength in Numbers(by Preker, Schellekens and Peter Zweifel)- was the most downloaded publication on the World Bank website in 2012.
Insurance has been top of mind in recent years as a way to achieve access to affordable health care, for both middle and low-income groups. Now that many African countries are in the early development phase of structuring health insurances, they are facing the same challenges in scaling up health insurance benefits for their people. This volume shows that, when properly designed and coupled with public subsidies, health insurance can contribute to the well-being not just of high-income, but of low-income households as well. It can also contribute to development goals such as improved access to health care, better financial protection against the cost of illness, and reduced social exclusion.
This book provides a unique overview of the global journey in scaling up health insurance from the 19th to the early 21st centuries as well as an in-depth analysis of the historical, political, institutional and economic underpinnings of health insurance from around the world. The volume contains chapters on major policy challenges to create the conditions for scaling up health insurance, case studies from around the world, and research on the challenges in implementation.
The editors explain the laws of health economics. There is a tight relation between Gross Domestic Product per capita and healthcare expenditures (the first law of health economics), which means that an influx of donor money into the public health sector in a low-income country will not raise the total amount of money in the health system. The extra funding crowds out private funds or substitutes existing local public expenditures (third law of health economics). In poor countries, out-of-pocket payments will be high (the second law of health economics), easily pushing people into poverty when they need care. A different approach is needed, the editors argue, to lower the overall risk. This can be achieved by making the unknown risk of transactions known, by leveraging local, existing institutions, social capital, and private sector expertise.
‘During the past century, health insurance has played a major role in financing health care and protecting people from the financial hardships of illness in Western Europe and other developed regions of the world. This book provides a unique and comprehensive review of the political, economic and the institutional challenges that low- and middle-income countries face in scaling up health insurance coverage and benefits for their populations,’ said Kees Storm, chairman of the Health Insurance Fund in an endorsement for the book.
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