Private Voluntary Health Insurance: Consumer Protection and Prudential Regulation (World Bank Publications)

Health insurance can offer protection against catastrophic medical expenses and improve access to health care. There are, however, imperfections in the insurance market that require intervention such as asymmetry of information between the policy holder and the insurance company, moral hazard that can occur on the side of the insured or the provider of health services, risk selection that may lead to cream skim a particular market, and others. To encourage the effective development of Voluntary Private Health Insurance, it will be necessary for policymakers to establish and enforce regulatory standards that will attempt to correct inefficiencies from market failures and that will achieve desired social objectives. This book is intended to help countries that are contemplating how to design and implement a legal framework for a private health insurance market. First, it provides an overview of private health insurance, the rationale for insurance regulation, and the institutions involved in administering insurance laws. It then reviews the key standards and protections that are often used in regulating private health insurance. As part of the discussion on regulatory standards, options for supervisors in certain areas where policy and regulation approaches vary will be noted. To illustrate international experience, examples of the regulation of private health insurance from several low, middle, and high-income countries will be drawn upon throughout the book.