Scaling Up Affordable Health Insurance : Staying the Course

'Scaling Up Affordable Health Insurance: Staying the Course' is the fifth volume in a series of in-depth reviews on the role of health care financing in improving access for low-income populations to needed care, protecting them from the impoverishing effects of illness, and addressing the important issues of social exclusion in government financed programs. Success in improving access and financial protection through community and private voluntary health insurance have led many countries to attempt to make membership compulsory and to offer subsidized insurance through the public sector. The protagonists are divided into several camps; from supporters of health insurance to opponents or skeptics. Today many low- and middle-income countries are no longer listening to this dichotomized debate between vertical and horizontal approaches to health care. Instead, they are experimenting with new and innovative approaches to health care financing. Health insurance is becoming a new paradigm for reaching the Millennium Development Goals. The research for this volume shows that when properly designed and coupled with public subsidies, health insurance can contribute to the well-being of poor and middle-class households, not just the rich. And it can contribute to development goals such as improved access to health care, better financial protection against the cost of illness, and reduced social exclusion. The book is organized into three main parts. Major policy directions in financing health care are discussed in Part 1, with a particular focus on the pre-conditions for scaling up. Part 2 moves from theory to practice with overviews and country level studies on health insurance development. Finally, part 3 highlights the implementation challenges.

The IFC and the World Bank are committed to helping low- and middle-income countries scale up financing mechanisms like health insurance that help make health services more sustainable and protect the population against the impoverishing effects of illness. The authors and contributors to this book provide a unique review of the global experience in scaling up health insurance during the 20th and early 21st centuries. The book provides an in-depth analysis of the historical, political, institutional, and economic underpinnings of health insurance from around the world. --- Guy Ellena, Director, Manufacturing, Agribusiness, and Services International Finance Corporation

What are the reasons for the existence and growth of social health insurance? And, are there limits to social health insurance? Social health insurance often has a noble beginning, being presented to the population as a technical solution for overcoming market failures in private insurance markets and addressing equity considerations. Too often during the design and implementation phases, however, politicians seeking election or reelection introduce elements that undermine both the efficiency and equity objectives that might otherwise have been achieved through broad coverage under social health insurance. --- Peter Zweifel, Professor Emeritus of Economics, University of Zurich

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 institutional challenges that low- and middle-income countries face in similarly scaling up health insurance coverage and benefits for their populations. --- Kees J. Storm, Chairman, Health Insurance Fund, Anheuser-Busch InBev S.A. and KLM N.V., Vice Chairman, Unilever and Pon Holdings B.V., Supervisory Board, AEGON N.V. Board of Directors, Baxter International Inc.