1 / 15

DESIGN ELEMENT 2. Choice of Insurance Financing Mechanism

DESIGN ELEMENT 2. Choice of Insurance Financing Mechanism. Presented by: Chris Atim. October 19, 2009. Objectives. Understand the different mechanisms for financing health insurance and factors to help decide which model is most appropriate for you

keiki
Download Presentation

DESIGN ELEMENT 2. Choice of Insurance Financing Mechanism

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. DESIGN ELEMENT 2. Choice of Insurance Financing Mechanism Presented by: Chris Atim October 19, 2009

  2. Objectives • Understand the different mechanisms for financing health insurance and factors to help decide which model is most appropriate for you • Examine the strengths and challenges of each financing mechanism, particularly as they relate to the participant’s country

  3. Outline • Health Insurance Models: advantages and disadvantages • Deciding which model is right for you: • Environmental considerations • Insurance goals • Equity

  4. Health insurance - definition • Health insurance systems pool the losses associated with health risks so that in return for a premium (or tax) beneficiaries are protected from those losses if the insured risk occurs • Risks of loss are spread and shared among many individuals • Facilitates lower premiums, more diversified risks and viability • Works best when (classically) • Pool of individuals is large (Hsiao: more than 5000) • Individual risks are independent (so not for epidemics!) • But compare apparent paradox of Thies’ mutuelle experience

  5. Major types of HI • Universal, mandatory, social • Public or national health service model (Beveridge) • Typified by UK • Classical social health insurance (Bismarckian) • Typified by Germany • Voluntary health insurance • Private voluntary (commercial schemes) • Eg USA, South Africa • Community based (CBHI, mutuelles/MHOs) • Eg Senegal, Mali • Emerging national health insurance scheme (NHIS) in Africa • Ghana, Rwanda, Tanzania

  6. Basic features of the HI types

  7. Reality more complex than schematics • Consider these interesting variations: • Switzerland • All individuals required by law to carry health insurance • But HI is provided by private commercial insurance who must accept anyone regardless of risk • Govt pays subsidies to enable poor to buy HI; no public insurance • France • Based on social security with defined contributions according to income; 6 special regimes • But 98% of French belong to mutuelles due to high co-pays and to avoid paying OOP up front • Thailand

  8. Thailand: Development of Universal Coverage in Stages Source: Thaworn Sakunphanit, “Universal Health Care Coverage Through Pluralistic Approaches: Experience from Thailand”, http://www.nhso.go.th/eng/content/uploads/files/research_pub_04.pdf; accessed Oct 17, 2009

  9. Key features of HI types (2) • Public or national health service • Govt or public service managed with general taxation as revenue base • Coverage based on residence or national territory not work • Hence 100% coverage normal in this system • SHI • Legally mandated coverage for some pop. groups • Direct link between contributions and benefits • Autonomously run by health funds, parastatals, or social security

  10. Key features (3) • Private voluntary insurance • Privately owned, run for profit or non-profit • Premiums individually or risk-rated • Individual or group membership • CBHI or mutuelles /MHOs • Not for profit, focus on informal sector • Community or member owned and controlled • Ethic of community solidarity and mutual aid

  11. Key features (4) • NHIS • Targets previously excluded groups (informal /rural sectors) as well as formal sector • Govt subsidies from tax revenues to enable key groups and vulnerable persons to join • Payroll contributions by formal sector (Ghana, Rwanda, Tanzania) • Decentralized management, run semi-autonomously by public agency • Most countries have a mix of mechanisms, esp before but often also with universal coverage

  12. Advantages and challenges Table exercise: Take 10 mins to list the potential advantages and challenges of the different types of scheme. Each table will be assigned a different scheme type.

  13. Advantages and challenges

  14. Advantages and challenges (2)

  15. Thank you

More Related