Governing Mandatory Health Insurance: Learning from Experience
William D. Savedoff, Pablo Enrique Gottret
World Bank Publications, Jan 1, 2008 - Business & Economics - 277 pages
Although mandatory health insurance programs are being proposed or expanded in many developing countries, relatively little attention has been given to how these programs are governed. The available literature focuses almost exclusively on operational features that are important but will necessarily change over time-such as eligibility, benefit packages, and premiums. Governing Mandatory Health Insurance instead looks at the institutional and political forces that affect the behavior of such programs within their social and historical contexts and how five dimensions of governance-coherent decision-making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability-can influence the long-term performance of health insurance programs in terms of coverage, financial protection, efficiency, and sustainability. Governing Mandatory Health Insurance addresses these issues by drawing on the experiences of four countries-Chile, Costa Rica, Estonia, and the Netherlands. It shows how governance works in these countries and extracts lessons for developing countries with mandatory health insurance programs, focusing on the mechanisms for assuring solvency, financial protection, and health care services of good quality.
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accountable afﬁliated agencies assessment audits autonomy beneﬁciaries beneﬁts package budget CCSS Chile Coherent decisionmaking structures competition conﬂicts of interest Consistency and stability context contracts contribution rates copayments corporatist Costa Rica countries coverage decisions deﬁned deﬁnitions difﬁcult directors economic efﬁciency EHIF employers established Estonia executive president expenditures ﬁnancial protection ﬁnancing ﬁrms ﬁrst ﬁve FONASA and ISAPREs framework health care health care providers health care services Health Insurance Fund health insurance system health services income inﬂuence institutions internal legal texts legislation mandatory health insurance MHI entities MHI system Ministry of Health monitoring negotiations Netherlands objectives Ofﬁce oversight payments percent performance political population premiums private health insurance private insurers reforms regulatory reports representatives requirements responsibilities risk role rules Salud sanctions sickness funds signiﬁcant Social Affairs Social Health Insurance solvency speciﬁc Stakeholder participation Supervision and regulation supervisory board tion Transparency and information Yes/No Examples