Governing Mandatory Health Insurance: Learning from Experience
William D. Savedoff, Pablo Enrique Gottret
World Bank, 2008 - Business & Economics - 227 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 administrative affiliation agencies associations audits autonomy beneficiaries benefits package budget CCSS Chile Coherent decisionmaking structures Consistency and stability consumer context contracts copayments corporatist Costa Rica costs coverage decisions defined economic efficiency EHIF EHIF's employers established Estonia Estonian Health Insurance executive president expenditures financial protection FONASA framework governance dimensions governance mechanisms health care providers health care services Health Insurance Fund health insurance system health services incentives income institutions ISAPREs labor legislation Maarse mandatory health insurance ment MHI entities MHI governance MHI systems Ministry of Health negotiations Netherlands OECD organizations oversight payments percent performance political population premiums private health insurance private insurers public sector reforms regulatory relationship reports representatives requirements responsibilities risk role Salud scheme sickness funds Social Health Insurance Social Security solvency Stakeholder participation Supervision and regulation supervisory board tion Transparency and information Transparency International World Bank