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Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation

Author

Listed:
  • Greg Brunner
  • Pablo Gottret
  • Birgit Hansl
  • Vijayasekar Kalavakonda
  • Somil Nagpal
  • Nicole Tapay

Abstract

Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance.

Suggested Citation

  • Greg Brunner & Pablo Gottret & Birgit Hansl & Vijayasekar Kalavakonda & Somil Nagpal & Nicole Tapay, 2012. "Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation," World Bank Publications - Books, The World Bank Group, number 13093.
  • Handle: RePEc:wbk:wbpubs:13093
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    References listed on IDEAS

    as
    1. William D. Savedoff & Pablo Gottret, 2008. "Governing Mandatory Health Insurance : Learning from Experience," World Bank Publications - Books, The World Bank Group, number 6526.
    2. Craig Thorburn, 2004. "On the measurement of solvency of insurance companies : recent developments that will alter methodsadopted in emerging markets," Policy Research Working Paper Series 3199, The World Bank.
    3. Sapelli, Claudio & Vial, Bernardita, 2003. "Self-selection and moral hazard in Chilean health insurance," Journal of Health Economics, Elsevier, vol. 22(3), pages 459-476, May.
    4. Benjamin Lorent, 2008. "Risks and regulation of insurance companies: is Solvency II the right answer?," Working Papers CEB 08-007, ULB -- Universite Libre de Bruxelles.
    5. Taylor, Michael & Fleming, Alex, 1999. "Integrated financial supervision : lessons of Northern European experience," Policy Research Working Paper Series 2223, The World Bank.
    6. Tabor, Steven R., 2005. "Community-based health insurance and social protection policy," Social Protection Discussion Papers and Notes 32545, The World Bank.
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    Cited by:

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    2. Veronica Vargas & Sayem Ahmed & Alayne M Adams, 2018. "Factors enabling comprehensive maternal health services in the benefits package of emerging financing schemes: A cross-sectional analysis from 1990 to 2014," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-15, September.

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