By George J. Schieber
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Extra resources for Innovations in Health Care Financing: Proceedings of a World Bank Conference, March 10-11, 1997 (World Bank Discussion Paper)
Sample text
Hammer analyze user charges and review their effects on revenue raising, equity, and efficiency from conceptual, empirical, and country perspectives. Joseph Wang'ombe summarizes Sub-Saharan Africa's experience with user charges. Andrew Creese and Sara Bennett discuss the conceptual underpinnings of and real-world experiences with informal rural risk-sharing arrangements. Sirilaksana Khoman presents an example of one of these arrangements, the health card used in Thailand. How revenues are managed has important implications for the efficiency with which such revenues are used.
Given its emphasis on financing, this paper focuses on economic and administrative issues. But noneconomic considerations, particularly each country's social, political, and cultural environment, are of critical importance. An attempt is made to capture these elements in the policy and technical discussions below, particularly in the discussions on taxation and on the public-private mix of financing, as well as in the summaries of the health care systems in each region. Still, since these discussions are fairly general, they may underemphasize the importance of noneconomic factors in health policymaking.
The benefit packages of most insurance programs are designed to deal with moral hazard. Features that mitigate moral hazard in health insurance include cost sharing (deductibles, copayments, coinsurance), physical (for example, maximum of twenty mental health visits) and financial limits on benefits (for example, $10,000 in coverage for pharmaceuticals), and total expenditure limits on policies (for example, lifetime insurance coverage limited to $500,000). Frequent renewability is also used to deter moral hazard since premiums can be adjusted to account for the actual and projected experience of the group.
