[afro-nets] Social Health Insurance Reexamined

["Claudio Shuftan" <claudio@hcmc.netnam.vn>]

Social Health Insurance Reexamined
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Adam Wagstaff, Development Research Group, The World Bank, Washington DC, USA

Available online as PDF file [27p] at: 
http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/PDF/wps4111.pdf 

As TXT file at:
http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/INDEX/wps4111.txt 

"..Social health insurance (SHI) is enjoying something of a revival in parts of the developing world at the moment.

Many countries that have in the past relied largely on tax finance (and out-of-pocket payments) have introduced Social health insurance SHI, 

or are thinking about doing so. And countries with SHI already in place are making vigorous efforts to extend coverage to the informal sector. Ironically, this revival is occurring at a time when the traditional SHI countries in Europe have either already reduced payroll financing in favor of general revenues, or are in the process of doing so.

This paper examines how Social health insurance SHI fares in health care delivery, revenue collection, covering the formal sector, and its impacts on the labor market. It argues that SHI does not necessarily deliver good quality care at a low cost, partly because of poor regulation of SHI purchasers. It suggests that the costs of collecting revenues can be substantial, even in the formal sector where nonenrollment and evasion are commonplace, and that while SHI can cover the

formal sector and the poor relatively easily, it fares badly in terms of covering the nonpoor informal sector workers until the economy has reached a high level of economic development. 

The paper also argues that Social health insurance SHI can have  negative labor market effects, including formal sector workers moving into the informal sector, and poor households covered at the taxpayer's expense being caught in a poverty trap..."

Mrs. Ana Lucia Ruggiero (WDC) 
mailto:EQUIDAD@LISTSERV.PAHO.ORG