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Health insurance can offer protection against catastrophic medical expenses and improve access to health care. There are, however, imperfections in the insurance market that require intervention such as asymmetry of information between the policy holder and the insurance company, moral hazard that can occur on the side of the insured or the provider of health services, risk selection that may lead to cream skim a particular market, and others. To encourage the effective development of Voluntary Private Health Insurance, it will be necessary for policymakers to establish and enforce regulatory standards that will attempt to correct inefficiencies from market failures and that will achieve desired social objectives. This book is intended to help countries that are contemplating how to design and implement a legal framework for a private health insurance market. First, it provides an overview of private health insurance, the rationale for insurance regulation, and the institutions involved in administering insurance laws. It then reviews the key standards and protections that are often used in regulating private health insurance. As part of the discussion on regulatory standards, options for supervisors in certain areas where policy and regulation approaches vary will be noted. To illustrate international experience, examples of the regulation of private health insurance from several low, middle, and high-income countries will be drawn upon throughout the book.
For humanitarian reasons and the concern for households' economic and health security, the health sector is at the center of global development policy. Developing countries and the international community are scaling up health systems to meet the Millennium Development Goals (MDGs) and are improving financial protection by securing long-term support for these gains. Yet money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills; well structured, results-based financing reforms are needed. Unfortunately, global evidence of "successful" health financing policies that can guide the reform effort is very limited and therefore the policy debate is often driven by ideological, one-size-fits-all solutions. Good Practices in Health Financing: Lessons from Reforms in Low- and Middle-Income Countries attempts to begin to fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The participating countries are: Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. The study seeks to identify common enabling factors of their good performance. While the findings for each country are important, collectively they send a clear message to the global community that more attention is needed to define "good practice" and then to evaluate and disseminate the global evidence base.
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