Beyond Survival

Truman G. Packard, Cristian C. Baeza

Description

'Beyond Survival' breaks new ground in the ongoing debate about health finance and financial protection from the costs of health care. The evidence and discussion support the need to consider financial protection, in addition to health status, as a policy objective when setting priorities for health systems.
This book reviews the Latin American experience with health reform in the last 20 years and the fundamentals of health system financing, using new evidence to show the magnitude and mechanisms that determine the impoverishing effects of health events (diseases, accidents, and those of the life cycle). It provides options for policy makers on how to protect, and help household to protect themselves,against this impoverishment.
The authors use empirical evidence from six case studies commissioned for this report, on Argentina, Chile, Colombia, Ecuador, Honduras, and Mexico. This book provides policy makers with a solid conceptual basis for decisions on the contents of mandatory health insurance benefit packages, choices of financing mechanisms, and the roles of public policy in this field.
'Beyond Survival' provides an in-depth analysis of, and organizational alternatives for, risk pooling and health insurance for financial protection. It analyzes the urgent need to extend risk pooling to the informal sector, the challenges for current social insurance arrangements, and options for policy makers to effectively extend risk pooling to the informal sector.

Sujets

• Health care
• Health system
• Health care reform
• Risk pool
• Health insurance
• Health

Informations

• Publié par: world-bank-publications
• Publié le: 20 juin 2006
• Nombre de lectures: 32
• EAN13: 9780821365724
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Beyond
Survival
PROTECTING HOUSEHOLDS
FROM HEALTH SHOCKS
IN LATIN AMERICA
Cristian C. Baeza
Truman G. Packard
STANFORD UNIVERSITY PRESSBeyond SurvivalBeyond Survival
Protecting
Households from
Health Shocks
in Latin America
Cristian C. Baeza
Truman G. Packard
A COPUBLICATION OF STANFORD ECONOMICS AND FINANCE,
AN IMPRINT OF STANFORD UNIVERSITY PRESS, AND THE WORLD BANK© 2006 The International Bank for Reconstruction and Development / The World Bank
1818 H Street, NW
Washington, DC 20433
Telephone [phone]
Internet www.worldbank.org
E-mail [e-mail]
All rights reserved.
1 2 3 4 5 09 08 07 06
A copublication of Stanford Economics and Finance, an imprint of Stanford University
Press, and the World Bank.
Stanford University Press The World Bank
1450 Page Mill Road 1818 H Street, NW
Palo Alto, Calif. 94304 Washington, DC 20433
The findings, interpretations, and conclusions expressed herein are those of the
author(s) and do not necessarily reflect the views of the Board of Executive Directors
of the World Bank or the governments they represent.
The World Bank does not guarantee the accuracy of the data included in this work.
The boundaries, colors, denominations, and other information shown on any map in
this work do not imply any judgment on the part of the World Bank concerning the
legal status of any territory or the endorsement or acceptance of such boundaries.
Rights and Permissions
The material in this work is copyrighted. Copying and/or transmitting portions or all
of this work without permission may be a violation of applicable law. The World Bank
encourages dissemination of its work and will normally grant permission promptly.
For permission to photocopy or reprint any part of this work, please send a request
with complete information to the Copyright Clearance Center, Inc., 222 Rosewood
Drive, Danvers, MA 01923, USA, telephone [phone], fax [phone],
www.copyright.com.
All other queries on rights and licenses, including subsidiary rights, should be
addressed to the Office of the Publisher, World Bank, 1818 H Street NW,
Washington, DC 20433, USA, fax [phone], e-mail [e-mail].
ISBN 10: 0-8213-6571-1 (World Rights except North America)
ISBN 13: 978-0-8213-6571-7
ISBN 0-8047-5674-0 (Hardcover) (North America)
ISBN 0-8047-5675-9 (Softcover)
eISBN: 0-8213-6572-X
DOI: 10.1596/978-0-8213-6571-7
Library of Congress Cataloging-in-Publication Data has been requested.Latin American
Development Forum Series
This series was created in 2003 to promote, debate, and disseminate
information and analysis and convey the excitement and complexity of the
most topical issues in economic and social development in Latin America
and the Caribbean. It is sponsored by the Inter-American Development
Bank, the United Nations Economic Commission for Latin America and the
Caribbean, and the World Bank. The manuscripts chosen for publication
represent the highest quality in each institution’s research and activity out-
put and have been selected for their relevance to the academic community,
policy makers, researchers, and interested readers.
Advisory Committee Members
Inés Bustillo, Director, Washington Office, Economic Commission for
Latin America and the Caribbean, United Nations
Guillermo Calvo, Chief Economist, Inter-American Development Bank
José Luis Guasch, Regional Adviser, Latin America and the Caribbean
Region, World Bank
Steven Haber, A. A. and Jeanne Welch Milligan Professor, Department of
Political Science, Stanford University; Peter and Helen Bing Senior
Fellow, the Hoover Institution
Eduardo Lora, Principal Adviser, Research Department, Inter-American
Development Bank
José Luis Machinea, Executive Secretary, Economic Commission for Latin
America and the Caribbean, United Nations
Guillermo E. Perry, Chief Economist, Latin America and the Caribbean
Region, World Bank
Luis Servén, Research Manager, Development Economics Vice Presidency,
World BankContents
Foreword xiii
Acknowledgments xvii
About the Authors xix
Abbreviations xxi
EXECUTIVE SUMMARY 1
Health Care Systems in LAC: Functions and Organization 2Shocks, Household Welfare, and the Risk of Poverty 2
Public Policy’s Role in Household Protection against
Health Shocks 5
The Role of Alternative Risk-Pooling Arrangements 6
Risk Pooling for Everyone: The Challenge of a Growing
Informal Economy 9
The Quest for Efficiency and Universal Coverage:
Health Sector Reform in LAC 11
1 HEALTH CARE SYSTEMS IN LATIN AMERICA AND THE
CARIBBEAN: FUNCTIONS AND ORGANIZATION 17
Health System Functions 17
Sources of Financing for an Equity Subsidy 22
Alternative Organizational Arrangements for Risk Pooling 24
Health Systems in Latin America and the Caribbean 26
2 HEALTH SHOCKS, HOUSEHOLD WELFARE, AND THE
RISK OF POVERTY 33
Country and Household Spending on Health 34
Evidence of the Impact of Health on Household Income 38
Policy Mechanisms to Address Household Losses of
Income Due to Health Shocks 42
Cost of Health Care and Its Impact on Consumption 44
viiviii CONTENTS
The Impact of Health Spending Shocks on Household
Welfare in Six Latin American and Caribbean Countries 49
Impoverishing Out-of-Pocket Expenditure on Health 54
3 PUBLIC POLICY’S ROLE IN HOUSEHOLD PERCEPTION,
PREPARATION, AND PROTECTION AGAINST HEALTH SHOCKS 59
Household Strategies for Managing
and Coping with Shocks 60
The Importance of Information on Household
Choices to Cover Health Shocks 63
Information Problems that Plague Provision of
Insurance Instruments 64
The Role of Public Policy in Protecting Households from
the Impoverishing Effects of Health Shocks 67
The Government’s Role in Augmenting Household Risk
Management, Financial Protection, and Health Outcomes 71
Household Coping Strategies 75
Policy Lessons from Earlier Applications of the
Comprehensive Insurance Framework to Other Losses 76
4 THE ROLE OF ALTERNATIVE RISK-POOLING ARRANGEMENTS 81
Society’s Need for Financial Protection 81
The Importance of a Mandatory Benefits Package 83
Risk Pooling in Latin America and the Caribbean 84
What Arrangement Gives the Best
Financial Protection? 84
What Makes the Difference? 88
5 RISK POOLING FOR EVERYONE: THE CHALLENGES POSED
BY A GROWING INFORMAL ECONOMY 95
The Challenge of Extending Risk Pooling 95
Policy Options for Risk 97
What Explains the Low Participation of the Informal
Nonpoor in Contributory Risk-Pooling Schemes? 99
Policy Options for Extending Contributory Risk Pooling
among the Informal and the Self-Employed Nonpoor 107
6 THE QUEST FOR EFFICIENCY AND UNIVERSAL COVERAGE:
HEALTH SECTOR REFORM IN LATIN AMERICA
AND THE CARIBBEAN 127
Achieving Universal Coverage 130
Improving Health Sector Efficiency in Latin America
and the Caribbean 137
Lessons and Challenges 150