Foreword |
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xiii | |
Acknowledgments |
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xv | |
Abbreviations and Acronyms |
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xix | |
Introduction |
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1 | (1) |
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Definition of Community-Based Health Financing |
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2 | (1) |
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Objective and Scope of this Volume |
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3 | (1) |
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3 | (1) |
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4 | (1) |
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4 | (12) |
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16 | (3) |
PART 1 DEVELOPMENT CHALLENGES IN HEALTH CARE FINANCING |
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19 | (38) |
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Rich-Poor Differences in Health Care Financing |
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21 | (16) |
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Achieving Financial Protection against the Cost of Illness |
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21 | (1) |
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Exclusion of Low-Income Rural Populations and Informal Workers |
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22 | (1) |
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Understanding the Origins of Rich-Poor Differences in Health Care Financing |
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23 | (3) |
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Key Obstacles in Extending Financial Protection through Formal Arrangements |
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26 | (11) |
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The Role of Communities in Combating Social Exclusion |
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37 | (20) |
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Origins of Social Exclusion from Formal Health Care Financing |
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37 | (7) |
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Role of Communities in Providing Financial Protection against Illness |
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44 | (5) |
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Recent Evidence of Communities' Role in Combating Social Exclusion |
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49 | (2) |
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51 | (6) |
PART 2 INSURANCE, MICROINSURANCE, AND REINSURANCE |
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57 | (166) |
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Introduction to Insurance and Reinsurance Coverage |
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59 | (16) |
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What Does Reinsurance Do? |
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59 | (2) |
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What Are the Traditional Reinsurance Methods? |
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61 | (4) |
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What Is Nontraditional (Financial) Reinsurance? |
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65 | (1) |
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What Principles Govern a Reinsurance Program? |
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66 | (3) |
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What Do Community-Based Health Insurance Funds Need? |
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69 | (2) |
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How Does a Reinsurance Program Work? |
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71 | (2) |
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73 | (2) |
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From Microfinance to Micro Health Insurance |
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75 | (28) |
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The Evolution of Microfinance |
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75 | (4) |
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Understanding Microfinance Today |
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79 | (8) |
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87 | (3) |
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Microinsurance as Part of Microfinance |
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90 | (3) |
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Some Lessons for Microinsurance |
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93 | (7) |
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100 | (3) |
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Health Insurance and Reinsurance at the Community Level |
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103 | (22) |
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103 | (5) |
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Reinsurance of Health Insurance for the Informal Sector |
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108 | (17) |
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To Insure or Not to Insure? Reflections on the Limits of Insurability |
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125 | (28) |
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The Problem of Insurability |
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126 | (1) |
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Multiplying Criteria or Dividing the Concept |
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127 | (2) |
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129 | (3) |
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132 | (8) |
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140 | (1) |
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A Practical Delimitation of the Scope of Insurance |
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141 | (5) |
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146 | (2) |
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Annex 6A Dual Theory of Risk and the Safety Coefficient |
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148 | (5) |
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A Model of Microinsurance and Reinsurance |
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153 | (34) |
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153 | (3) |
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The Principles Underlying the Reinsurance Model |
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156 | (1) |
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156 | (3) |
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Simulation of the Relationship between Microinsurers and Reinsurer |
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159 | (1) |
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160 | (13) |
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173 | (1) |
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Annex 7A A Mathematical Model |
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174 | (4) |
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Annex 7B Calculating the Reinsurance Premium |
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178 | (1) |
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Annex 7C Calculating the Mean Benefit Expenditure and Its Variance |
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179 | (4) |
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Annex 7D Calculating the Effects of Reinsurance |
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183 | (4) |
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Local Consensus and Estimates of Medical Risk |
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187 | (16) |
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Local Consensus at the Community Level |
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187 | (1) |
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From Consensus to Methodical Estimates |
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188 | (1) |
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Estimating the Probability p of an Unknown Event |
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189 | (3) |
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Estimates Based on Consensual Expert Opinions: NGT or Delphi Methods |
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192 | (3) |
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Estimates Based on Nonconsensual Expert Opinions: ``Maximum Likelihood'' and Bayesian Methods |
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195 | (2) |
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197 | (2) |
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199 | (4) |
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Insurance and Market Failure at the Microinsurance Level |
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203 | (20) |
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Typical Challenges of Microinsurers |
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203 | (7) |
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Solutions to Typical Challenges of Microinsurers |
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210 | (7) |
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217 | (1) |
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Annex 9A Insurance Problem Solving, Selected Countries |
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218 | (5) |
PART 3 IMPLEMENTATION ISSUES |
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223 | (104) |
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Building Capacity and Strengthening Implementation at the Community Level |
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225 | (20) |
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226 | (1) |
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Experience Designing and Implementing Microinsurance |
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227 | (6) |
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233 | (5) |
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Building Capacity for Microinsurance Schemes---The Role of Reinsurance |
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238 | (2) |
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240 | (5) |
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Role of Central Governments in Furthering Social Goals through Microinsurance Units |
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245 | (22) |
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246 | (4) |
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Potential and Actual Mechanisms for Influencing Microinsurance Schemes |
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250 | (9) |
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Summary, Discussion, and Conclusions |
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259 | (2) |
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Annex 11A Five Case Studies |
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261 | (6) |
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Regulatory Environment for Microinsurance and Reinsurance |
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267 | (10) |
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Basic Regulations that May Apply |
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268 | (4) |
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Additional Regulations that May Apply |
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272 | (5) |
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Role of Subsidies in Microinsurance: Closing the ``Recovery Gap'' |
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277 | (16) |
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277 | (4) |
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Closing the Recovery Gap: A Model |
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281 | (4) |
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Closing the Recovery Gap: Europe's Experience |
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285 | (3) |
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Do More Subsidies Mean More Equity? |
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288 | (1) |
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289 | (4) |
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Linking Ability and Willingness to Contribute to Microinsurance |
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293 | (10) |
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The Application of Willingness to Pay to Microinsurance Units |
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294 | (3) |
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The Affordability of Microinsurance Units |
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297 | (1) |
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Willingness to Pay and Reinsurance |
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298 | (1) |
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299 | (4) |
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Creating a Favorable Market Environment for Microinsurance at the Community Level |
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303 | (10) |
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Link between Market Factors and Development of Microinsurance Units |
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303 | (2) |
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Creating a Favorable Environment for Growth in Microinsurance |
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305 | (2) |
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Protection against Financial Insolvency |
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307 | (1) |
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The Need for Reinsurance for Microinsurers |
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307 | (1) |
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Reinsurance Options for Microinsurance Units |
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307 | (2) |
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Possible Formats for Reinsurance for Microinsurance Units |
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309 | (1) |
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Factors Facilitating Reinsurance for Microinsurers |
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310 | (3) |
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Minimum Accounting and Statistical Framework |
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313 | (14) |
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313 | (1) |
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Identification of the Benefit Package and Its Cost |
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313 | (3) |
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Establishing the Income Side |
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316 | (2) |
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Balance between Income and Expenditure |
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318 | (4) |
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Other Information Needed to Calculate Variance |
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322 | (1) |
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General Management Information |
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322 | (1) |
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323 | (1) |
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324 | (3) |
PART 4 TOWARD A REINSURANCE PILOT IN THE PHILIPPINES |
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327 | (160) |
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Social Health Insurance in the Philippines: A Review of the Context |
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329 | (24) |
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330 | (3) |
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Health Services Financing and Spending |
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333 | (2) |
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335 | (1) |
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Household Income, Ability to Pay, and Health Expenditures |
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336 | (2) |
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The Community-Based Health Care Organization Market |
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338 | (1) |
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CBHCOs: What Type of Partnership in Health Care Financing and Delivery? |
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338 | (2) |
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340 | (6) |
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346 | (2) |
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348 | (5) |
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Epidemiological Data on Health Risks in the Philippines |
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353 | (24) |
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The Contribution of Epidemiology |
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353 | (3) |
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First Impressions: Demographics |
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356 | (2) |
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Profiling Health Needs: The Epidemiological Snapshot |
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358 | (12) |
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Profiling Future Health Needs: Health Risk Factors |
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370 | (1) |
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Predicting Health Care Demand at the Local Level |
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371 | (2) |
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373 | (4) |
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Attitudes toward Solidarity, Risk, and Insurance in the Rural Philippines |
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377 | (18) |
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A Brief Overview of Philippine Social History |
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379 | (1) |
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380 | (1) |
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Perspectives on Organizational Behavior in Microinsurance Units |
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381 | (4) |
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Evidence from Philippine Rural Microinsurers |
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385 | (2) |
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Spiral Evolution of Microinsurers |
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387 | (1) |
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Sectoral Cultures and Risk |
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388 | (1) |
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Stakeholder Interest and Risk |
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388 | (2) |
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390 | (5) |
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Structuring Demand and Supply in Community Health in Philippine Insurance |
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395 | (18) |
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Environment Conducive to Microinsurance Development |
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396 | (5) |
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Demand Issues Linked to the Target Population |
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401 | (3) |
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Demand Issues Linked to Scheme Design |
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404 | (2) |
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406 | (2) |
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408 | (5) |
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Actuarial Assessment of the ORT Health Plus Scheme in the Philippines |
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413 | (10) |
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413 | (1) |
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Medical Facilities and Personnel |
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413 | (1) |
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414 | (1) |
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414 | (1) |
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Economic and Demographic Context |
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415 | (1) |
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Financial and Actuarial Assessment of the Scheme |
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416 | (4) |
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420 | (3) |
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Assessment of Piloting Social Reinsurance in the Philippines |
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423 | (64) |
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Social, Re: The Concept, the Questions, the Assumptions |
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423 | (1) |
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424 | (2) |
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Assessing the Market in the Philippines |
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426 | (1) |
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427 | (2) |
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429 | (2) |
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431 | (4) |
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435 | (2) |
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437 | (2) |
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Critical Uncertainties and Risks |
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439 | (2) |
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441 | (6) |
APPENDIXES |
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A. Data Template: A Framework for Accounting and Statistics |
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447 | (12) |
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447 | (1) |
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Overview of the Data Template: Options and Navigation |
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448 | (8) |
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How the Data Template Works |
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456 | (1) |
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457 | (2) |
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459 | (6) |
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How to Launch a Simulation |
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459 | (2) |
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461 | (1) |
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462 | (3) |
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465 | (22) |
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Glossary of Terms, General |
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465 | (16) |
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Glossary of Terms, Data Template |
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481 | (3) |
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484 | (3) |
About the Coeditors and Contributors |
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487 | (8) |
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487 | (1) |
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487 | (8) |
Index |
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495 | |