Transcript Stable and Predictable Development Assistance for Health

AIID
Health Care for the World’s Poorest
Is voluntary (private) health insurance an option?
Jacques van der Gaag
Beijing, October 17, 2007
AIID
The Bottom Billion
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in stagnant countries
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the poor in growing countries
AIID
Relationship between Health Expenditures per capita and GDP per capita
Log Health Expenditures/capita
9
8
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2
1
4
5
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Log GDP/capita
10
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Relationship between Health Expenditures per capita and GDP per capita
First Law of Health Economics
Dependent Variable: Log Total Health Expenditures/capita
Constant
-3.51***
Log GDP/capita
1.08***
R-squared
0.95
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Out of Pocket share of Health Expenditures
Protection: Out of Pocket Expenditure Share
1.0
0.8
0.6
0.4
0.2
0.0
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Log GDP/capita
10
11
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Basic conclusions:
-in low income countries, overall resources for health care will be
scarce
-conventional efforts (ODA; debt relieve) to change this will not
succeed
The challenges:
-how to increase overall resources without crowding-out private
resources
-how to use private resources more efficiently
Health care for the poor in growing countries
Example: Colombia
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Comprehensive health insurance scheme
Two regimes:1. contributory
2. subsidized
(thus: ex ante inequality)
Include public and private insurers
Contract with public and private providers
Results to day: - better health care for all
- better health for all
- ex post: more equality
Health Care for the Poor in Stagnant Countries
Background
- low GPD/cap
scarce resources for health
- share of out-of-pocket expenditures is high
How to leverage those out-of-pocket expenditures
Pre-paid Low-cost Voluntary Health Insurance
Demand side
-keep private resources in system
-tailor product to need/means
-increase coverage by directly subsidizing premiums
-focus on group insurance
-empower consumers/patients
Supply side
- performance contracts with public and private providers
- build-in provider incentives
PHARMACCESS (A Dutch NGO)
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workplace projects with focus on AIDS
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expand programs to include general health care
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expand coverage by providing health insurance to other groups
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Health Insurance Fund
What is the Willingness-to-Pay
for
Health Insurance?
Contingent Evaluation Studies
•Informal sector workers in Wuhan, China
•Rural India
•Rural Iran
•Ethiopia
•Namibia
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CONCLUSION
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Poor people do not need to go without access to health care.
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Access can be increased if and when
- available private resources (out-of-pocket payments) stay in the system;
- voluntary (private, preferably group) health insurance is being developed that
realistically takes the needs and resources of the poor into account;
- this insurance is suitably subsidized;
- public and private insurance entities are involved;
- performance contracts are written with both public and private providers;
- governments and donors stop insisting on one “public sector model” that is
assumed to fit all.