Health Care for the Worlds Poorest Is voluntary private health insurance an option

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Health Care for the Worlds PoorestIs voluntary
(private) health insurance an option?
Jacques van der Gaag
Beijing, October 17, 2007
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The Bottom Billion

• in stagnant countries
• the poor in growing countries

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Relationship between Health Expenditures per
capita and GDP per capita
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Relationship between Health Expenditures per
capita and GDP per capita
First Law of Health Economics
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Protection Out of Pocket Expenditure Share
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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

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Health care for the poor in growing countries

• Example Colombia
• Comprehensive health insurance scheme
• Two regimes1. 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

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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
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PHARMACCESS (A Dutch NGO)

• workplace projects with focus on AIDS
• expand programs to include general health care
• expand coverage by providing health insurance to
  other groups
• Health Insurance Fund

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What is the Willingness-to-Payfor Health
Insurance?
Contingent Evaluation Studies

• Informal sector workers in Wuhan, China
• Rural India
• Rural Iran
• Ethiopia
• Namibia

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CONCLUSION

• Poor people do not need to go without access to
  health care.
• 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.