The Prices in the Crises
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World Bank, Washington, DC
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Governments in many low- and
middle-income countries are developing health insurance
products as a complement to tax-funded, subsidized provision
of health care through publicly operated facilities. This
paper discusses two rationales for this transition. First,
health insurance would boost fiscal revenues for health
care, as post-treatment out-of-pocket payments to providers
would be replaced by pre-treatment insurance premia to
health ministries. Second, increased patient choice and
carefully designed physician reimbursements would increase
quality in the health care sector. This essay shows that, at
best, these objectives have only been partially met. Despite
evidence that health insurance has provided financial
protection, consumers are not willing to pay for
unsubsidized premia. Health outcomes have not improved
despite an increase in utilization. The authors argue that
this is not because there was no room to improve the quality
of care but because behavioral responses among health care
providers have systematically undermined the objectives of
these insurance schemes.
Palabras clave
HEALTH MINISTRIES, HEALTH INSURANCE UTILIZATION, HEALTH INSURANCE, HEALTH CARE QUALITY, MORAL HAZARD, ADVERSE SELECTION, HEALTH CARE PROVIDER BEHAVIOR, MEDICAL INSURANCE PREMIUMS