accra, ghana october 19-23, 200 9 extending health insurance: how to make it work design element 3:...
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Accra, Ghana October 19-23, 2009
Extending Health Insurance: How to Make It Work
DESIGN ELEMENT 3: POPULATION COVERAGE
October 19-23
Hong Wang, MD, PhDHS20/20 Project
Feasibility of Insurance Design and Implementation
Monitoring and Evaluation
Insurance Financing
options
Benefits package
Population coverage
Opera-tional
process
Organiza-tional
structure
Provider engage-
ment
Figure 1: Design Elements for a Health Insurance Scheme
Objectives of this Element
Identify different types of populations to be covered by health insurance (the beneficiaries)
Determine how to plan for the expansion of health insurance to new beneficiary groups
Understand the factors that need to be considered when expanding health insurance to new beneficiary groups
Universal Coverage
Population coverage
Benefit coverage
Trade-off between population coverage and benefit coverage
Trade-off between Population and Benefit Coverage
Population coverage
Benefit coverage
Adverse Selection
When potential consumers know their own risk levels but insurers are unable to distinguish among risks
High-risk consumers are able to purchase insurance at a premium that is based on a lower-risk group
Death Spiral can happen due to adverse selection
(Rothschild & Stiglitz 1976, Feldstein 1993, Pauly 1999)
Population-service matrix
Level of services
Urban Population Rural Population
Public sector
employees
Private sector
employees
Self-employed/ unemployed
Public sector/
employees
Private sector
employees
Self-employed/ Farmers
Comprehensive Package of Health Services (CPHS)
Expanded-BPHS (EBPHS)
Basic Package of Health Services (BPHS)
Population-service matrix Level of services
Urban Population Rural Population
Public sector
employees
Private sector
employees
Self-employed/ unemployed
Public sector/
employees
Private sector
employees
Self-employed/ Farmers
Comprehensive Package of Health Services (CPHS)
Expanded-BPHS (EBPHS)
Basic Package of Health Services (BPHS)
A Case from China: Types of Health Insurance
- Tax-based health insurance G + I
- Employment-based health insurance Er + Ee
- Subsidized community-based health insurance I + G
- Individual private-based health insurance I + Er
Table 1. Population-service matrix and current financing status in China before 1980
Level of services
Urban Population Rural Population
Public sector
employees
Private sector
employees
Self-employed/
unemployed
Public sector/ employees
Private sector
employees
Self-employed/ Farmers
Comprehensive Package of
Health Services (CPHS)
Expanded-BPHS (EBPHS)
Basic Package of Health Services (BPHS)
Table 2. Population-service matrix and current financing status in China during 1980-1990
Level of services
Urban Population Rural Population
Public sector employees
Private sector
employees
Self-employed/
unemployed
Public sector/
employees
Private sector employees
Self-employed/ Farmers
Comprehensive Package of
Health Services (CPHS)
Expanded-BPHS (EBPHS)
Basic Package of Health Services (BPHS)
Table 1. Population-service matrix and current financing status in China after 2003
Level of services
Urban Population Rural Population
Public sector employees
Private sector
employees
Self-employed/
unemployed
Public sector/
employees
Private sector employees
Self-employed/ Farmers
Comprehensive Package of Health Services (CPHS)
Expanded-BPHS (EBPHS)
Basic Package of Health Services (BPHS)
Feasibility of Insurance Design and Implementation
Monitoring and Evaluation
Insurance Financing
options
Benefits package
Population coverage
Opera-tional process
Organiza-tional
structure
Provider engage-
ment
Figure 1: Design elements for a health insurance scheme
System Equity
Financial contributions based on wealth- vertical equity in financing
Service utilization based on need - horizontal equity in service
Discussion Questions
Is it possible to increase both population and benefit coverage without increasing the total financing resources and how to do it?
How can we mitigate/eliminate adverse selection?
What other options exist to identify groups in the population-service matrix?
Accra, Ghana October 19-23, 2009
Extending Health Insurance: How to Make It Work
Thank you