accra, ghana october 19-23, 200 9 extending health insurance: how to make it work design element 3:...

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