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Health Care for the World’s Poorest Is voluntary (private) health insurance an option?

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. in stagnant countries the poor in growing countries. AIID.

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Health Care for the World’s Poorest Is voluntary (private) health insurance an option?

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  1. AIID Health Care for the World’s PoorestIs voluntary (private) health insurance an option? Jacques van der Gaag Beijing, October 17, 2007

  2. AIID The Bottom Billion • in stagnant countries • the poor in growing countries

  3. AIID Relationship between Health Expenditures per capita and GDP per capita

  4. AIID Relationship between Health Expenditures per capita and GDP per capita First Law of Health Economics

  5. AIID Protection: Out of Pocket Expenditure Share

  6. AIID 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

  7. Health care for the poor in growing countries Example: Colombia • 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

  8. 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

  9. 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

  10. What is the Willingness-to-Payfor Health Insurance? Contingent Evaluation Studies • Informal sector workers in Wuhan, China • Rural India • Rural Iran • Ethiopia • Namibia

  11. AIID

  12. 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.

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