PHM-Exch> Thinking of introducing social health insurance? Ten questions

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


 *Thinking of introducing social health insurance? Ten questions* *Ole
Doetinchem, Guy Carrin, David Evans
*Technical brief for policy-makers, Number 4/2009
World Health Organization
*Languages*: EN, FR, ES
*WHO reference number*: WHO/HSS/HSF/PB/09.04



PB 4/09 Thinking of introducing social health insurance? Ten questions [pdf
484kb]<http://www.who.int/entity/health_financing/documents/pb_e_09_04-10qshi.pdf>

PB 4/09 Vous envisagez de mettre en place une assurance maladie sociale ?
Dix questions à vous poser [pdf
588kb]<http://www.who.int/entity/health_financing/documents/pb_f_09_04-10qshi.pdf>

PB 4/09 ¿Piensa implantar un seguro social de salud? Diez preguntas [pdf
1.29Mb]<http://www.who.int/entity/health_financing/documents/pb_s_09_04-10qshi.pdf>

*1. What do you mean by social health insurance?*

“…….Social health insurance (SHI) is one of the possible organizational
mechanisms for raising and pooling funds to finance health services, along
with tax-financing, private health insurance, community insurance, and
others1. Typically in the more mature European SHI systems, working people
and their employers, as well as the self-employed, pay contributions that
cover a package of services available to the insurees and their dependents.
In most cases they are obliged to make these contributions by law. Many
governments also pay subsidies into these systems in order to ensure or
improve their financial sustainability.



Within this context, there has been considerable variation in how Social
health insurance SHI systems have developed across countries. Contributions
are sometimes held in a single fund, or there might be several funds that
compete for membership.



These funds may be run by government or by nongovernmental or parastatal
organizations. Contributions have generally, but not always, ensured that
the rich contribute more than the poor but contributions do not typically
vary with health status. The sick do not pay more than the healthy, to allow
the financial risks of paying for care to be shared across the healthy and
the sick, or across the life cycle for individuals. A multitude of ways of
paying providers can be observed, from unrestricted fee for service, to
selective contracting at negotiated rates……”

2.   How will SHI contribute to your health system objectives?
3.   Will SHI raise additional funding for health?
4.   Are all stakeholders in support of SHI?
5.   Is there a legal framework for SHI to operate within?
6.   Are revenue collection procedures technically feasible?
7.   Are the physical and intellectual resources available to setup a SHI
organization?
8.   What benefits will SHI members be entitled to?
9.   How should the SHI purchase or provide health services?
10. Can SHI operate at a financial equilibrium?....”


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