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<DIV><B>From:</B> <A title=ruglucia@PAHO.ORG
href="mailto:ruglucia@PAHO.ORG">Ruggiero, Mrs. Ana Lucia (WDC)</A> </DIV>
<DIV style="FONT: 10pt arial"><BR> </DIV>
<DIV class=Section1>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#993300
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #993300; FONT-FAMILY: Arial">Private
Health Insurance in Low and Middle-Income
Countries<o:p></o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#993300
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #993300; FONT-FAMILY: Arial">Scope,
Limitations, and Policy Responses<o:p></o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Denis
Drechsleri and Johannes P. Jüttingii<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">OECD
Development Centre, <st1:PersonName w:st="on">Mar</st1:PersonName>ch,
2005<o:p></o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><B><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></B></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Available online as
PDF file [73p.] at: <A
href="http://hc.wharton.upenn.edu/impactconference/drechsler_031005.pdf"><FONT
color=#333399><SPAN
style="COLOR: #333399">http://hc.wharton.upenn.edu/impactconference/drechsler_031005.pdf</SPAN></FONT></A>
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">“……This
paper aims at analyzing characteristics of private health insurance (PHI) in
low- and middle income countries and evaluating its significance for national
health systems. It yields three major results: <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN-LEFT: 1in; TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo2"><![if !supportLists]><FONT
face=Symbol color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Symbol"><SPAN
style="mso-list: Ignore">·<FONT face="Times New Roman" size=1><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></FONT></SPAN></SPAN></FONT><![endif]><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">First,
private health insurance PHI involving pre-payment and risk sharing currently
only plays a marginal role in the developing world. Coverage rates are generally
below 10 % of the population while private risk sharing programs only have wider
significance in a small number of countries (e.g., <st1:country-region
w:st="on">South Africa</st1:country-region>, <st1:country-region
w:st="on">Uruguay</st1:country-region>, and <st1:place
w:st="on"><st1:country-region
w:st="on">Lebanon</st1:country-region></st1:place>).
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN-LEFT: 1in; TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo2"><![if !supportLists]><FONT
face=Symbol color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Symbol"><SPAN
style="mso-list: Ignore">·<FONT face="Times New Roman" size=1><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></FONT></SPAN></SPAN></FONT><![endif]><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Secondly, in many
countries the importance of private health insurance PHI to finance health care
is on a rise. Various factors contribute to this development: growing
dissatisfaction with public health care, liberalization of markets and increased
international trade in the insurance industry, and overall economic growth
allowing higher and more diversified consumer demand. This last aspect in
particular is expected to put pressure on the supply side of the system to
increase choices and improve the quality of health care coverage.
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal
style="MARGIN-LEFT: 1in; TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo2"><![if !supportLists]><FONT
face=Symbol color=#333399 size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Symbol"><SPAN
style="mso-list: Ignore">·<FONT face="Times New Roman" size=1><SPAN
style="FONT: 7pt 'Times New Roman'">
</SPAN></FONT></SPAN></SPAN></FONT><![endif]><FONT face=Arial color=#333399
size=2><SPAN style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Third,
the development of private health insurance PHI presents both opportunities and
threats to the health care system of developing countries. If PHI is carefully
managed and adapted to local needs and preferences, it can be a valuable tool to
complement existing health care financing options. In particular non-profit
group-based insurance schemes could become an important pillar of the health
care financing system, especially for individuals who would otherwise be left
outside of a country’s health insurance system. <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=2><SPAN
style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><BR>However, private
health insurance PHI could also undermine the objective of universal coverage.
Opening up markets for private health insurance without an appropriate
regulatory framework might lead to rising inequalities in the access to health
care: it may lead to cost escalation, a deterioration of public services, a
reduction of the provision of preventive health care and a widening of the
rich-poor divide in a country’s medical system. Given these risks, the crucial
challenge for policy makers is to develop a regulatory framework
….”<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt; FONT-FAMILY: Arial"><o:p> </o:p></SPAN></FONT></P>
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