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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">
<DIV> <A title=EQUIDAD@LISTSERV.PAHO.ORG
href="mailto:EQUIDAD@LISTSERV.PAHO.ORG">EQUIDAD@LISTSERV.PAHO.ORG</A>
</DIV></DIV>
<DIV><FONT face=Arial size=2></FONT><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">Social
Health Insurance Reexamined<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"><BR>Adam
Wagstaff, Development Research Group, The World Bank, <st1:place
w:st="on"><st1:City w:st="on">Washington</st1:City> <st1:State
w:st="on">DC</st1:State>, <st1:country-region
w:st="on">USA</st1:country-region></st1:place><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=1><SPAN
style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial">Available online as
PDF file [27p] at: <o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial"><A
href="http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/PDF/wps4111.pdf"><FONT
color=#333399><SPAN
style="COLOR: #333399">http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/PDF/wps4111.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=1><SPAN
style="FONT-SIZE: 9pt; 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=1><SPAN style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial">As TXT
file at:<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN style="FONT-SIZE: 9pt; COLOR: #333399; FONT-FAMILY: Arial"><A
href="http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/INDEX/wps4111.txt"><FONT
color=#333399><SPAN
style="COLOR: #333399">http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2007/01/09/000016406_20070109161148/Rendered/INDEX/wps4111.txt</SPAN></FONT></A>
<o:p></o:p></SPAN></FONT></P>
<P class=MsoNormal style="MARGIN-LEFT: 0.5in"><FONT face=Arial color=#333399
size=1><SPAN
style="FONT-SIZE: 9pt; 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"><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">“……Social health
insurance (SHI) is enjoying something of a revival in parts of the developing
world at the moment.<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">Many
countries that have in the past relied largely on tax finance (and out-of-pocket
payments) have introduced Social health insurance SHI,
<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">or are
thinking about doing so. And countries with SHI already in place are making
vigorous efforts to extend coverage to the informal sector. Ironically, this
revival is occurring at a time when the traditional SHI countries in <st1:place
w:st="on">Europe</st1:place> have either already reduced payroll financing in
favor of general revenues, or are in the process of doing
so.<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 examines how Social health insurance SHI fares in health care delivery,
revenue collection, covering the formal sector, and its impacts on the labor
market. It argues that SHI does not necessarily deliver good quality care at a
low cost, partly because of poor regulation of SHI purchasers. It suggests that
the costs of collecting revenues can be substantial, even in the formal sector
where nonenrollment and evasion are commonplace, and that while SHI can cover
the<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">formal
sector and the poor relatively easily, it fares badly in terms of covering the
nonpoor informal sector workers until the economy has reached a high level of
economic development. <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">The
paper also argues that Social health insurance SHI can have negative labor
market effects, including formal sector workers moving into the informal sector,
and poor households covered at the taxpayer’s expense being caught in a poverty
trap…..”<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></DIV></BODY></HTML>