Download Governing Mandatory Health Insurance: Learning from by William Savedoff, Pablo Gottret PDF

By William Savedoff, Pablo Gottret

Crucial medical health insurance schemes are being proposed or elevated in lots of constructing international locations, yet with really little cognizance to how they need to be ruled. This e-book considers how 5 dimensions of governance-coherent decision-making constructions, stakeholder participation, transparency and knowledge, supervision and rules, and consistency and stability-influence the insurance, monetary safeguard, and potency of crucial medical insurance entities. It additionally appears to be like on the institutional and political forces that have an effect on the habit of such entities inside their social and historic context. It addresses those concerns through interpreting reviews from 4 countries--Chile, Costa Rica, Estonia, and the Netherlands-and develops classes for constructing nations relating to those very important dimensions of governance, paying unique consciousness to questions of assuring solvency, monetary security, and caliber well-being care prone.

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Qxp 18 5/23/08 9:02 AM Page 18 Governing Mandatory Health Insurance intentional policy choice, while in others it is an unintended consequence of the system’s failure. In many richer countries, wealthier individuals are permitted to “opt out” of public MHI programs (for example, Germany, the Netherlands) and obtain private medical insurance. Meanwhile, in lower income countries, only a relatively small proportion of the population actually receives coverage (the Dominican Republic, the Kyrgyz Republic) despite political goals of universality.

For example, one study statistically tested the impact of various governance arrangements on pension fund performance (defined as rates of return on assets and solvency). They find that retiree representation on boards actually reduces returns on assets held by public pension funds in the United States, while there was no measurable difference between those with in-house or external money managers (Mitchell and Hsin 1994). Recent work on pension funds for the World Bank reinforces Williamson’s characterization above, defining governance as “the systems and processes by which a company or government manages its affairs with the objective of maximizing the welfare of and resolving the conflicts of interest among its stakeholders” (Carmichael and Palacios 2003, p.

In such cases, the insurance agency may have autonomy but it is directly and actively supervised by the government and its representatives, who tend to be engaged regularly or be consulted in determining benefits, negotiating budgets, and setting premiums. The relationship with providers can be quite limited, acting effectively as a passive third-party payer, or quite extensive, engaging in detailed negotiations with providers and their representative associations. The third model includes multiple insurers who may or may not be competing with one another for clients.

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