Social Reinsurance: A New Approach To Sustainable Community Health Financing

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Traditional sources of health care financing are often inadequate leaving many of the 1.3 billion poor people in low- and middle-income countries without access to the most basic health services. Governments in these countries have tried to reach these excluded populations through public clinics and hospitals. To help pay for these services, governments often use a combination of broad-based general revenues, contributions from the formal labor force, and user fees, similar to the financing mechanisms used by Western industrial countries. However, these mechanisms are not always effective in many developing countries, leaving many of the poor without essential health care or financial protection against the cost of illness. 'Social Reinsurance' details community-based approaches to insuring people against medical risk not based on individual risk rating as in private insurance, but rather using decentralized social insurance based on the average risk. This book shows how the concept of social insurance can be implemented in countries that do not have the capacity to finance or organize large-scale systems. It also details the strategies and public policies that countries can use to mitigate the shortcomings of community-financing plans designed along the lines of micro-insurance. Reinsurance is stressed as a tool for enlarging the risk pool and spreading risks across larger population groups, which no single micro-insurance scheme can do on its own. Social Reinsurance also discusses other measures to strengthen micro-insurance-based community-financing programs. This volume provides an important review of health-financing policy for rural and informal-sector workers in low- and middle-income countries.

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26528 Social Reinsurance A New Approach to Sustainable Community Health Financing Editors David M. Dror and Alexander S. Preker THE WORLD BANK Washington, D.C. INTERNATIONAL LABOUR OFFICE Geneva © 2002 The International Bank for Reconstruction and Development / The World Bank and the International Labour Organisation All rights reserved. 1 2 3 4 05 04 03 02 World Bank 1818 H Street, NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org E-mail: [email protected] International Labour Office 4, route des Morillons CH-1211 Geneva 22 Switzerland Fax: (+41 22) 799 6938 Internet: www.ilo.org/publns E-mail: [email protected] The findings, interpretations, and conclusions expressed here are those of the author(s) and do not necessarily reflect the views of the Board of Executive Directors of the World Bank or the governments they represent, or the views of the International Labour Office. The World Bank and the International Labour Office cannot guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply on the part of the World Bank or the International Labour Office any judgment of the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is copyrighted. No part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or inclusion in any information storage and retrieval system, without the prior written permission of the World Bank. The World Bank encourages dissemination of its work and will normally grant permission promptly. For permission to photocopy or reprint, please send a request with complete information to the Copyright Clearance Ce