Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries

The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represe...

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Main Author:	Bitran, Ricardo
Format:	Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2014
Subjects:	ABSENTEEISM ACCESS TO HEALTH CARE ACCESS TO HEALTH CARE SERVICES ACCESS TO HEALTH SERVICES ACCESS TO SERVICES ADMINISTRATIVE COSTS ADVERSE SELECTION ADVERSE SELECTION PROBLEMS AMBULATORY CARE AVERAGE WAGE CAPITA HEALTH SPENDING CASUAL EMPLOYMENT CATASTROPHIC EXPENDITURES CATASTROPHIC HEALTH SPENDING CHILD HEALTH CHILD HEALTH SERVICES CHOICE OF HEALTH FINANCING SYSTEM CHRONIC CONDITION CITIES COLLECTION OF CONTRIBUTIONS COMMUNITY HEALTH CONTRACTUAL ARRANGEMENTS COSTS OF HEALTH CARE DELIVERY SYSTEM DRUGS ELDERLY PEOPLE EMPLOYEE EMPLOYER CONTRIBUTION EMPLOYMENT EFFECTS EMPLOYMENT STATUS ENROLLEES EXPOSURE FAMILIES FAMILY INCOME FINANCIAL INCENTIVES FINANCIAL PROTECTION FINANCIAL RISK FINANCIAL VIABILITY HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH COVERAGE HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE FUND HEALTH INSURANCE FUNDS HEALTH INSURANCE PLAN HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH NEEDS HEALTH ORGANIZATION HEALTH POLICY HEALTH PROVIDERS HEALTH RESULTS HEALTH SAVINGS ACCOUNTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HOSPITALS HOUSEHOLD ENTERPRISES HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD SURVEY HUMAN DEVELOPMENT ILLNESS IMMIGRANTS IMPACT EVALUATIONS INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INFORMAL ECONOMY INFORMAL EMPLOYMENT INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURANCE ARRANGEMENTS INSURANCE CONTRIBUTIONS INSURANCE PLAN INTEGRATION JOBS LABOR FORCE LABOR MARKET LABOR RELATIONS LABOR SUPPLY LABOUR LAID-OFF WORKERS LAWS LEGAL PROTECTIONS LEGAL REQUIREMENTS LOW INCOME LOW-INCOME COUNTRIES MEDICAL CARE MEDICAL CONDITIONS MEDICAL EXPENDITURES MEDICAL INSURANCE MEDICINES MIGRANTS MONTHLY PREMIUM MORAL HAZARD NATIONAL HEALTH NATIONAL HEALTH INSURANCE NONGOVERNMENTAL ORGANIZATIONS NUTRITION OUTPATIENT CARE OUTPATIENT SERVICES PATIENTS PAYROLL TAX POCKET PAYMENTS PRELIMINARY RESULTS PREVIOUS STUDIES PRIVATE EMPLOYMENT PRIVATE ENTERPRISES PRIVATE HEALTH INSURANCE PRIVATE INSURANCE PRIVATE INSURERS PRIVATE PROVIDERS PRIVATE SECTOR PRIVATE SECTOR WORKERS PROBABILITY PRODUCTION UNITS PUBLIC HEALTH PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SPENDING QUALITY OF CARE RISK SHARING SAFETY NETS SERVANTS SOCIAL DEVELOPMENT SOCIAL HEALTH INSURANCE SOCIAL SECURITY SOCIAL SECURITY BENEFITS TOTAL EMPLOYMENT UNEMPLOYED UNEMPLOYMENT UNEMPLOYMENT INSURANCE UNINTENDED CONSEQUENCE UNIVERSAL HEALTH INSURANCE COVERAGE UNPAID WORKERS URBAN WORKERS WAGE GAP WORKER WORKERS WORKING CONDITIONS YOUNGER WORKERS
Online Access:	http://documents.worldbank.org/curated/en/2014/01/19491214/universal-health-coverage-challenge-informal-employment-lessons-developing-countries http://hdl.handle.net/10986/18637

id	okr-10986-18637
recordtype	oai_dc
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	English en_US
topic	ABSENTEEISM ACCESS TO HEALTH CARE ACCESS TO HEALTH CARE SERVICES ACCESS TO HEALTH SERVICES ACCESS TO SERVICES ADMINISTRATIVE COSTS ADVERSE SELECTION ADVERSE SELECTION PROBLEMS AMBULATORY CARE AVERAGE WAGE CAPITA HEALTH SPENDING CASUAL EMPLOYMENT CATASTROPHIC EXPENDITURES CATASTROPHIC HEALTH SPENDING CHILD HEALTH CHILD HEALTH SERVICES CHOICE OF HEALTH FINANCING SYSTEM CHRONIC CONDITION CITIES COLLECTION OF CONTRIBUTIONS COMMUNITY HEALTH CONTRACTUAL ARRANGEMENTS COSTS OF HEALTH CARE DELIVERY SYSTEM DRUGS ELDERLY PEOPLE EMPLOYEE EMPLOYER CONTRIBUTION EMPLOYMENT EFFECTS EMPLOYMENT STATUS ENROLLEES EXPOSURE FAMILIES FAMILY INCOME FINANCIAL INCENTIVES FINANCIAL PROTECTION FINANCIAL RISK FINANCIAL VIABILITY HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH COVERAGE HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE FUND HEALTH INSURANCE FUNDS HEALTH INSURANCE PLAN HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH NEEDS HEALTH ORGANIZATION HEALTH POLICY HEALTH PROVIDERS HEALTH RESULTS HEALTH SAVINGS ACCOUNTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HOSPITALS HOUSEHOLD ENTERPRISES HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD SURVEY HUMAN DEVELOPMENT ILLNESS IMMIGRANTS IMPACT EVALUATIONS INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INFORMAL ECONOMY INFORMAL EMPLOYMENT INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURANCE ARRANGEMENTS INSURANCE CONTRIBUTIONS INSURANCE PLAN INTEGRATION JOBS LABOR FORCE LABOR MARKET LABOR RELATIONS LABOR SUPPLY LABOUR LAID-OFF WORKERS LAWS LEGAL PROTECTIONS LEGAL REQUIREMENTS LOW INCOME LOW-INCOME COUNTRIES MEDICAL CARE MEDICAL CONDITIONS MEDICAL EXPENDITURES MEDICAL INSURANCE MEDICINES MIGRANTS MONTHLY PREMIUM MORAL HAZARD NATIONAL HEALTH NATIONAL HEALTH INSURANCE NONGOVERNMENTAL ORGANIZATIONS NUTRITION OUTPATIENT CARE OUTPATIENT SERVICES PATIENTS PAYROLL TAX POCKET PAYMENTS PRELIMINARY RESULTS PREVIOUS STUDIES PRIVATE EMPLOYMENT PRIVATE ENTERPRISES PRIVATE HEALTH INSURANCE PRIVATE INSURANCE PRIVATE INSURERS PRIVATE PROVIDERS PRIVATE SECTOR PRIVATE SECTOR WORKERS PROBABILITY PRODUCTION UNITS PUBLIC HEALTH PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SPENDING QUALITY OF CARE RISK SHARING SAFETY NETS SERVANTS SOCIAL DEVELOPMENT SOCIAL HEALTH INSURANCE SOCIAL SECURITY SOCIAL SECURITY BENEFITS TOTAL EMPLOYMENT UNEMPLOYED UNEMPLOYMENT UNEMPLOYMENT INSURANCE UNINTENDED CONSEQUENCE UNIVERSAL HEALTH INSURANCE COVERAGE UNPAID WORKERS URBAN WORKERS WAGE GAP WORKER WORKERS WORKING CONDITIONS YOUNGER WORKERS
spellingShingle	ABSENTEEISM ACCESS TO HEALTH CARE ACCESS TO HEALTH CARE SERVICES ACCESS TO HEALTH SERVICES ACCESS TO SERVICES ADMINISTRATIVE COSTS ADVERSE SELECTION ADVERSE SELECTION PROBLEMS AMBULATORY CARE AVERAGE WAGE CAPITA HEALTH SPENDING CASUAL EMPLOYMENT CATASTROPHIC EXPENDITURES CATASTROPHIC HEALTH SPENDING CHILD HEALTH CHILD HEALTH SERVICES CHOICE OF HEALTH FINANCING SYSTEM CHRONIC CONDITION CITIES COLLECTION OF CONTRIBUTIONS COMMUNITY HEALTH CONTRACTUAL ARRANGEMENTS COSTS OF HEALTH CARE DELIVERY SYSTEM DRUGS ELDERLY PEOPLE EMPLOYEE EMPLOYER CONTRIBUTION EMPLOYMENT EFFECTS EMPLOYMENT STATUS ENROLLEES EXPOSURE FAMILIES FAMILY INCOME FINANCIAL INCENTIVES FINANCIAL PROTECTION FINANCIAL RISK FINANCIAL VIABILITY HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH COVERAGE HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE FUND HEALTH INSURANCE FUNDS HEALTH INSURANCE PLAN HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH NEEDS HEALTH ORGANIZATION HEALTH POLICY HEALTH PROVIDERS HEALTH RESULTS HEALTH SAVINGS ACCOUNTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HOSPITALS HOUSEHOLD ENTERPRISES HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD SURVEY HUMAN DEVELOPMENT ILLNESS IMMIGRANTS IMPACT EVALUATIONS INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INFORMAL ECONOMY INFORMAL EMPLOYMENT INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURANCE ARRANGEMENTS INSURANCE CONTRIBUTIONS INSURANCE PLAN INTEGRATION JOBS LABOR FORCE LABOR MARKET LABOR RELATIONS LABOR SUPPLY LABOUR LAID-OFF WORKERS LAWS LEGAL PROTECTIONS LEGAL REQUIREMENTS LOW INCOME LOW-INCOME COUNTRIES MEDICAL CARE MEDICAL CONDITIONS MEDICAL EXPENDITURES MEDICAL INSURANCE MEDICINES MIGRANTS MONTHLY PREMIUM MORAL HAZARD NATIONAL HEALTH NATIONAL HEALTH INSURANCE NONGOVERNMENTAL ORGANIZATIONS NUTRITION OUTPATIENT CARE OUTPATIENT SERVICES PATIENTS PAYROLL TAX POCKET PAYMENTS PRELIMINARY RESULTS PREVIOUS STUDIES PRIVATE EMPLOYMENT PRIVATE ENTERPRISES PRIVATE HEALTH INSURANCE PRIVATE INSURANCE PRIVATE INSURERS PRIVATE PROVIDERS PRIVATE SECTOR PRIVATE SECTOR WORKERS PROBABILITY PRODUCTION UNITS PUBLIC HEALTH PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SPENDING QUALITY OF CARE RISK SHARING SAFETY NETS SERVANTS SOCIAL DEVELOPMENT SOCIAL HEALTH INSURANCE SOCIAL SECURITY SOCIAL SECURITY BENEFITS TOTAL EMPLOYMENT UNEMPLOYED UNEMPLOYMENT UNEMPLOYMENT INSURANCE UNINTENDED CONSEQUENCE UNIVERSAL HEALTH INSURANCE COVERAGE UNPAID WORKERS URBAN WORKERS WAGE GAP WORKER WORKERS WORKING CONDITIONS YOUNGER WORKERS Bitran, Ricardo Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
relation	Health, Nutrition, and Population (HNP) discussion paper;
description	The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to quality and timely health care. ISWs are generally reluctant to enroll in insurance schemes, including social health insurance (SHI), community insurance, and other arrangements. Further, initiatives to enroll them in self-financed contributory schemes have generally resulted in adverse selection, as those with high anticipated health needs are more willing to pay and enroll than others. Successful initiatives to cover this population group are the ones where government has abandoned its expectations to derive relatively substantial revenue from it. Offering this group a benefits package that is relatively smaller than that of formal workers and charging them a premium that is only a fraction of that charged to formal workers is a strategy used by some countries to limit the need for public subsidies. While there is evidence that greater insurance coverage has improved access to health services for ISWs and their dependents, in several countries it has not yet improved financial protection for this target group. A broad set of reforms will be required to strengthen the supply side to ensure that additional public financing translates into improved coverage for ISWs.
format	Publications & Research :: Working Paper
author	Bitran, Ricardo
author_facet	Bitran, Ricardo
author_sort	Bitran, Ricardo
title	Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
title_short	Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
title_full	Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
title_fullStr	Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
title_full_unstemmed	Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries
title_sort	universal health coverage and the challenge of informal employment : lessons from developing countries
publisher	World Bank, Washington, DC
publishDate	2014
url	http://documents.worldbank.org/curated/en/2014/01/19491214/universal-health-coverage-challenge-informal-employment-lessons-developing-countries http://hdl.handle.net/10986/18637
_version_	1764442322130436096
spelling	okr-10986-186372021-04-23T14:03:48Z Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries Bitran, Ricardo ABSENTEEISM ACCESS TO HEALTH CARE ACCESS TO HEALTH CARE SERVICES ACCESS TO HEALTH SERVICES ACCESS TO SERVICES ADMINISTRATIVE COSTS ADVERSE SELECTION ADVERSE SELECTION PROBLEMS AMBULATORY CARE AVERAGE WAGE CAPITA HEALTH SPENDING CASUAL EMPLOYMENT CATASTROPHIC EXPENDITURES CATASTROPHIC HEALTH SPENDING CHILD HEALTH CHILD HEALTH SERVICES CHOICE OF HEALTH FINANCING SYSTEM CHRONIC CONDITION CITIES COLLECTION OF CONTRIBUTIONS COMMUNITY HEALTH CONTRACTUAL ARRANGEMENTS COSTS OF HEALTH CARE DELIVERY SYSTEM DRUGS ELDERLY PEOPLE EMPLOYEE EMPLOYER CONTRIBUTION EMPLOYMENT EFFECTS EMPLOYMENT STATUS ENROLLEES EXPOSURE FAMILIES FAMILY INCOME FINANCIAL INCENTIVES FINANCIAL PROTECTION FINANCIAL RISK FINANCIAL VIABILITY HEALTH CARE HEALTH CARE DELIVERY HEALTH CARE PROVIDERS HEALTH CARE REFORM HEALTH COVERAGE HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH INSURANCE HEALTH INSURANCE FUND HEALTH INSURANCE FUNDS HEALTH INSURANCE PLAN HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH INSURANCE SCHEMES HEALTH NEEDS HEALTH ORGANIZATION HEALTH POLICY HEALTH PROVIDERS HEALTH RESULTS HEALTH SAVINGS ACCOUNTS HEALTH SECTOR HEALTH SERVICES HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HEALTH-CARE HOSPITALS HOUSEHOLD ENTERPRISES HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD SURVEY HUMAN DEVELOPMENT ILLNESS IMMIGRANTS IMPACT EVALUATIONS INCOME INCOME COUNTRIES INCOME GROUPS INCOME HOUSEHOLDS INFORMAL ECONOMY INFORMAL EMPLOYMENT INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURANCE ARRANGEMENTS INSURANCE CONTRIBUTIONS INSURANCE PLAN INTEGRATION JOBS LABOR FORCE LABOR MARKET LABOR RELATIONS LABOR SUPPLY LABOUR LAID-OFF WORKERS LAWS LEGAL PROTECTIONS LEGAL REQUIREMENTS LOW INCOME LOW-INCOME COUNTRIES MEDICAL CARE MEDICAL CONDITIONS MEDICAL EXPENDITURES MEDICAL INSURANCE MEDICINES MIGRANTS MONTHLY PREMIUM MORAL HAZARD NATIONAL HEALTH NATIONAL HEALTH INSURANCE NONGOVERNMENTAL ORGANIZATIONS NUTRITION OUTPATIENT CARE OUTPATIENT SERVICES PATIENTS PAYROLL TAX POCKET PAYMENTS PRELIMINARY RESULTS PREVIOUS STUDIES PRIVATE EMPLOYMENT PRIVATE ENTERPRISES PRIVATE HEALTH INSURANCE PRIVATE INSURANCE PRIVATE INSURERS PRIVATE PROVIDERS PRIVATE SECTOR PRIVATE SECTOR WORKERS PROBABILITY PRODUCTION UNITS PUBLIC HEALTH PUBLIC PROVIDERS PUBLIC SECTOR PUBLIC SPENDING QUALITY OF CARE RISK SHARING SAFETY NETS SERVANTS SOCIAL DEVELOPMENT SOCIAL HEALTH INSURANCE SOCIAL SECURITY SOCIAL SECURITY BENEFITS TOTAL EMPLOYMENT UNEMPLOYED UNEMPLOYMENT UNEMPLOYMENT INSURANCE UNINTENDED CONSEQUENCE UNIVERSAL HEALTH INSURANCE COVERAGE UNPAID WORKERS URBAN WORKERS WAGE GAP WORKER WORKERS WORKING CONDITIONS YOUNGER WORKERS The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to quality and timely health care. ISWs are generally reluctant to enroll in insurance schemes, including social health insurance (SHI), community insurance, and other arrangements. Further, initiatives to enroll them in self-financed contributory schemes have generally resulted in adverse selection, as those with high anticipated health needs are more willing to pay and enroll than others. Successful initiatives to cover this population group are the ones where government has abandoned its expectations to derive relatively substantial revenue from it. Offering this group a benefits package that is relatively smaller than that of formal workers and charging them a premium that is only a fraction of that charged to formal workers is a strategy used by some countries to limit the need for public subsidies. While there is evidence that greater insurance coverage has improved access to health services for ISWs and their dependents, in several countries it has not yet improved financial protection for this target group. A broad set of reforms will be required to strengthen the supply side to ensure that additional public financing translates into improved coverage for ISWs. 2014-06-12T18:26:24Z 2014-06-12T18:26:24Z 2014-01 http://documents.worldbank.org/curated/en/2014/01/19491214/universal-health-coverage-challenge-informal-employment-lessons-developing-countries http://hdl.handle.net/10986/18637 English en_US Health, Nutrition, and Population (HNP) discussion paper; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank, Washington, DC Publications & Research :: Working Paper Publications & Research

Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries

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