Health Insurance Reform in Four Latin American Countries : Theory and Practice
The author examines public economics rationales for public intervention in health insurance markets, draws on the literature of organizational design to examine alternative intervention strategies, and considers health insurance reforms in four Lat...
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| Format: | Policy Research Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2014
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| Online Access: | http://documents.worldbank.org/curated/en/2000/11/729384/health-insurance-reform-four-latin-american-countries-theory-practice http://hdl.handle.net/10986/19776 |
| Summary: | The author examines public economics
rationales for public intervention in health insurance
markets, draws on the literature of organizational design to
examine alternative intervention strategies, and considers
health insurance reforms in four Latin American countries --
Argentina, Brazil, Chile, and Colombia -- in light of the
theoretical literature. Equity has been the main reason for
large-scale public intervention in the health insurance
sector, despite the well-known failures of insurance and
health care markets associated with imperfect information.
Recent reforms have sought less to make private markets more
efficient than to make public provision more efficient,
sometimes by altering the focus and function of existing
institutions (such as the obras sociales in Argentina) or by
encouraging the growth of new ones (such as Chile's
ISAPREs). Generally, these four Latin American countries
have reformed the ways insurance and care are organized and
delivered, have tried to extend formal coverage to
previously marginalized groups, and have tried to finance
this extension fairly. Colombia instituted an implicit
two-tiered voucher scheme financed through a proportional
wage tax. Chile's financing mechanism is similar but
the distribution of benefits is less progressive, so the net
effect is less redistributive. Argentina's remodeled
obras system went halfway: the financing base is similar and
there is some implicit redistribution from richer to poorer
obras, but the quality of insurance increases with income.
On the face of it, Brazil's health insurance system is
less redistributive than those of the other three countries,
as no tax is earmarked for financing health insurance. But
taxes paid by higher-income taxpayers are not reduced when
they choose private insurance, highlighting the problem of
examining the health sector independent of the general tax
and transfer system. |
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