Wang, HongSwitlick, KimberlyOrtiz, ChristineZurita, BeatrizConnor, Catherine2012-03-192012-04-042012-03-192012-04-042012-01-18978-0-8213-8982-910.1596 / 978-0-8213-8952-9https://hdl.handle.net/10986/2227https://hdl.handle.net/10986/5913Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well as to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. The purpose of this handbook is to provide policy makers and health insurance designers with practical, action-oriented support that will deepen their understanding of health insurance concepts, help them identify design and implementation challenges, and define realistic steps for the development and scaling up of equitable, efficient, and sustainable health insurance schemes. The handbook takes policy makers and health insurance designers through a step-by-step series of considerations and tasks that need to be achieved. The handbook's philosophy is to not be dogmatic, ideological, or prescriptive. This handbook was prepared to be used in a six-day regional workshop. Clearly, health insurance design is an intensive political and technical process that takes much longer than six days. The expectation for the workshop is that by the end of the week, each team has a clear idea of next steps that they could take back home to engage other stakeholders and move toward scaling up and improving the performance of health insurance in their country.CC BY 3.0 IGOABILITY TO PAYACCESS TO HEALTH CAREACCESS TO HEALTH SERVICESACCESS TO SERVICESACTUARIESADMINISTRATIVE COSTSADMINISTRATIVE EFFICIENCYADVERSE SELECTIONBASIC HEALTH SERVICESBURDEN OF DISEASECAR ACCIDENTCHILD HEALTHCLINICSCOMMUNITY HEALTHCOMPREHENSIVE HEALTH INSURANCECONDOMSCONSUMERSCONTRIBUTION RATECOST CONTROLCOST OF SERVICESCOST SHARINGDECISION MAKINGDEMAND FOR HEALTHDEMAND FOR HEALTH CAREDEMAND FOR SERVICESDETERMINANTS OF HEALTHDIAGNOSISDISADVANTAGED POPULATIONSDOCTORSDRUGSEMERGENCY CAREEPIDEMICSEXERCISESFAMILIESFAMILY INCOMEFAMILY PLANNINGFEE FOR SERVICEFINANCIAL BARRIERSFINANCIAL CATASTROPHEFINANCIAL MANAGEMENTFINANCIAL PROTECTIONFINANCIAL RESOURCESFINANCIAL RISKFINANCIAL RISK PROTECTIONFINANCING HEALTH CAREFRAUDFREE CAREGOVERNMENT POLICIESHEALTH CAREHEALTH CARE COVERAGEHEALTH CARE DELIVERYHEALTH CARE EXPENDITUREHEALTH CARE FACILITIESHEALTH CARE PROVIDERSHEALTH CARE REFORMHEALTH CARE SERVICESHEALTH CARE UTILIZATIONHEALTH CENTERSHEALTH CONDITIONSHEALTH COSTSHEALTH EDUCATIONHEALTH EXPENDITUREHEALTH EXPENDITURESHEALTH FACILITIESHEALTH FINANCINGHEALTH FINANCING SYSTEMHEALTH INDUSTRYHEALTH INSURANCEHEALTH INSURANCE COVERAGEHEALTH INSURANCE FUNDHEALTH INSURANCE PLANHEALTH INSURANCE PROGRAMHEALTH INSURANCE SCHEMEHEALTH INSURANCE SCHEMESHEALTH INSURANCE SYSTEMHEALTH INTERVENTIONSHEALTH ORGANIZATIONHEALTH OUTCOMESHEALTH POLICYHEALTH POLICY OBJECTIVESHEALTH PROFESSIONALSHEALTH PROMOTIONHEALTH PROVIDERSHEALTH REFORMHEALTH SECTORHEALTH SERVICEHEALTH SERVICESHEALTH SPENDINGHEALTH STATUSHEALTH SYSTEMHEALTH SYSTEMSHEALTH WORKERSHEALTH · FUNDINGHIGH FERTILITYHIV/AIDSHOSPITAL BEDSHOSPITAL CAPACITYHOSPITAL CAREHOSPITAL SECTORHOSPITALIZATIONHOSPITALSHOUSEHOLD INCOMEHUMAN RESOURCESILLNESSIMMUNIZATIONIMPROVEMENTS IN HEALTHINCENTIVES FOR PROVIDERSINCOMEINCOME COUNTRIESINCOME GROUPSINCOME POPULATIONINDEXESINEFFICIENT DELIVERYINFECTIOUS DISEASESINFLATIONINFORMAL PAYMENTSINFORMAL SECTORINFORMAL SECTOR WORKERSINFORMATION SYSTEMINFORMATION SYSTEMSINPATIENT CAREINSURANCE AGENCIESINSURANCE CLAIMSINSURANCE COMPANIESINSURANCE FUNDSINSURANCE LAWINSURANCE PACKAGEINSURANCE PLANINSURANCE PREMIUMINSURANCE SYSTEMSINSURERSLABOR MARKETSLEGAL FRAMEWORKLIFE INSURANCELOW-INCOME COUNTRIESMARKETINGMEDICAL BENEFITSMEDICAL EXPENSESMEDICAL INSURANCEMEDICAL SERVICESMEDICAREMEDICINESMORAL HAZARDMORBIDITYMORTALITYMUTUAL AIDNATIONAL HEALTHNATIONAL HEALTH INSURANCENATIONAL HEALTH SERVICENONGOVERNMENTAL ORGANIZATIONSNURSESOUTPATIENT CAREOUTPATIENT SERVICESPATIENTPATIENTSPHARMACIESPOCKET PAYMENTSPREGNANT WOMENPREVENTIVE CAREPRIMARY CAREPRIMARY HEALTH CAREPRIMARY HEALTH CARE SERVICESPRIVATE CLINICSPRIVATE HEALTH INSURANCEPRIVATE INSURANCEPRIVATE SECTORPROFESSIONAL ASSOCIATIONSPROGRAMSPROVIDER PAYMENTPROVISION OF SERVICESPUBLIC HEALTHPUBLIC HEALTH INSURANCEPUBLIC SECTORQUALITY CONTROLQUALITY OF HEALTHREIMBURSEMENT RATESREINSURANCERISK SHARINGSCHOOL HEALTHSCREENINGSICKNESS FUNDSSOCIAL HEALTH INSURANCESOCIAL INSURANCESOCIAL SECURITYSUPPLY OF HEALTH PROVIDERSSUSTAINABILITYUNEMPLOYMENTVACCINATIONSWORKERSWorld Bank10.1596/978-0-8213-8982-9