Brunner, GregGottret, PabloHansl, BirgitKalavakonda, VijayasekarNagpal, SomilTapay, Nicole2013-04-092013-04-092012-05-14978-0-8213-8756-6DOI:10.1596/978-0-8213-8756-6https://hdl.handle.net/10986/13093Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular, insurance laws are designed to prevent insurers from becoming insolvent and from engaging in unfair practices and discriminatory behavior. When private health insurance serves as a significant source of financing in a nation's health care system, usually insurance laws also include a range of consumer protection laws that enhance both access to the services covered by private health insurers and the adequacy of the benefits provided by the insurer. This chapter provides a general overview of private health insurance. It begins with a discussion of the definition of private health insurance and the potential roles of private health insurance as part of a nation's health care financing system. In addition, the chapter reviews the variety of entities that sell private health insurance.en-USCC BY 3.0 IGOaccess to health careaccess to health servicesaccident insuranceactuariesadministrative costsadverse selectionAgentsambulanceannual financial statementsAssuranceauditorsbeneficiariesCapital Requirementscapitationcapitation paymentcapitation paymentscare planschoice of providerclinicscoinsurancecommissionscompensationcomplementary medicineConsumer Protectionconsumerscontracts with providerscost of health careCost sharingcosts of health careCoveragecredit riskdelivery of health caredental careeconomies of scaleequitable access to health careexpendituresFamiliesfiduciaryfinancial incentivefinancial incentivesFinancial Informationfinancial managementfinancial resourcesfinancial riskfinancing health caregeneral insurancehealth budgetshealth carehealth care costshealth care expenditureshealth care financinghealth care needshealth care providerhealth care providershealth care serviceshealth care spendinghealth care systemhealth expenditureshealth financingHealth IndustryHealth InstitutionsHealth Insurancehealth insurance coveragehealth insurance fundhealth insurance industryhealth insurance markethealth insurance marketshealth insurance policieshealth insurance regulationhealth insurance schemehealth insurance schemeshealth insurance systemHealth maintenanceHealth maintenance organizationhealth maintenance organizationshealth plansHealth Policyhealth reformshealth servicehealth serviceshealth spendinghealth statusHealth SystemsHMOHMOshospitalizationhospitalshuman resourcesillnessincomeincome countriesincome groupsincome populationIndemnityinformal sectorinformation systemsinspectionsinsurance activitiesinsurance benefitsInsurance brokersinsurance buyersinsurance claimsInsurance Commissionersinsurance companiesinsurance contractsinsurance coverageinsurance functioninsurance industriesinsurance industryinsurance lawinsurance licensesinsurance marketinsurance marketsinsurance policiesinsurance premiuminsurance premium ratesinsurance premiumsinsurance productsinsurance ratesinsurance regulationinsurance riskinsurance supervisioninsurance supervisorsinsurance systemsinsurance­riskinsurersintegrityIntermediariesinternal controlsinterventioninvestigationslawslegal frameworklevel playing fieldLife Insurancelow-income countriesmanaged caremanaged care plansmarket failuresmarket forcesmarketingmedical caremedical conditionsmedical expensesmedical insuranceMedicaremoral hazardmutual insurance companiesnational healthNational Health InsuranceNational Health Policynational health servicesNon-Life Insurancenongovernmental organizationsNutritionpatientpayments for health carepolicyholdersprice competitionprimary careprivate health coveragePrivate Health Insuranceprivate health insurersprivate hospitalsprivate insuranceprivate insurersPrivate Sectorprivate spendingprogramsprovision of health servicespublic healthpublic health carePublic health insurancepublic health systempublic insurancepublic insurerpublic providerspublic sectorrehabilitationReinsurancereinsurance companiesreinsurersrenewalsReservesRisk Factorsrisk managementrisk managerssmokingsocial health insuranceSolvencySolvency Requirementssupervisory agenciessupervisory authoritiessupervisory frameworksupervisory infrastructuresupervisory systemsurgeryunderwritingworkersworkers compensationWorld Bank10.1596/978-0-8213-8756-6