Contents -- Foreword -- Preface -- Acknowledgments -- Abbreviations and Acronyms -- 1. The Evolution of Health Insurance in Developing Countries -- Overview -- Objectives of Review -- Methodology -- Review of Opportunities for Expanding VHI Markets -- Annex: Model Specification for Impact Evaluation Studies -- Notes -- References -- PART 1 ECONOMIC UNDERPINNINGS -- 2. Insights on Demand for Private Voluntary Health Insurance in Less Developed Countries -- Introduction -- Toward an Applicable Theory of Medical Insurance Demand -- The Theory of Insurance Demand -- When Is Insurance Most Valuable? -- Moral Hazard: What If Insurance Affects the Amount of Loss? -- Insurance Demand- and Supply-Side Cost Sharing -- Adverse Selection and Voluntary Insurance Markets -- Cream Skimming and Demand -- Insurance Reserves and Demand -- Group Insurance Demand -- Effect of Insurance Subsidies on Demand -- Demand for Protection against Risk Reclassification -- Health Insurance, Income, and Demand -- New Technology, Cost Containment, and Insurance Demand -- Other Reasons for Nonpurchase of Insurance or Market Failure -- Applying Theory to Demand for Health Insurance in Developing Countries -- Note -- References -- 3. Supply of Private Voluntary Health Insurance in Low-Income Countries -- Introduction -- Benefit Package -- Risk Selection Effort -- Loading -- Vertical Restraints/Vertical Integration -- Conclusions -- Annex 3A: Types and Efficiency Effects of Regulation -- Annex 3B: Corruption -- Annex 3C: Quality of Governance -- Notes -- References and Other Sources -- 4. Market Outcomes, Regulation, and Policy Recommendations -- Market Equilibria in Voluntary Insurance Markets -- Structure and Intensity of Regulation of Health Insurance -- Policy Recommendations -- Subsidized and Regulated Insurance -- Ideal and Alternative Public-Private Combinations.

Ideal Model of Private Insurance Purchasing and Markets in LICs -- Conclusion -- Notes -- References -- 5. Provision of a Public Benefit Package alongside Private Voluntary Health Insurance -- Introduction -- Background -- The Model -- A Public Choice Perspective -- Conclusions -- Notes -- References -- 6. Economics of Private Voluntary Health Insurance Revisited -- Introduction -- Why Is Demand for Insurance So Low? -- What to Regulate and How to Regulate It -- What Is the Optimal Subsidy? -- How Might Voluntary Insurance Affect the Public Package of Care? -- Notes -- PART 2 EMPIRICAL EVIDENCE -- 7. Scope, Limitations, and Policy Responses -- Introduction -- Data and Methodology -- Growth of Private Health Insurance in Low- and Middle-Income Countries -- Regional Challenges to Integrating Private Health Insurance into a Health System -- Conclusions and Outlook -- Notes -- References -- 8. Lessons for Developing Countries from the OECD -- Introduction -- Roles and Scope of Private Health Insurance in OECD Countries -- Lessons for Developing Countries -- Conclusion -- Notes -- References -- 9. Trends and Regulatory Challenges in Harnessing Private Voluntary Health Insurance -- Background and Context -- Patterns of Health Financing -- Experience with Private Health Insurance -- Using Private Health Insurance to Serve the Public Interest -- Conclusions -- Notes -- References -- PART 3 FROM THEORY TO PRACTICE -- 10. Financial and Management Best Practice in Private Voluntary Health Insurance -- Introduction -- Voluntary Health Financing: Institutional Capacity from a Management Perspective -- Institutional Capacity from a Technical, Financial, and Balance Sheet Perspective -- Solvency -- Regulation -- Best Practices for Individual Insurers -- Best Practices for an Insurance Industry -- Summary of the Current State of Voluntary Health Insurance.

Voluntary Health Insurance in Developing Countries -- Notes -- References and Other Sources -- 11. Opportunities and Constraints in Management Practices in Sub-Saharan Africa -- Introduction -- Context of Voluntary Health Insurance in Sub-Saharan Africa -- Voluntary Health Insurance in South Africa and in the Countries of West Africa and East Africa -- Issues in South Africa -- Issues in West Africa -- Issues in East Africa -- Conclusion -- Note -- References and Other Sources -- 12. Facilitating and Safeguarding Regulation in Advanced Market Economies -- Introduction -- Overview of Regulation in Advanced Market Economies -- Solvency Regulation -- Regulation of Pricing and Risk Selection -- Conclusions -- Notes -- References -- 13. Financial and Other Regulatory Challenges in Low-Income Countries -- Introduction -- Out-of-Pocket Payments and Private Voluntary Health Insurance -- General Challenges in Developing a PVHI Market -- Regulatory Issues and Challenges in LICs -- Regulatory and Supervisory Authority -- Conclusion -- Note -- References -- Appendix: Review of the Literature on Voluntary Private Health Insurance -- Introduction -- Methods and Results -- Definitions and Frameworks -- Demand for Voluntary Health Insurance -- Supply of Voluntary Health Insurance -- Performance and Impact of Voluntary Health Insurance -- Conclusions and Recommendations -- Note -- Bibliography -- About the Coeditors and Contributors -- Index -- BOXES -- 11.1 Survey of Risk Management Competency -- 13.1 Georgia: Proposed Health Care Financing Policy -- 13.2 The Philippines: Supervision and Regulation of Health Care Financing -- 13.3 Chile: Supervision and Regulation of Health Care Financing -- A.1 OECD Defi nitions of the Functions of Private Health Insurance -- A.2 A Demand-Side Story from Wiesmann and Jütting -- FIGURES -- 1.1 Rule of 80 Optimal Development Path.

1.2 Fragile States' Suboptimal Development Path -- 1.3 Progress toward Subsidy-Based Health Financing -- 1.4 Progress toward Insurance-Based Health Financing -- 1.5 Voluntary and Mandatory Health Financing Instruments under a New Multipillar Approach -- 1.6 Impact of Voluntary Health Insurance -- 3.1 Differentiation of Benefits -- 3.2 Ex Post Moral Hazard -- 3.3 Effect of Insurance Coverage on Monopolistic Pricing -- 3.4 Forms of Vertical Restraints and Integration Imposed by the Insurer -- 4.1 Market Model of Regulation -- 4.2 Types of Health Insurance according to Intensity of Regulation -- 4.3 Efficiency Loss of Regulation as an Externality -- 4.4 Optimality and the Size of the Required Subsidy -- 4.5 Public Demand as Determinant of Government Spending -- 5.1 Extent of the Statutory Package for the Poor -- 5.2 Expenditure Choices of the Rich -- 5.3 Indifference Curves with Voluntary Insurance -- 5.4 Preferences of Low-Wealth, Middle-Wealth, and High-Wealth Citizens -- 7.1 Systems of Health Care Financing -- 7.2 Analytical Framework -- 7.3 Relative Importance of Private Insurance Markets, 2003 -- 7.4 Total Health Expenditure and PHI Spending in Latin America and the Caribbean -- 7.5 Total Health Expenditure and PHI Spending in the Middle East and North Africa -- 7.6 Total Health Expenditure and PHI Spending in Eastern Europe and Central Asia -- 7.7 Total Health Expenditure and PHI Spending in Sub-Saharan Africa -- 7.8 Total Health Expenditure and PHI Spending in East Asia and the Pacific -- 8.1 Typology of Health Insurance Arrangements -- 8.2 Government and Social Insurance Share of Total Health Expenditure, 2003 -- 8.3 Private Health Insurance and Out-of-Pocket Payment Shares of Total Health Expenditure, 2003 -- 8.4 PHI Expenditure as a Share of Total Health Expenditure, 1990-2003 -- 8.5 Private Health Insurance and GDP Per Capita, 2003.

8.6 Out-of-Pocket Payments and PHI as a Percentage of Total Health Expenditure, 2003 -- 8.7 Variation in PHI Expenditure and Coverage in Countries with Waiting Times for Elective Surgery -- 8.8 Public and Private Health Spending as a Share of GDP and Expenditure Financed by Private Health Insurance, 2003 -- 9.1 Sources of Health Expenditure by System and Income -- 9.2 Public and Private Health Expenditures for Selected Countries -- 9.3 Continuum of Insurance Arrangements -- 9.4 Share of Population with Private Health Insurance, Selected OECD Countries, 2000 -- 9.5 Countries with the Highest Private Health Insurance Expenditures, 2000 -- 10.1 Correlation of Government Policy Changes and Health Insurance Penetration in Australia, 1972-2000 -- 10.2 Technical Control Cycle -- A.1 Types of Private Health Insurance -- A.2 Schematic for Health Economics -- A.3 Kutzin's Framework of Health Financing Functions -- A.4 Framework for Analysis of the Market for Voluntary Health Insurance in the European Union -- TABLES -- 1.1 Framework for Analyzing Policy Options for Voluntary Health Insurance -- 1.2 Market Indicators for Benefi ts of Voluntary Health Insurance -- 1A.1 Insurance Coverage under Easy and Hard Access -- 3.1 Factors Affecting the Size of the Benefit Package -- 3.2 Factors Affecting Risk Selection Effort -- 3.3 Factors Affecting the Net Price of Health Insurance (Loading) -- 3.4 Factors Affecting Insurer-Driven Vertical Integration -- 3.5 Factors Affecting Provider-Driven Vertical Integration -- 3.6 Forms of Integration -- 3.7 Factors Affecting the Degree of Concentration of Health Insurance Sellers in Markets for Private Health Insurance -- 3A.1 Regulations that Tend to Lower Efficiency -- 3A.2 Regulations that Tend to Enhance Efficiency -- 3A.3 Health Insurance Regulation in Specific Countries.

3B.1 Transparency International Corruption Index 2003, Selected Countries.