Francesca Colombo

Private Health Insurance in OECD Countries

Governments often look to private health insurance (PHI) as a possible means of addressing some health system challenges. For example, they may consider enhancing its role as an alternative source of health financing and a way to increase system capacity, or promoting it as a tool to further additional health policy goals, such as enhanced individual responsibility. In some countries policy makers regard PHI as a key element of their health coverage systems While private health insurance represents, on average, only a small share of total health funding across the OECD area, it plays a significant role in health financing in some OECD countries and it covers at least 30% of the population in a third of the OECD members. It also plays a variety of roles, ranging from primary coverage for particular population groups to a supporting role for public systems. This paper assesses evidence on the effects of PHI in different national contexts and draws conclusions about its ... Certains gouvernements voient dans l’assurance maladie privee un moyen de relever quelquesuns des defis lies aux systemes de sante. Par exemple, certains envisagent de promouvoir son role de source de financement de substitution, de l’utiliser pour accroitre les capacites du systeme, ou encore de la faire contribuer a la realisation d’autres objectifs de la politique de sante, tels que le renforcement de la responsabilite individuelle. Dans certains pays, les decideurs considerent l’assurance maladie privee comme un element fondamental du systeme de couverture maladie. Bien que l’assurance maladie privee ne represente en moyenne qu’une petite fraction du financement total des depenses de sante dans la zone OCDE, elle constitue dans quelques pays Membres un mode de financement important des soins et couvre au moins 30 pour cent de la population dans un tiers des pays de l’OCDE. Elle joue par ailleurs des roles multiples, allant de l’octroi d’une couverture primaire a des ...

Addressing multimorbidity to improve healthcare and economic sustainability

Patients with multimorbidity are responsible for more than half of all healthcare utilization, challenging the healthcare budgets of all European nations. Although the European Union is showing signs of a fragile economic recovery, achieving sustainable growth will depend on delivering a combination of fiscal responsibility, structural reforms, and improved efficiency. Addressing the challenges of multimorbidity and providing more effective, affordable, and sustainable care, has climbed the political agenda at a global, European, and national level. Current healthcare systems are poorly adapted to cope with the challenges of patients with multimorbidity. Little is known about the epidemiology and natural history of multimorbidity; the evidence base is weak; clinical guidelines are not always relevant to this population; and financing and delivery systems have not evolved to adequately measure and reward quality and performance. Pockets of innovation are, however, beginning to emerge. In Spain, for example, the ongoing economic crisis has forced regional governments to deliver substantial efficiency savings and, with this in mind, integrated care programmes have been introduced across the country for people with chronic disease and multimorbidity. Early results suggest that formalized integrated care for patients with multimorbidity improves their perceptions of care coordination, reduces hospital and emergency admissions and readmissions, and reduces average costs per capita. Such innovations require meaningful investments at a national level – something that is now supported within the framework of the European Unions Stability and Growth Pact.

Private Health Insurance in the Netherlands

Private health insurance (PHI) is the sole source of primary health coverage for a third of the Netherlands’ population earning above a set income threshold. Social insurance (together with limited public (tax-based financing) is the main source of health coverage for the majority of the population. Most socially insured also purchase supplementary private health coverage. All citizens are eligible for a system of coverage for long-term care and care for the chronically ill. Thus, in the Netherlands, the source of health financing is determined according to the category of health risk, type of illness, as well as income level. Decisions have been made allocating the cost of more expensive long-term care and coverage of high-risk individuals and persons earning below a set level, to social or public insurance, or to PHI subsidised by a broader pool. From an equity perspective, the Dutch public/private financing mix appears to do well, although challenges remain. There appear to be ... Pour les Neerlandais situes dans le tiers superieur de l’echelle des revenus, l’assurance maladie privee constitue l’unique source de couverture maladie primaire. L’assurance sociale (et, dans une mesure restreinte, certains financements publics d’origine fiscale) represente pour sa part la principale source de couverture maladie pour la majorite de la population. La plupart des affilies au regime social sont egalement titulaires d’une couverture maladie privee supplementarite. Tous les citoyens sont admissibles a une couverture pour soins de longue duree, et les soins aux malades chroniques sont egalement couverts. Aux Pays-Bas, la source de financement des soins de sante est donc determinee selon la categorie de risque de sante, le type de maladie ainsi que le niveau de revenu. La decision a ete prise d’allouer les couts induits par les soins de longue duree (plus onereux), les personnes a haut risque et les personnes gagnant moins d’un certain revenu a l’assurance sociale ou ...

Typology of Public Coverage for Long-Term Care in OECD Countries

The importance of long-term care (LTC) — that is, care for people dependent on help for daily living activities1 — as measured by cost and utilization is growing in all high-income countries. This is a direct consequence of population ageing and, in particular, the growing number of very old people in the population. The share of the population aged over 80 years old, currently at around 4 per cent on average according to the Organization for Economic Cooperation and Development (OECD), is expected to triple to 11–12 per cent by 2050 (Figure 2.1). The sheer number of elderly that need assistance in carrying out activities of daily living is growing as a result.

The Slovak Health Insurance System and The Potential Role for Private Health Insurance

This paper analyses the Slovak health insurance system and the policy challenges it faces. It describes the structure of health coverage and health sector reforms being implemented by the Slovak government. It provides a preliminary assessment of the possible impact of such reforms, with a focus on the health insurance system and the possible introduction of private health insurance (PHI). It assesses how private health insurance would impact upon the health system, particularly equity, efficiency incentives facing providers and insurers, and responsiveness. The Slovak health system is based upon a mandatory Bismarck-style social health insurance system. Contributions are shared between employers and employees and the state contributes for the inactive population. Five non-profit and non-competing insurers operate nationwide, one of which covers two-thirds of the population. Individuals can freely enrol with any of the insurance companies and a risk equalisation system ... Ce document presente une analyse du systeme d’assurance de sante Slovaque et les defis politiques que celui-ci engendre. Une description de la structure de couverture sante et des reformes mises en oeuvre par le gouvernement Slovaque y est presentee ainsi qu’une evaluation preliminaire de l’impact possible de telles reformes. L’accent est porte sur le systeme d’assurance-maladie et l’introduction possible d’une assurance maladie privee (AMP). Y figure egalement une evaluation de la maniere dont une AMP aura des repercussions sur le systeme de sante lui-meme et plus particulierement en ce qui concerne l’equite et les incitations a l’efficience auxquelles sont confrontes les fournisseurs de services et les assureurs et la reactivite du systeme de sante face aux besoins des utilisateurs. Le systeme de sante Slovaque et base sur un systeme d’assurance maladie sociale obligatoire du style Bismarck. Les contributions sont partagees entre les employeurs et les employes avec une ...

Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa

Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the countrys spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africas private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution.

Erratum to: Addressing multimorbidity to improve healthcare and economic sustainability

[This corrects the article DOI: 10.15256/joc.2016.6.74.].

Política de salud

Durante los ultimos anos Mexico ha avanzado significativamente en el sector salud. Mediante su innovador programa Seguro Popular, Mexico ha practicamente logrado ya la cobertura universal para la poblacion, como sucede en la mayoria de los demas paises de la OCDE. No obstante, a pesar de las importantes mejoras en la esperanza de vida y la mortalidad infantil, permanece aun por debajo del promedio de la OCDE en lo que corresponde a los indicadores basicos del estado de la salud. Si bien el gasto total en salud (publico y privado) ha crecido mas rapidamente en la ultima decada, dicho gasto sigue siendo muy inferior al de otros paises de la OCDE. El nivel de gasto publico es especialmente bajo y el gasto de bolsillo de los particulares es muy elevado. Ademas, el sistema de salud esta fragmentado, lo que conduce al desperdicio en el gasto y a considerables disparidades en el acceso a la atencion de la salud de un estado a otro. Mejorar los servicios de salud del pais exigira atender los problemas de los estados mas pobres, privilegiar los servicios donde se pueda ofrecer la maxima relacion calidad-precio y mejorar la eficiencia de la atencion. Estos cambios permitiran que Mexico cumpla el compromiso establecido en el Pacto por Mexico para igualar la calidad y la cobertura entre los diferentes esquemas de servicios de salud. Tal aspiracion debera motivar nuevas reformas a fin de ampliar el acceso a estos, con politicas basadas en el establecimiento de metas tanto de la cobertura de los servicios como de la utilizacion efectiva de los mismos por parte de los diferentes grupos socioeconomicos y en las diversas regiones.