Social Health Insurance for Developing Nations

Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.

Foreword	p. vii
Acknowledgments	p. ix
Abbreviations	p. xi
Introduction, Context, and Theory	p. 1
Context	p. 4
Theory and Principles	p. 11
References	p. 18
Design and Implementation of Social Health Insurance	p. 21
Design	p. 21
Implementation	p. 33
Summary	p. 39
References	p. 40
Kenya: Designing Social Health Insurance	p. 43
Background	p. 43
Design of the NSHIF	p. 47
Implementation Issues	p. 52
Conclusion	p. 59
References	p. 59
Ghana: Initiating Social Health Insurance	p. 61
Background	p. 61
Evolution of Health Financing Mechanisms	p. 65
Design Issues	p. 71
Implementation Issues	p. 75
Successes and Challenges	p. 77
References	p. 79
The Philippines: Extending Coverage beyond the Formal Sector	p. 81
Background	p. 81
Delivery of Health Services	p. 86
Design and Implementation Issues	p. 90
Impact of SHI	p. 103
References	p. 104
Colombia: Social Health Insurance with Managed Competition to Improve Health Care Delivery	p. 105
Background	p. 105
Health Care Reform	p. 108
Design	p. 110
Implementation	p. 113
Achievements	p. 124
Challenges	p. 124
References	p. 131
Thailand: Achieving Universal Coverage with Social Health Insurance	p. 133
Background	p. 133
Health Insurance Development before Universal Coverage	p. 140
Achieving Universal Coverage	p. 146
Lessons Learned from Universal Coverage	p. 151
Challenges	p. 153
Conclusion	p. 154
References	p. 154
Lessons Learned and Policy Implications	p. 155
The Development Context Matters	p. 158
The Five Country Case Studies	p. 159
Positive Changes Attributable to SHI	p. 159
Major Challenges Inherent in Implementation	p. 162
Policy Implications	p. 165
Conclusions	p. 170
References	p. 171
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Social Health Insurance for Developing Nations

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