An insightful overview of health insurers and a guide to sustainability for provider organizations.Physicians experience ongoing frustrations in their relationships with health plans. Even as they ...struggle to keep up with accelerating clinical advances, they face daunting challenges from payers that are transitioning from traditional fee-for-service contracts to complex alternative payment models. In Health Plans Unmasked, Martin Lustick, MD, offers insights and guidance for those who face the herculean task of transforming their business practices to achieve financial stability while improving outcomes for their patients.By explaining both how and why insurance companies behave the way they do, Dr. Lustick helps providers avoid mistakes and take advantage of opportunities for success. He provides information on:• The evolution of health care financing in the United States• The nuts and bolts of health plan capabilities and the real motives of health plan administrators• Tips for successful contracting strategies • Alternative payment models and the promises of value-based careWith a career spanning five decades as a practicing pediatrician, chief operating officer of a medical group, chief medical officer of a hospital, and chief medical officer of a health plan, Dr. Lustick provides a straightforward guide to sustainability for provider organizations. Physicians, office managers, and anyone in a health-related field will benefit from his breaking down the role of health plans in our health care ecosystem.
Private Voluntary Health Insurance Greg Brunner, Pablo Gottret, Birgit Hansl, Vijayasekar Kalavakonda, Somil Nagpal, Nicole Tapay
2012, 05-14-2012, 2012-05-14, 20120101
eBook, Book
Open access
Health 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.
Catastrophe Risk Financing in Developing Countries provides a detailed analysis of the imperfections and inefficiencies that impede the emergence of competitive catastrophe risk markets in developing ...countries. The book demonstrates how donors and international financial institutions can assist governments in middle- and low-income countries in promoting effective and affordable catastrophe risk financing solutions.The authors present guiding principles on how and when governments, with assistance from donors and international financial institutions, should intervene in catastrophe insurance markets. They also identify key activities to be undertaken by donors and institutions that would allow middle- and low-income countries to develop competitive and cost-effective catastrophe risk financing strategies at both the macro (government) and micro (household) levels. These principles and activities are expected to inform good practices and ensure desirable results in catastrophe insurance projects.Catastrophe Risk Financing in Developing Countries offers valuable advice and guidelines to policy makers and insurance practitioners involved in the development of catastrophe insurance programs in developing countries.
Governments in developing countries have been increasingly involved in the support of commercial agricultural (crop and livestock) insurance programs in recent years. A striking example is China, ...where, with support (and premium subsidies) from the central and provincial governments, the agricultural insurance market grew dramatically to become the second largest market in the world (after the United States) in 2008. In India and Mexico, weather-based crop insurance has been developed on a large scale to protect farmers against the vagaries of the weather. Many other countries have investigated the feasibility of agricultural insurance, and some have implemented pilot programs. This book aims to inform and update public and private decision makers involved in promoting agricultural insurance about recent developments in agriculture insurance. The literature is heavily biased toward the practice and experience of a few very large public-private programs in Northern America and Europe, which are driven by large public financial subsidies. This book provides decision makers with a framework for developing agricultural insurance. It is based on an analytical review of the rationale for public intervention in agricultural insurance and a detailed comparative analysis of crop and livestock insurance programs provided with and without government support in more than 65 developed and developing countries. The comparative analysis is based on a survey conducted by the World Bank's agricultural insurance team in 2008. Drawing on the survey results, the book identifies some key roles governments can play to support the development of sustainable, affordable, and cost-effective agricultural insurance programs.
One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how ...each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.
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.
Takaful and mutual insurance Gonulal, Serap O; Gonulal, Serap O
2012., 2013, 2012, 10-17-2012, 2014-05-14, 20130101
eBook, Book
Open access
Takaful, which means 'cooperative', is an insurance approach that is instrumental to providing insurance services to Muslims and others with religious objections to aspects of conventional commercial ...insurance models, specifically interest payments, uncertainty, or gambling kind of transactions.
The development challenges of addressing health problems in low- and middle- income countries are daunting but not insurmountable. There are now known and affordable interventions to deal with many ...aspects of the HIV/AIDS crisis as well as the continued challenge posed by malaria and other major infectious diseases. Three major development objectives of health insurance in low- and middle income countries are highlighted in this volume: securing sustainable financing for health care providers that serve the health needs of vulnerable populations; providing financial protection against the impoverishing cost of illness; and reducing social exclusion from organized health financing and delivery systems. Private health insurance schemes can address the needs of the poor and other vulnerable populations with appropriate combinations of subsidies, risk pooling, household savings, and user charges. The authors of this book argue in favor of a multipillar approach to health care financing in low- and middle-income countries that combines these instruments in addressing the underlying development objectives described above, while putting a strong emphasis on private voluntary health insurance. In this way, private means can make a significant contribution to public ends.
Private voluntary health insurance already plays an important role in the health sector of many low and middle income countries. The book reviews the context under which private insurance could ...contribute to an improvement in the financial sustainability of the health sector, financial protection against the costs of illness, household income smoothing, access to care, and market productivity. This volume is the third in a series of in-depth reviews of the role of health care financing in providing access for low-income populations to needed halthcare, protecting them from the impoverishing effects of illness, and addressing the important issues of social exclusion in government financed programs.
Insurance in a Climate of Change Mills, Evan
Science (American Association for the Advancement of Science),
08/2005, Volume:
309, Issue:
5737
Journal Article
Peer reviewed
Catastrophe insurance provides peace of mind and financial security. Climate change can have adverse impacts on insurance affordability and availability, potentially slowing the growth of the ...industry and shifting more of the burden to governments and individuals. Most forms of insurance are vulnerable, including property, liability, health, and life. It is incumbent on insurers, their regulators, and the policy community to develop a better grasp of the physical and business risks. Insurers are well positioned to participate in public-private initiatives to monitor loss trends, improve catastrophe modeling, address the causes of climate change, and prepare for and adapt to the impacts.
Full text
Available for:
BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
PDF
