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1. Constitutional rights to health care: the consequences of placing limits on the right to health care in several Western and Eastern European countries.

Author

Den Exter, André, Hermans, Bert, and den Exter, André

Subjects
*CIVIL rights, *MEDICAL care, *TREATIES, *COST control, *HEALTH policy, *COMPARATIVE studies, *CONTRACTS, *ECONOMICS, *HEALTH, *HEALTH care rationing, *HUMAN rights, *HEALTH insurance, *INTERNATIONAL relations, *JURISPRUDENCE, *LEGISLATION, *RESEARCH methodology, *MEDICAL cooperation, *MEDICAL protocols, *NATIONAL health services, *PHYSICIANS, *POLICY sciences, *PUBLIC health, *RESEARCH, *RESOURCE allocation, *GOVERNMENT aid, *PRIVATE sector, *GOVERNMENT policy, *EVALUATION research, *PATIENT selection
Abstract

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]

Published
1998
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2. Building Systems for Universal Health Coverage in South Korea

Author

Na, Sanggon and Kwon, Soonman

Subjects
INSURANCE CONTRIBUTIONS, HEALTH INSURANCE PROGRAM, SOCIAL WELFARE, CONTRIBUTION RATES, HEALTH INSURANCE, NATIONAL HEALTH INSURANCE, MEASUREMENT, AGING, HEALTH CARE PROVISION, HEALTH SYSTEM, PHYSICIANS, PRIMARY CARE, PROVIDER PAYMENT, FINANCING, HEALTH REFORM, IMPLEMENTATION, EMPLOYMENT, QUALITY OF HEALTH, PHYSICIAN, INSURANCE COVERAGE, MONITORING, HEALTH COVERAGE, POPULATION, UNEMPLOYMENT, INCOME, HEALTH INSURANCE FUNDS, HEALTH CARE DELIVERY, HEALTH INFORMATION, CAPITA HEALTH EXPENDITURE, WORKERS, INFORMAL SECTOR, HEALTH INSURANCE EXPENDITURE, INCENTIVES, ABILITY TO PAY, MULTIPLE INSURERS, FEE FOR SERVICE, MEDICINES, FINANCIAL INCENTIVE, HEALTH OUTCOMES, SOCIAL HEALTH INSURANCE, MEDICAID, HEALTH PLANNING, HEALTH, HEALTH EXPENDITURE, DEMAND FOR HEALTH, HEALTH CARE QUALITY, INTEGRATION, PUBLIC LONG- TERM CARE, STROKE, HEALTH REFORMS, DEMAND FOR HEALTH CARE, FEE- FOR-SERVICE, INSURANCE SYSTEM, HEALTH CARE PROVIDERS, HEALTH ECONOMICS, HEALTH INSURANCE SYSTEM, INSURERS, PATIENT, INFORMATION SYSTEMS, MEDICAL SERVICES, HEALTH SPENDING, ACCESS TO HEALTH CARE, EVALUATION, ADMINISTRATIVE COSTS, PATIENTS, CANCER PATIENT, FINANCIAL INCENTIVES, HEALTH CARE EXPENDITURE, HEALTH INFORMATION SYSTEM, PUBLIC LONG- TERM CARE INSURANCE, DECISION MAKING, FEE-FOR-SERVICE, HEALTH CARE COVERAGE, SUSTAINABLE HEALTH CARE, INFORMATION SYSTEM, MORTALITY, MEDICAL FEES, REIMBURSEMENT RATES, RISKS, CLINICS, PUBLIC INSURANCE, HEALTH PROVIDERS, FEE SCHEDULES, HOSPITALS, PHARMACISTS, HEALTH SECTOR, SOCIAL SECURITY, HEALTH-CARE, COST SHARING, INCENTIVES FOR PROVIDERS, CONTRIBUTION RATE, POCKET PAYMENT, COSTS, MARKETING, HEALTH PROMOTION, HOSPITAL BEDS, HEALTH SPECIALIST, SURGERY, FEES, SOCIAL POLICY, DEMAND, QUALITY OF HEALTH CARE, HEALTH INSURANCE COVERAGE, LIFE EXPECTANCY, RISK SHARING, PHARMACEUTICAL SPENDING, HEALTH INSURANCE SCHEME, COST EFFECTIVENESS, RISK, COST CONTROL, HEALTH POLICY, HEALTH INFORMATION SYSTEMS, HEALTH CARE REFORM, HEALTH INSURANCE CONTRIBUTIONS, PUBLIC PROVIDERS, DELIVERY OF HEALTH CARE, CHOICE, ACCESS TO DRUGS, FEE-FOR-SERVICE PAYMENT, PREGNANCY, HEALTH CARE, INSURANCE, SOCIAL DEVELOPMENT, NUTRITION, PUBLIC HEALTH, EQUITY, PUBLIC LONG-TERM CARE, FINANCIAL PROTECTION, SOCIAL MARKETING, HEALTH CARE SYSTEM, MEDICAL CARE, DOCTORS, HOSPITAL SECTOR, KNOWLEDGE, INCOME COUNTRIES, STRATEGY, INTERNET, NATIONAL HEALTH, HEALTH INSTITUTIONS, HOSPITAL ADMISSION, INPATIENT CARE, BEDS, CARE, SOCIAL INSURANCE CONTRIBUTIONS, POCKET PAYMENTS, SOCIAL INSURANCE, HEALTH CARE UTILIZATION, PRIVATE HOSPITALS, HEALTH-CARE PROVIDERS, FEE SCHEDULE, HEALTH CARE FACILITIES, INSURANCE FUNDS, FEE-FOR- SERVICE, PROVISION OF SERVICES, HEALTH CARE FINANCING, FEE-FOR- SERVICE SYSTEM, HEALTH CARE REFORMS
Abstract

This paper broadly examines the development process of Korea’s health care system toward the achievement of Universal Health Coverage. Korea implemented a series of health care reforms after a rapid expansion of population coverage to improve efficiency and equity in financing and delivery of health care. The authors also investigate changes in the governance structure of Korea’s national health Insurance, which is now represented by two agencies: National Health Insurance Service (NHIS) and Health Insurance Review and Assessment Service (HIRA). Health insurance agencies have improved the accountability and transparency of the health insurance system, thanks to the ICT-based centralized claim review and assessment. Lessons and challenges from Korea’s experiences and achievements on the road to UHC could provide valuable policy implications to low- and middle-income countries.

Published
2015

3. Actuarial Costing of Universal Health Insurance and Coverage in Indonesia : Options and Preliminary Results

Author

Guerard, Yves, Wiener, Mitch, Rokx, Claudia, Schieber, George, Harimurti, Pandu, Pambudi, Eko, and Tandon, Ajay

Subjects
HEALTH INSURANCE PROGRAM, CITIES, COSTS OF CARE, HEALTH SPENDING INCREASES, CAPITATION, PUBLIC HEALTH PROVIDERS, HEALTH INSURANCE, MEDICAL TECHNOLOGY, AGING, YOUNG AGES, PRIMARY CARE, EMPLOYMENT, POLICY MAKERS, HEALTH COVERAGE, COMPLICATIONS, INCOME, HEALTH CARE EXPENDITURES, WORKERS, INFORMAL SECTOR, MEDICAL SYSTEM, PRIVATE INSURANCE, MORAL HAZARD, ADMINISTRATIVE EXPENSES, PUBLIC SPENDING, PRIVATE SPENDING, SOCIAL HEALTH INSURANCE, HEALTH EXPENDITURE, HEALTH CARE PROVIDERS, INSURERS, HEALTH SERVICE, PATIENT, PUBLIC SERVICES, ADMINISTRATIVE COSTS, QUALITY CONTROL, MEDICAL COSTS, POOR HEALTH, HEALTH FACILITIES, NUMBER OF BIRTHS, ELDERLY, PRESCRIPTION DRUGS, BASIC HEALTH SERVICES, DELIVERY SYSTEM, FEE SCHEDULES, HOSPITALS, FINANCIAL RISK, HEALTH PROMOTION, HOSPITAL BEDS, PREGNANT WOMEN, PAYMENTS FOR HEALTH SERVICES, HEALTH SPECIALIST, MEDICAL PROCEDURES, SURGERY, WORLD HEALTH ORGANIZATION, ANTENATAL CARE, UNIVERSAL HEALTH INSURANCE COVERAGE, CITIZENS, POPULATION INCREASE, POPULATION PROJECTIONS, HEALTH INSURANCE SCHEME, HUMAN DEVELOPMENT, COST CONTROL, HEALTH POLICY, PUBLIC PROVIDERS, NATIONAL LEVELS, PRIVATE INSURANCE POLICIES, INFORMAL SECTOR WORKERS, MATERNITY CARE, HEALTH CARE, HOSPITALIZATION, HEALTH SYSTEMS, HEALTH SYSTEMS STRENGTHENING, NUTRITION, PUBLIC HEALTH, FINANCIAL BARRIERS, HEALTH CARE SYSTEM, DEMAND FOR SERVICES, PRIVATE HEALTH INSURANCE, SUPPLY OF HEALTH CARE, DEVELOPING COUNTRIES, PREGNANCIES, NATIONAL HEALTH, INCOME GROUPS, HEALTH INSTITUTIONS, COST OF MEDICAL CARE, PUBLIC HEALTH SERVICES, TRANSPORTATION, INSURANCE PREMIUMS, QUALITY OF CARE, ADVERSE SELECTION, FEE SCHEDULE, PUBLIC EXPENDITURE, HEALTH CARE FACILITIES, OUTPATIENT CARE, EXPENSIVE FACILITIES, HOSPITAL, C-SECTION, GROSS DOMESTIC PRODUCT, FREE CHOICE, CHILD HEALTH, NATIONAL HEALTH INSURANCE, PUBLIC SUPPORT, HEALTH SYSTEM, PHYSICIANS, PROVIDER PAYMENT, VULNERABLE POPULATIONS, MEDICAL CONDITIONS, COST OF CARE, C-SECTIONS, FINANCIAL CATASTROPHE, HEALTH PROGRAMS, NATIONAL GOVERNMENT, MATERNITY SERVICES, PUBLIC INSURER, PRIVATE INSURERS, AGE DISTRIBUTION, HOLISTIC APPROACH, SEX DISTRIBUTION, PUBLIC HOSPITALS, FEE FOR SERVICE, MEDICINES, FINANCIAL INCENTIVE, HEALTH OUTCOMES, POPULATION DISTRIBUTION, POLICY DECISIONS, PUBLIC HEALTH PROGRAMS, CHOICE OF PROVIDERS, DEMAND FOR HEALTH, HEALTH ORGANIZATION, MEDICAL CARE COSTS, PUBLIC HEALTH INSURANCE, PUBLIC HEALTH SPENDING, HEALTH INSURANCE SYSTEM, SOCIAL ISSUES, PRIVATE DOCTORS, PRIVATE HEALTH SERVICES, MEDICAL SERVICES, LIVE BIRTHS, ACCESS TO HEALTH CARE, PATIENTS, RURAL AREAS, DEMAND FOR HEALTH SERVICES, AGE GROUPS, PROGRESS, IMPROVEMENTS IN SERVICE QUALITY, DECISION MAKING, EQUAL TREATMENT, HEALTH CARE RATIONING, MORTALITY, MEDICAL EXPENSES, RADIOLOGY, MEDICAL INSURANCE, MATERNAL HEALTH, REIMBURSEMENT RATES, CLINICS, LOW INCOME, HEALTH PROVIDERS, HEALTH SECTOR, SOCIAL SECURITY, CENTRAL BUDGET, COST SHARING, MEDICAL TECHNOLOGIES, QUALITY SERVICES, VULNERABLE GROUPS, MEDICAL EQUIPMENT, BURDEN OF DISEASE, ABORTION, HOSPITAL OUTPATIENT SERVICES, EPIDEMIOLOGY, MIDWIFE, MIDWIVES, CAPITAL COSTS, MINISTRY OF HEALTH, PUBLIC HEALTH SYSTEM, FINANCIAL IMPACT, CAPITATION FEE, LOCAL GOVERNMENTS, PUBLIC HEALTH CARE, COST-SHARING REQUIREMENTS, INTERNATIONAL COMMUNITY, MATERNAL HEALTH CARE, SEX, NATIONAL POLICY, SERVICE PROVISION, HUMAN RESOURCES, MEDICAL CARE, RICHER COUNTRIES, DOCTORS, ILLNESS, EXPENDITURES, QUALITY OF SERVICES, CHILD CARE, HEALTH FINANCING, HEALTH CARE SPENDING, SOCIOECONOMIC STATUS, INCOME COUNTRIES, MANAGED CARE, HEALTH EXPENDITURES, EPIDEMIOLOGICAL CHANGES, INPATIENT CARE, BEDS, ANTENATAL VISITS, NATURAL RESOURCES, HEALTH COST, PRIVATE HOSPITALS, HEALTH SERVICES, MATERNAL DEATH, PRACTITIONERS, URBAN AREAS, CAPITATION PAYMENTS, LACK OF INFORMATION, HEALTH CARE FINANCING, HEALTH SERVICE DELIVERY
Abstract

This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.

Published
2011