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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.

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.

Health policy has been for some time high on the agenda of many countries - and where it has not, it should be. Since no ideal model of health services has ever been devised, one may look for favorable elements in the health sector of a given country and examine their applicability to other countries. This paper analyzes Israel's health sector in this context.

This paper argues that the brunt of the reform-induced increase in Polish social expenditures has been borne by social insurance arrangements (mainly pensions and unemployment compensation) rather than by social assistance schemes targeted to the poor or more temporary social safety net schemes. This is largely due to ease of access to social security and its more attractive benefit structure. Much of recent social expenditure reform had an ad-hoc nature and was driven by the need to alleviate looming financial distress. A major policy challenge is to avoid a further burdening of social security by needs that should be addressed by basic income support and emergency assistance policies or by general transfers (e.g., family allowances). Current reform needs are illustrated by using unemployment benefits and pensions as examples.

This country assessment of the private health sector in Mali is part of a series of studies designed to deepen understanding of ways to enhance the health policy framework, business environment, and investment climate in which the private health sector operates in African countries. The Malian health system has evolved dramatically since the middle of the 1980s. A large part of the analysis in this report relies on the reprocessing and the mining of existing databases, the financial and macroeconomic models based on those data, and elements reconstructed through triangulation. Those calculations proved indispensable for assessing the main demographic trends in the private sector, for estimating the growth of community centers (CSCOMs) and private mutual insurance, and identifying how to reinforce them. The growth of the private sector is further held back by insufficient educational preparation for practice in the private sector and in rural areas. For-profit and not-for-profit health care providers, pharmacies, and schools should be given beefier access to funding during start-up. Other financial engineering strategies (participation, etc.) could also be devised. The government of Mali has an opportunity to take advantage the large and dynamic private health sector in contributing to its national health care objectives and outcomes. The study describes the various instruments of stewardship towards the private sector that could be used such as information, regulations, financing and direct provision of public services in areas of significant market failure.

In the absence of formal insurance services, smallholder farmers are devoid of effective ways of managing numerous risks they encounter in their daily lives. One response mechanisms common among rural households is reliance on network-based collective action arrangement driven by motives of reciprocity and altruism. The indigenous financial institutions constitute a striking example of risk-sharing and risk-pooling arrangements widely practiced by the bulk of rural communities in Africa. Of these arrangements, the Ethiopian iddir can be considered as a unique and viable institution worth investigation to understand its nature and logic. Drawing on the synthesis of the available literature and household surveys, this study attempts to explain the essence and dynamism of iddir; describe its risk-pooling and risk-sharing mechanisms; investigate the principles and rules underlying its procedures and operations. It also assesses its rules using an analytical framework known as the \"institutional analysis and development framework\". This study can contribute to the debate concerning the logic and potential of informal institutions in, partially, meeting the insurance needs of smallholder farmers. It is important to understand and promote the mechanisms by which indigenous arrangements attempt to bridge the gap left by the formal sector. En l'absence de services d'assurance formelle, les petits agriculteurs sont dépourvus de moyens efficaces de gérer les risques qu'ils rencontrent dans leur vie quotidienne. Un mécanisme d'intervention commun des ménages ruraux est l'arrangement d'action collective basé sur le réseau, guidé par la réciprocité et l'altruisme. Les institutions financières indigènes constituent un exemple frappant du systeme de risk-pooling et risk-sharing largement pratiqué par la majorité des communautés rurales en Afrique. Parmi ces dispositions, les iddir éthiopiens peuvent être considérés comme une institution unique et viable et il vaut la peine d'en comprendre la nature et la logique. S'appuyant sur la synthese de la littrature et des enquêtes auprès des ménages disponibles, cette étude vise à expliquer l'essence et le dynamisme de l'iddir; décrire ses mécanismes de risk-pooling et risk-sharing; analyser les principes et les règies qui sont à la base de ses procédures et ses opérations. On évalue aussi ses règies en utilisant un cadre analytique connu sous le nom d'\"institutional analysis and development framework\". Cette étude peut contribuer au débat sur la logique et le potentiel des institutions informelles pour répondre, partiellement, aux besoins d'assurances des petits agriculteurs. Il est important de comprendre et de promouvoir les mécanismes par lesquels les arrangements autochtones tentent de combler le vide laissé par le secteur formel.

'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.

In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns – different groups obtained access to healthcare as their socio-political importance grew. A major inflection point occurred following the Asian financial crisis of 1997. To stave off social unrest, the government provided health coverage for the poor for the first time, creating a path dependency that influenced later policy choices. The end of this programme coincided with decentralisation, leading to experimentation with several different models of health provision at the local level. When direct elections for local leaders were introduced in 2005, popular health schemes led to success at the polls. UHC became an electoral asset, moving up the political agenda. It also became contested, with national policy-makers appropriating health insurance programmes that were first developed locally, and taking credit for them. The Indonesian experience underlines the value of policy experimentation, and of a close understanding of the contextual and political factors that drive successful UHC models at the local level. Specific drivers of success and failure should be taken into account when scaling UHC to the national level. In the Indonesian example, UHC became possible when the interests of politically and economically influential groups were either satisfied or neutralised. While technical considerations took a back seat to political priorities in developing the structures for health coverage nationally, they will have to be addressed going forward to achieve sustainable UHC in Indonesia.

Caste plays a role at every stage of an Indian’s economic life, in school, university, the labor market, and into old age. The influence of caste extends beyond private economic activity into the public sphere, where caste politics determines access to public resources. The aggregate evidence indicates that there has been convergence in education, occupations, income, and access to public resources across caste groups in the decades after independence. Some of this convergence is likely due to affirmative action, but caste-based networks could also have played an equalizing role by exploiting the opportunities that became available in a globalizing economy. Ethnic networks were once active in many advanced economies but ceased to be salient once markets developed. With economic development, it is possible that caste networks will cease to be salient in India. The affirmative action programs may also be rolled back and (statistical) discrimination in urban labor markets may come to an end if and when there is convergence across caste groups. In the interim period, however, it is important to understand the positive and negative consequences of caste involvement across a variety of spheres in the Indian economy.