https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)61690-6.pdf

Closing the gap in a generation: health equity through action on the social determinants of health

The author systematically examines one of the important issues of information — establishing the market price. He introduces the concept of «search» — where a buyer wanting to get a better price, is forced to question sellers. The article deals with various aspects of finding the necessary information.

Economics of Information

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)13861-5.pdf

Household catastrophic health expenditure: a multicountry analysis.

正しい方法がわかる臨床基本手技 : from the New England journal of medicine

Over the past decade interest in the economic evaluation of health care interventions has risen1 Reviews of published studies have, however, shown gaps in the quality of work2 3 4 5 As far back as 1974 Williams listed the essential elements of economic evaluations,6 and more recently Drummond and colleagues set out the methodological areas generally agreed among economists7 Guidelines for economic evaluations have been promulgated and reviewed by many bodies,8 9 10 11 12 13 14 but few medical journals have explicit guidelines for peer review of economic evaluations or consistently use economist reviewers for economic papers even though they are a major publication outlet for economic evaluations15 16 17 In January 1995 the BMJ set up a working party on economic evaluation to improve the quality of submitted and published economic articles

It was not our intention to be unduly prescriptive or stifle innovative methods; our emphasis is on improving the clarity of economic evaluations We also did not address those issues of conduct that have been emphasised in other guidelines13 14 15 16 17 18

The working party's objectives were to improve the quality of submitted and published economic evaluations by agreeing acceptable methods and their systematic application before, during, and after peer review Its task was to produce: (a) guidelines for economic evaluation, together with a comprehensive supporting statement which could be easily understood by both specialist and non-specialist readers; (b) a checklist for use by referees and authors; and (c) a checklist for use by editors

In producing the guidelines the working party has concentrated on full economic evaluations comparing two or more health care interventions and considering both costs and consequences19 Articles sent to the BMJ and other medical journals are often more broadly based “economic …

/pdf/guidelines-for-authors-and-peer-reviewers-of-economic-uz9mnnz1jd.pdf

Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party.

An empirical model of access to health care, health care expenditure and impoverishment in Kenya: learning from past reforms and lessons for the future

This paper summarizes the results of three individual research projects (Asfaw, 2005; Lamiraud et al., 2005; Xu et al., 2005) measuring the impact of membership in a health insurance scheme in three African countries, namely Kenya, Senegal and South Africa. It is structured as follows. The first section briefly outlines the health care systems in Kenya, Senegal and South Africa, followed by a short description of the methodology and data used in the research. The later sections focus on empirical results and policy implications.

https://papers.ssrn.com/sol3/Delivery.cfm/SSRN_ID916703_code450247.pdf?abstractid=916703&mirid=1

What is the Impact of Social Health Protection on Access to Health Care, Health Expenditure and Impoverishment? A Comparative Analysis of Three African Countries

ed, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in this "Technical Brief for Policy-Makers" are those of the authors, and do not necessarily reflect the official position of the World Health Organization. Thinking of introducing social health insurance?

https://www.who.int/healthsystems/topics/financing/healthreport/26_10Q.pdf

Thinking of introducing social health insurance? Ten questions

The search for a ‘‘good’’ health systemis constant. Even in countries wherecomprehensively organized national healthsystems have existed for over a century,the debate on how best to design them toensuretheeffectivefinancing,organizationand provision of care is as lively andcontroversial as ever.During the last quarter of the20th century many countries proposed awide variety of sweeping reforms, someof which were adopted and refined, andothers rejected. That period can be viewedas one in which a ‘‘natural experiment’’was conducted on a global scale. It hasyielded surprisingly little, however, in theway of real, evidence-based understandingof what works well.Much of current research on healthpolicy seeks to discover quantitative rela-tionships that can explain the achievementof health systems in relation to their designand the wider context within which theyoperate. One such relationship which isalready quite well understood concernsthe role played by risk-pooling, or insur-ance (1).Thereisagrowingconsensusthat,other things being equal, systems in whichthedegreeofrisk-poolingisgreaterachievemore.Risk-pooling is beneficial becausehealthcarecostsaregenerallyunpredictableandsometimeshigh.Peoplecannotreliablyforecast when they will fall ill and needto make use of health services. When ithappens, the costs of those services can besignificant. Risk-pooling increases the like-lihood that those who need health carewillbeabletoobtainitinanaffordableandtimely manner. It allows resources to betransferred from the healthy to the sick.From the viewpoint of individuals andhouseholds, contributions during timesof good health can be used to meet healthcare costs in the event of illness. In manycases, pooling also contributes towardsredistributive goals by making those withhigher incomes contribute more in orderto subsidize the poor.Community-basedhealthinsuranceor‘‘micro-insurance’’(2) is one approach torealizing the benefits of risk-pooling incountries without the organizational capa-citytooperateformalschemesonanationallevel. Risk-pooling, on any scale, has itsdownside, however. Clients who areinsured and therefore do not have to paythe full cost of services may be inclinedto over-use those services, while providersmay be happy to let them do so because itenables them to earn more (moral hazard).In addition, those who are more likely torequirecarehaveastrongerincentivetojoina voluntary risk-pooling scheme (adverseselection).Suchproblemscouldbereducedin micro-insurance schemes since theirsmall scale and community focus mightprovide informal safeguards against them.Smallnessinitsturnisamixedblessingthough. As Dror explains in this issue ofthe Bulletin (pp. 672–678), the smaller ascheme is the harder it is for it to remainsolvent. That is a statistical reality whichcannotbeavoided.Hesuggestsreinsuranceas an approach to help micro-insuranceschemes overcome the threat of financialfailure. Just as households can pool theirresourcestohelpreducefluctuationintheirhealth spending, so can insurance schemesthemselves. Throughreinsurance, schemesthat have faced fewer demands on theirfunds than anticipated can indirectlysubsidize those that have faced more.The potential benefits of reinsurancein countries where micro-insurers operateare clear. Unfortunately, however, reinsur-ancealsofacesthetwindifficultiesofmoralhazard and adverse selection. Micro-insur-ance schemes that reinsure may haveweaker incentives to contain the costs ofthebenefitstheypayout;andschemesthatare more likely to face budget blow-outs inany given period are more likely to chooseto reinsure.Reinsurance is attractive because itexpandsthesizeoftheriskpool,andallowsgreater scope for costs to be shared. Insome circumstances, however, it may bepreferablesimplytoestablishschemeswithlargerriskpoolsfromtheoutset.Examplesalready exist of district-based health insur-ance (3), targeting tens of thousands ofpeopleratherthanasmallcommunity.Suchlarger schemes can also benefit fromeconomies of scale in administrationand transaction costs.Alternatively it may be feasible toencourage progressive scaling up of micro-insurance schemes, possibly through aplanned programme of mergers, to formever larger risk pools. Such an approachcould allow infrastructure and other cap-abilities to develop over time, and mayeventuallyleadtotheemergenceofasingleregional (or national) risk pool whichmany would consider to be the ideal.In addition, attempts to employ risk-pooling will fail if they do not have theconfidenceofthepeopletheyseektoserve.Any pooling scheme will be judged by itsresults, and if problems of access oraffordability persist people will quicklybecome cynical. Appropriate arrangementsare needed to oversee the scheme so asto ensure that the benefits of risk-poolingare in fact realized.More fundamentally, those who paycontributions when they are healthy mustknow that, if and when they need care, thepooling scheme will still be there to helpthem. The failure of an insurer can be ascatastrophic for those affected as thecollapseofabank.Countriesmaythusneedto regulate insurers and micro-insurers toensure financial probity in the same waythattheyregulatethebankingindustry.Theimportance of oversight and regulationfor effective risk-pooling should not beoverlooked.Similarly, other initiatives to improvehealth system performance — whetherby increasing the efficiency of serviceproviders, building up human resourcesor enhancing access to traditional healing— will struggle where government is weakin its role as protector of the public’sinterests.Successinthatrole,definedbytheWorld Health Report 2000 — health systems:improving performance as stewardship, is un-doubtedlyakeyfactorindetermininglevelsof health system achievement. In contrastto the concept of pooling risk, however,little evidence currently exists as to whatconstitutes effective stewardship, how tobringitaboutandthemechanismsbywhichit has an impact on achievement. Thereinlies another key challenge in understandingthe complex relationships that link policyand performance.

/pdf/risk-pooling-necessary-but-not-sufficient-28yvrkfxr8.pdf

Guy Carrin

Papers

An empirical model of access to health care, health care expenditure and impoverishment in Kenya: learning from past reforms and lessons for the future

What is the Impact of Social Health Protection on Access to Health Care, Health Expenditure and Impoverishment? A Comparative Analysis of Three African Countries

Thinking of introducing social health insurance? Ten questions

Risk-pooling--necessary but not sufficient?

Social health insurance: how feasible is its expansion in the African region?