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DESIGN ELEMENT 3: POPULATION COVERAGE. Hong Wang, MD, PhD HS20/20 Project. October 19-23. Figure 1: Design Elements for a Health Insurance Scheme. Feasibility of Insurance Design and Implementation. Insurance Financing options. Population coverage. Benefits package.
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DESIGN ELEMENT 3: POPULATION COVERAGE Hong Wang, MD, PhD HS20/20 Project October 19-23
Figure 1: Design Elements for a Health Insurance Scheme Feasibility of Insurance Design and Implementation Insurance Financing options Population coverage Benefits package Provider engage-ment Organiza- tional structure Opera-tional process Monitoring and Evaluation
Objectives of this Element • Identify different types of populations to be covered by health insurance (the beneficiaries) • Determine how to plan for the expansion of health insurance to new beneficiary groups • Understand the factors that need to be considered when expanding health insurance to new beneficiary groups
Universal Coverage • Population coverage • Benefit coverage • Trade-off between population coverage and benefit coverage
Trade-off between Population and Benefit Coverage Benefit coverage Population coverage
Adverse Selection • When potential consumers know their own risk levels but insurers are unable to distinguish among risks • High-risk consumers are able to purchase insurance at a premium that is based on a lower-risk group • Death Spiral can happen due to adverse selection (Rothschild & Stiglitz 1976, Feldstein 1993, Pauly 1999)
Figure 1: Design elements for a health insurance scheme Feasibility of Insurance Design and Implementation Insurance Financing options Population coverage Benefits package Provider engage-ment Organiza- tional structure Opera-tional process Monitoring and Evaluation
System Equity • Financial contributions based on wealth- vertical equity in financing • Service utilization based on need - horizontal equity in service
Discussion Questions • Is it possible to increase both population and benefit coverage without increasing the total financing resources and how to do it? • How can we mitigate/eliminate adverse selection? • What other options exist to identify groups in the population-service matrix?
