Social Reinsurance: A New Approach to Sustainable Community Health Financing

Abstract

This volume treats community-based microinsurance as an incremental first step to improved financial protection and access to health services for poor, rural, and informal-sector workers. It challenges the ability of low- and middle-income countries to leapfrog the long developmental process needed to build among excludedpopulation segments the trust in central government-run schemes that could extend coverage to the whole population as a big-bang top-down endeavor.

In the meantime, governments could introduce more pro-poor policies that would build on existing social capital to strengthen community action in securing financial protection against the cost of illness. Enhanced access to needed health care would occur by:

* Encouraging and supporting the development of insurance and reinsurance mechanisms at the community level that can protect against expenditure variance and enlarge the effective size of the risk pool;

* Increasing targeted subsidies to pay for the insurance and reinsurance premiums of low-income populations (in part or in full);

* Including the use of prevention and case-management techniques to avoid unnecessary expenditure variance, notably through provision of benefits with high externalities;

* Providing technical assistance to strengthen the schemes' management capacity; and

* Forgoing stronger links between microinsurance units and the benefits of existing formal financing and provider networks.

Keywords: micro health insurance, social insurance, insurance for the poor, community based health insurance, health financing