Risk and poverty are inextricably linked. Susceptibility to risk is a defining feature of what it means to be poor. Poor people often live in environments characterized by high weather and disease risk, and it is poor households that have the fewest tools to deal with drought, floods, and disease when they occur. Breaking the link between risk and poverty by insuring poor people both lessens the affliction of poverty and allows poor people to participate in income growth. This set of briefs considers how to increase the tools available to poor households to manage agricultural and health risks. The focus is how to develop insurance markets, along with other financial instruments such as credit, savings, and social protection policies. The series does not document the proven impact of insurance markets for the welfare of poor people; rather, it brings together briefs written by businesspeople, policymakers, and researchers that document innovations, lessons learned, and areas of future work and action.
Helping households manage the risks they face is important in reducing poverty in developing countries. All households face health risks, and when health shocks occur, they have a severe impact on people's livelihoods. High costs of treatment are often exacerbated by reduced income due to ill health. In some cases, people must also sell productive assets to pay for medical care. An estimated 1.3 billion people lack access to effective and affordable healthcare. Publicly funded healthcare, in its current form, is an inadequate mechanism for reaching the poor in many countries, in part because most states have limited health budgets. In two-thirds of all low-income countries, one-third of total health expenditures come directly from patients. Although developing countries bear 93 percent of the world's disease burden, people in most of these countries still have few options for insuring against health risks. The disease burden is highly concentrated in low-income groups, and most households have little disposable income to spend on healthcare coverage. Institutional innovations in recent years have begun to address issues of coping with health risks and financing healthcare.
Reducing poverty requires not just the generation of income among the poor, but also the protection of these incomes. Microinsurance offers innovative new ways to combat poverty in India through helping the rural poor systematically manage financial risks to their livelihoods and lives. The microinsurance industry is poised to take off, just as microcredit did a decade ago: 90 percent of the Indian population some 950 million people are not covered by insurance and represent an untapped market of nearly US$2 billion. This enormous missing market is ready for customized life and non-life insurance, but first, serious mismatches between the needs of the insured and the insurers must be overcome, pitting priorities against profits. This study strategically points to the numerous emerging opportunities for energising the rural insurance market, building on robust economic growth, increasing numbers of rural entrepreneurs and recent insurance regulations. Conclusions are based on new evidence from three states in India each with a population the size of some countries which also has policy relevance across the Asia-Pacific region and beyond. The study presents recommendations to realise the potential of this latent market.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Microinsurance - low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements - can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits - both designed to keep these arrangements in business - perversely limited these schemes' ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest.
Poor people in developing countries are often affected by droughts, floods, illness, crop failure, job loss, and economic downturns. Much of their energy goes into coping with these shocks and into day-to-day survival. While insurance and credit markets, combined with widespread social security, provide an important cushion against poverty in rich countries, the need for immediate survival may lock the poor into persistent poverty in developing countries.The poor in developing countries do have informal mechanisms to cope with risk and misfortune. These are based on income diversification, risk avoidance, self-insurance by saving together with family, and community-based mutual assistance. Nevertheless, the scope of these mechanisms remains limited. Repeated individual-specific shocks such as illness or pests, or covariate risks associated with drought, flood, or recession, undermine the ability of individuals and their families to cope withrisk.We now know much more about vulnerability to risk and how poor people cope. Even more importantly, we have learned much about the large long-term consequences of these risks, which condemns many to persistent poverty and excludes them from economic growth. But there is much that can be done. The micro-level studies that underpin this book offer new insights on how effective public action could be more effective in protecting the vulnerable against persistent poverty. Policy should focus onproviding a comprehensive menu of ex-ante and post-crisis protection mechanisms, including new forms of insurance, savings, safety nets, and the means to strengthen the poor's asset base. Local communities have a big role to play: public funds should not be used to replace indigenous community-basedsupport networks; rather they should be used to build on the strengths of these networks to ensure broader and more effective protection.With numerous thematic chapters and case studies of both best practice and of failure, from a mix of low-income and middle-income countries across the developing world, this book evaluates alternatives in widening insurance and protection provision, and makes an important contribution to the topical field of insurance and risk.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populationsand if so, how to do itor to serve them through other means.
Addressing the challenge of covering heath care expenses—while minimizing economic risks. Moral hazard—the tendency to change behavior when the cost of that behavior will be borne by others—is a particularly tricky question when considering health care. Kenneth J. Arrow’s seminal 1963 paper on this topic (included in this volume) was one of the first to explore the implication of moral hazard for health care, and Amy Finkelstein—recognized as one of the world’s foremost experts on the topic—here examines this issue in the context of contemporary American health care policy. Drawing on research from both the original RAND Health Insurance Experiment and her own research, including a 2008 Health Insurance Experiment in Oregon, Finkelstein presents compelling evidence that health insurance does indeed affect medical spending and encourages policy solutions that acknowledge and account for this. The volume also features commentaries and insights from other renowned economists, including an introduction by Joseph P. Newhouse that provides context for the discussion, a commentary from Jonathan Gruber that considers provider-side moral hazard, and reflections from Joseph E. Stiglitz and Kenneth J. Arrow. “Reads like a fireside chat among a group of distinguished, articulate health economists.” —Choice
