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This paper draws lessons from anti-fraud experiences in social health insurance programs of six selected countries across the income spectrum: Indonesia, the Philippines, Republic of Korea, Croatia, Turkey, and the United States. A standardized questionnaire was used to collect information on how the programs prevent, detect, and deter fraud. The questionnaire was supplemented by a literature review and conversations with key informants. The analysis summarizes similarities and differences in the legal framework, institutional mechanisms, and capacity to manage fraud. Across all countries, the primary responsibility for managing fraud lies with the public entity that administers the program. In terms of capacity, all program-administering agencies have dedicated anti-fraud units and staff. In addition, all countries have specific anti-fraud policies and guidelines that address fraud and have a clear operational and legal definition of fraud. In terms of preventing fraud, the use of pre-authorization screening for high-end procedures is common. For detecting fraud, most countries use anti-fraud 'hotlines' and encourage other forms of reporting of suspected fraudulent behavior; the use of 'red flags'-triggers that identify suspicious claims based on deviations from norms, is also common. The level of sophistication in using data analytics to detect potential fraud, however, varies across countries. Social health insurance programs in higher-income countries are more likely to use advanced statistical and data-mining techniques compared to those in lower-income countries. All programs across all countries undertake post-reimbursement medical claims and beneficiary audits. In terms of deterring fraud, sanctions often include the use of financial penalties, cancellation of contracts, and criminal prosecutions; however, in most countries, public providers are not penalized and prosecuted to the same degree as private providers.
Administrative procedures --- Crime and society --- Fraud --- Health care services industry --- Health economics and finance --- Health insurance --- Health, nutrition and population --- Industry --- Poverty reduction --- Services and transfers to poor --- Social accountability --- Social development --- Social health insurance
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This report is an output of the Better Regulation for Growth Program between the Dutch Ministry of Foreign Affairs, the UK Department for International Development (DFID) and IC, the Investment Climate Advisory Services of the World Bank Group. The reports identifies a set of minimum requirements for a well-functioning Ria light system that is tailored to the requirements of developing countries. Embracing the overall objectives and relevance of RIA, the paper explores the fundamental set of building blocks and activities required to establish and maintain a RIA light system, taking into account what it is considered as good practice. The paper argues that the following five basic criteria have to be in place for a functioning RIA system, which is referred to as "RIA light": 1) political commitment to establish and operate an effective and self sustaining RIA process; 2) a unit or group of regulatory reformers - preferably based in a central area of government - which oversees, comments and reports on the quality of regulatory proposals before decisions are made about regulation; 3) clear and consistently applied criteria and rules employed to screen regulatory proposals; 4) a transparent regulatory policy development process, which includes consultation with stakeholders; and 5) a capacity building program, involving preparation of guidelines; training of officials preparing RIA and facilitating the required cultural changes, and establishing monitoring, evaluation and reporting systems.
Administrative & Regulatory Law --- Administrative Procedures --- Advisory Services --- Corruption & anticorruption Law --- Cost-Effectiveness --- Economic Development --- Education --- Governance --- Knowledge for Development --- Law and Development --- Legislation --- National Governance --- Private Sector Development --- Public Hearings --- Public Policy --- Regulations --- Regulators --- Regulatory Agencies --- Technical Assistance
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The authors estimate the impact of aggregate indicators of "soft" and "hard" infrastructure on the export performance of developing countries. They build four new indicators for 101 countries over the period 2004-07. Estimates show that trade facilitation reforms do improve the export performance of developing countries. This is particularly true with investment in physical infrastructure and regulatory reform to improve the business environment. Moreover, the findings provide evidence that the marginal effect of infrastructure improvement on exports appears to be decreasing in per capita income. In contrast, the impact of information and communications technology on exports appears increasingly important for richer countries. Drawing on estimates, the authors compute illustrative exports growth for developing countries and ad-valorem equivalents of improving each indicator halfway to the level of the top performer in the region. As an example, improving the quality of physical infrastructure so that Egypt's indicator increases half-way to the level of Tunisia would increase exports by 10.8 percent. This is equivalent to a 7.4 percent cut in tariffs faced by Egyptian exporters across importing markets.
Administrative procedures --- Benefit analysis --- Cartels --- Comparative Advantage --- Decision making --- Econometric estimates --- Economic activity --- Economic development --- Economic Growth --- Economic Theory & Research --- Empirical evidence --- Empirical research --- Environment --- Environmental Economics & Policies --- Free Trade --- Highways --- International Economics and Trade --- Macroeconomics and Economic Growth --- Metals --- Real wages --- Resource allocation --- Returns to scale --- Roads --- Trade Policy --- Transaction costs --- Transparency --- Transport --- Transport Economics Policy & Planning --- True
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This paper looks at the evidence on the magnitude and impacts of forest illegal acts, examines the vulnerabilities of the forest sector, and proposes a strategy for combating forest crime. Forest crime prominently includes illegal logging but acts against the law also affect other sector operations such as forest products transport, industrial processing, and trade. Almost universally, criminal exploitation of forest products and commerce prevail as large amounts are unlawfully harvested, traded against regulations in domestic markets or smuggled across borders, often with the willing participation of corrupt forest service officials and border police. Illegal activities do not stop at the forest. They travel down the line to operations related to transportation, national and international trade of forest products. A particular form of illegal forest activity, corruption, has come to the forefront of the international debate on forests and is now being openly discussed in various fora because of the increasing awareness of the immense costs associated with it. In this paper, corrupt deeds are illegal actions that:(i) engage public officials; (ii) involve public property and power; (iii) are perpetrated for private gain; (iv) are intentional acts; and (v) are surreptitious. Illegal activities are main threat to global resources. A wide variety of illegal acts, including, among others, illegal logging, illegal trade, arson and unauthorized occupation of forestlands, take place in all kinds of forests, in developing and industrialized economies. Often illegal activities are associated with corruption, involving the willing participation of government officers, usually in complicity with parties of the private sector, in schemes to abuse public property. Illegal acts generate a number of undesirable economic impacts, harm the environment and the most vulnerable sectors of society. To conclude, the improvement of the policy and legislative framework and the proper enforcement of the law may be the most important issue in the future management of forest resources worldwide.
Administrative Procedures --- Agriculture --- Audits --- Biodiversity --- Cartels --- Competition --- Credit --- Debt --- Decision Making --- Deforestation --- Degradation --- Economic Development --- Economics --- Environment --- Environmental Economics & Policies --- Environmental Impact Assessments --- Equity --- Forestry Management --- Forests --- Incentives --- Land --- Land Reform --- Law and Development --- Logging --- Natural Resources --- Political Economy --- Property Rights --- Public Hearings --- Public Sector Development --- Taxes --- Timber Industry --- Trade --- Trees --- Water Pollution --- Wildlife Resources
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The authors estimate the impact of aggregate indicators of "soft" and "hard" infrastructure on the export performance of developing countries. They build four new indicators for 101 countries over the period 2004-07. Estimates show that trade facilitation reforms do improve the export performance of developing countries. This is particularly true with investment in physical infrastructure and regulatory reform to improve the business environment. Moreover, the findings provide evidence that the marginal effect of infrastructure improvement on exports appears to be decreasing in per capita income. In contrast, the impact of information and communications technology on exports appears increasingly important for richer countries. Drawing on estimates, the authors compute illustrative exports growth for developing countries and ad-valorem equivalents of improving each indicator halfway to the level of the top performer in the region. As an example, improving the quality of physical infrastructure so that Egypt's indicator increases half-way to the level of Tunisia would increase exports by 10.8 percent. This is equivalent to a 7.4 percent cut in tariffs faced by Egyptian exporters across importing markets.
Administrative procedures --- Benefit analysis --- Cartels --- Comparative Advantage --- Decision making --- Econometric estimates --- Economic activity --- Economic development --- Economic Growth --- Economic Theory & Research --- Empirical evidence --- Empirical research --- Environment --- Environmental Economics & Policies --- Free Trade --- Highways --- International Economics and Trade --- Macroeconomics and Economic Growth --- Metals --- Real wages --- Resource allocation --- Returns to scale --- Roads --- Trade Policy --- Transaction costs --- Transparency --- Transport --- Transport Economics Policy & Planning --- True
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This paper looks at the existing tools and approaches most commonly used in developed and developing countries to review the stock of regulations. The tools reviewed can generate benefits in the short term, but they are most effective as part of a longer-term sustained initiative. This paper has a particular focus on the challenges that arise from their use in emerging and developing countries. The objectives of this paper include: 1) explaining the rationale for the use of these tools and approaches; 2) discussing each one of them in a succinct way; 3) considering the extent to which these tools can support more systemic regulatory reforms in the medium and long terms; and 4) considering the particular challenges and opportunities regarding their use in developing and emerging economies. Section one is a brief description of the rationale and context for applying tools and approaches to review the stock of regulation. It includes a reference to benefits and preconditions to make use of these tools. It also presents a categorization of the most commonly used tools and a comparative table on the way these tools can be applied. Section two presents a description of each of the different tools and approaches available, and discusses the way they are used and their main components. It includes references to international experiences in which these tools have been integrated into the regulatory reform process. Section three presents preliminary commentary about some of the potential advantages, disadvantages, and impacts of using these tools and approaches in developing countries. Some particular cases are presented to illustrate these trends. The section also includes a short description of the sequence observed in the use of some of these tools. Moreover, this section illustrates how these tools can (or cannot) generate gains in the short term and also provide a basis for further and broader regulatory reform programs.
Administrative & Regulatory Law --- Administrative Costs --- Administrative Procedures --- Advisory Services --- Burden of Proof --- Bureaucracy --- Business Environment --- Civil Liberties --- Corruption --- E-Business --- E-Government --- Economic Development --- Information Technology --- Innovation --- Insurance --- Law and Development --- Legislation --- Legislative Process --- Macroeconomics and Economic Growth --- Market Economy --- Political Will --- Private Sector --- Private Sector Development --- Public officials --- Regulators --- Rule of Law
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In this first working paper the authors present and compare systems of indicators of regulatory quality, analyzing their conceptual underpinnings, technical properties, and usage by governments, stakeholders and academics. After having discussed the datasets and the types of data available, they authors consider a set of critical aspects related to the design, data gathering and utilization of indicators, providing suggestions for improvement. The authors' major findings and proposals are the following: systems of indicators have been developed ad hoc, by organizations pursuing different objectives over time and across the world. Conceptual underpinnings, modalities of data-gathering, and types of usage reflect different operationalizations of regulatory quality. In the construction of regulatory indicator datasets, the first essential step is to gauge the quality of data, in order to construct insightful and meaningful measurements. Especially in developing countries, the consideration of the quality of data is preliminary to any technical and statistical discussion on how to treat data. Western governments tend to use single measures with the specific purpose of improving methods of regulatory analysis (through studies that analyze the conduct of regulators). The authors have not found systematic attempts to measure how regulatory reform is changing the attitudes towards regulation of regulators and policy officers who develop legislation. Aggregation should reflect basic technical rules, but more importantly, it should be performed in a way that conveys messages to those who are supposed to make use of the composite measures. To illustrate, if the goals of regulatory reform are institutionalization, economic growth, accountability, interaction with the stakeholders and communication, aggregation should be performed along these four dimensions, not in relation to abstract technical properties.
Accountability --- Administrative Costs --- Administrative Procedures --- Advisory Services --- Business Development --- Business Environment --- Common Law --- Corruption --- Cost-Benefit analysis --- Cost-Effectiveness --- Data Collection --- Decision Making --- Disclosure --- Financial Management --- Good Governance --- Governance --- Governance Indicators --- Investment Climate --- Legal Framework --- Legislation --- Macroeconomics and Economic Growth --- National Governance --- Per Capita Income --- Political Institutions --- Private Sector Development --- Public Policy --- Public Sector --- Quality Assurance --- Regulators --- Rule of Law --- Statistical analysis --- Transparency
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This paper looks at the role and design of regulatory reform institutions in developing countries. These institutions are classified into four broad types: 1) regulatory reform units, commonly known in Organization for Economic Cooperation and Development (OECD) countries as oversight bodies for regulatory reform; 2) high-level committees for regulatory reform, established in some countries to leverage support and take decisions at a high political level; 3) advisory and/or advocacy bodies in charge of proposing improvements to the regulatory system by strengthening coordination and consultation mechanisms and by promoting the regulatory reform agenda; and 4) Ad hoc institutions for regulatory reform, established to launch regulatory reform efforts and to work on a single defined task or activity. This paper is divided into the following sections: section one briefly reviews the theoretical debate and literature about the role of institutions in facilitating higher economic growth, focusing in particular on regulatory institutions and their relevance in developing countries; section two discusses the main features of regulatory reform institutions at the center of government, namely regulatory oversight bodies, high level committees, advocacy and/ or advisory bodies and ad-hoc institutions for regulatory reform; and section three identifies the features of these institutions that are considered to be best practice. Section three also identifies and discusses lessons learned and the implications for establishing and operating such institutions in developing country contexts.
Accountability --- Administrative Procedures --- Administrative Reform --- Advisory Services --- Bureaucracy --- Business Environment --- Business Regulation --- Children and Youth --- Consensus --- Corruption --- Decision Making --- Economic Development --- Good Governance --- Governance --- Governance Indicators --- Human Resources --- Investment Climate --- Judiciary --- Local Government --- National Governance --- Political Economy --- Political Instability --- Political Will --- Private Sector Development --- Public Sector --- Regulators --- Regulatory Agencies --- Social Development --- Transparency --- Vested Interests --- Violence
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Over the last few years the Standard Cost Model (SCM) has become the regulatory reform tool of choice in European Union (EU) and Organization for Economic Co-operation and Development (OECD) countries for identifying and reducing regulatory compliance costs. SCM provides a relatively simple methodology to measure and communicate businesses' paperwork obligations arising from compliance with governments' regulations. More recently the SCM has also been adapted and applied in a number of developing countries, including Kenya, Zambia, Vietnam, Burkina Faso, and Rwanda. It is still too early days to conclude much on the SCM model's general applicability in developing countries. However as part of a broader reform package the SCM has proven capable of strengthening momentum by providing new insights into regulatory obligations, by quantifying the costs and time associated with information obligations both at aggregate and at a rule-specific level. It has hence proven useful both as a tool to target specific interventions and to monitor the impact of reform. This document provides a number of lessons from the first few years of using SCM in regulatory reforms, with a focus on business licensing, in developing countries. These lessons are not intended to provide a final account on how SCM is to be carried out in developing countries. Along with its dissemination across the globe, SCM has experienced a constant development. This document aims to point out a number of important issues that have been observed and tested during the initial measurements in World Bank client countries to prevent future practitioners from the need to re-invent the wheel.
Administrative Costs --- Administrative Procedures --- Advisory Services --- Best Practices --- Business Environment --- Business in Development --- Business Regulation --- Capacity Building --- Customization --- Data Collection --- Decision Making --- E-Business --- Economies of Scale --- Education --- Enterprise Surveys --- Focus Groups --- Knowledge for Development --- Legislation --- Outsourcing --- Private Sector Development --- Productivity --- Project Management --- Public Policy --- Public Sector --- Quality Assurance --- Quality Control --- Regulators
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Twenty years after the end of the war, Bosnia and Herzegovina (BiH) has yet to achieve shared prosperity for its citizens and approach European living standards. The country has been at peace since the end of 1995, but its development model needs adjustment if it is to join the ranks of prosperous European economies. BiH has a disproportionately large public sector that dates back to Yugoslav times and has only been partly reformed since, and the constitutional arrangements under the Dayton and Washington Agreements had as their aim the cessation of war rather than the explicit goal of building a viable and efficient state. Financial inflows, particularly aid and remittances, have been fueling consumption-based economic growth. These inflows were important in post-war recovery, and propelled the country back to middle-income status. However, reaching high levels of income, creating prosperity and eliminating poverty will only happen if BiH shifts toward an economic model that builds on international integration, especially with the EU, BiH's most important trading partner and anchor of institutional reform. BiH needs to rebalance its development model in two fundamental ways in order to succeed. First, it needs to unleash the potential of the private sector while reducing the footprint of the very large public sector. Second, the economy needs to shift from an inward focus driven by local consumption and imports to the potential of international integration through investments and exports. To achieve this country needs more (and larger) companies, vibrant small and medium sized enterprises and a business environment that allows them to grow and expand output, employment, and exports.
Administrative Procedures --- Air Pollution --- Air Quality --- Audits --- Capital Markets --- Carbon Dioxide --- Climate Change --- Coal --- Credit --- Debt --- Debt Markets --- Decision Making --- Deforestation --- Demographics --- Developed Countries --- Drinking Water --- Economic Development --- Economic Growth --- Emissions --- Energy Consumption --- Energy Efficiency --- Environment --- Environmental Economics & Policies --- Equity --- Expenditures --- Finance and Financial Sector Development --- Fossil Fuels --- Health Monitoring & Evaluation --- Health, Nutrition and Population --- Incentives --- Labor Costs --- Land --- Logging --- Macroeconomics and Economic Growth --- Natural Resources --- Political Economy --- Population Growth --- Property Rights --- Purchasing Power --- Risk Management --- Securities --- Tariffs --- Taxes --- Trade --- Unemployment --- Wages
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