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Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. This paper reports the results of a cluster randomized control trial in which 3,000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance; a voucher entitling eligible household members to 25 percent off their annual premium; and both. The four groups were balanced at baseline. In the control group, 6.3 percent (82/1296) of individuals were enrolled in the endline, compared with 6.3 percent (79/1257), 7.2 percent (96/1327), and 7.0 percent (87/1245) in the information, subsidy, and combined intervention groups; the adjusted odds ratios were 0.94, 1.12, and 1.15, respectively. Only among those reporting poor health were any significant intervention effects found, and only for the combined intervention: an enrollment rate of 16.3 percent (33/202) compared with 8.3 percent (18/218) in the control group, and an adjusted odds ratio of 2.50. The results suggest limited opportunities to raise voluntary health insurance enrollment through information campaigns and subsidies, and that these interventions exacerbate adverse selection.

Communities & Human Settlements --- Health Economics & Finance --- Health Law --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Housing & Human Habitats --- Law and Development --- Social Health Insurance --- Voluntary Enrollment

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Out-of-pocket payments (OOPs) are direct (at the point of service) financial contributions or co-payments by patients and their families associated with consumption of medical products (such as medicines) and/or services. They can be formal as well as informal payments. Together with taxation, social and private health insurance contributions, they constitute the main sources of financing for medical products and services in all countries of the world. This policy note looks at prevalence and trends of OOPs in Moldova during 2007-2013, evaluates their impact on the population's economic well-being (section two), identifies key drivers of the current OOPs (section three), and, based on the analysis, suggests several policy options for government's consideration (section four).

Access to Health Services --- Children --- Communicable Diseases --- Doctors --- Employment --- Equity --- Expenditures --- Health --- Health Economics & Finance --- Health Insurance --- Health Outcomes --- Health Policy --- Health System Performance --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Human Development --- Insurance --- International Comparisons --- Internet --- Living Standards --- Migration --- Nurses --- Pharmacies --- Population --- Poverty --- Price Elasticity --- Private Health Insurance --- Private Sector --- Public Health --- Quality Control --- Social Health Insurance --- Social Insurance --- Unemployment --- Workers

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This report analyzes equity and financial protection in the health sector of Zambia. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2007 Zambia demographic and health survey, the 2006 Zambia living conditions monitoring survey, the 2003 Zambia world health survey and the 2003 Zambia national health accounts. All analyses are conducted using original survey data and employ the health modules of the ADePT software. Overall, health care financing in Zambia in 2006 was fairly progressive, id est the better-off spent a larger fraction of their consumption on health care than the poor. The financing sources that contribute to the overall progressivity of health care finance are general taxation, which finances 42 per cent of domestic spending on health, and contributions made by private employers, which finance 9 per cent of spending. An additional contribution to overall progressivity is made through pre-payment mechanisms, but this remains fairly limited given that they only represent 1 per cent of total health finance. Out-of-pocket health payments, which account for 47 per cent of total health financing, appear to be proportional to income, with only slight and not statistically significant evidence of progressivity.

Breast Cancer --- Cervical Cancer --- Child Health --- Cost-Effectiveness --- Diabetes --- Diarrhea --- Disease Control & Prevention --- Doctors --- Employment --- Gender --- Health Economics & Finance --- Health Finance --- Health Insurance --- Health Monitoring & Evaluation --- Health Outcomes --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hiv/Aids --- Hospitals --- Human Resources --- Infant Mortality --- International Comparisons --- Living Standards --- Malaria --- Measles --- Mortality --- Nutrition --- Obesity --- Physicians --- Polio --- Poverty Reduction --- Private Health Insurance --- Private Sector --- Public Health --- Public Hospitals --- Public Sector --- Social Health Insurance --- Social Insurance --- Specialists --- Tuberculosis --- Violence --- Workers

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The health equity and financial protection reports are short country-specific volumes that provide a picture of equity and financial protection in the health sectors of low- and middle-income countries. Topics covered include: inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. This report analyses equity and financial protection in the health sector of Mongolia. In particular, it examines inequalities in health outcomes and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2005 Mongolia multiple indicator cluster survey and the 2007-08 Mongolia household socio-economic survey.

Breast Cancer --- Cervical Cancer --- Child Health --- Diabetes --- Diarrhea --- Disasters --- Doctors --- Gender --- Health Economics & Finance --- Health Finance --- Health Insurance --- Health Outcomes --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Infant Mortality --- Living Standards --- Malaria --- Measles --- Mortality --- Nurses --- Nutrition --- Obesity --- Polio --- Population Policies --- Poverty Reduction --- Private Health Insurance --- Private Sector --- Public Health --- Public Hospitals --- Public Sector --- Quality of Health Care --- Social Health Insurance --- Social Insurance --- Tuberculosis --- Violence

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This series is produced by the Health, Nutrition, and Population family (HNP) of the World Bank's Human Development Network (HDN). The papers in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The cost of a health insurance program will largely be determined by the size and composition of the covered population, the benefit package, cost sharing arrangements, the current and future supply of health care providers and facilities, and the provider payment mechanisms used. This note summarizes in broad strokes the subset of the possible Universal Coverage (UC) transition scenarios and their related costs in Indonesia. These scenarios were selected based on initial discussions with key stakeholders, and further broad-based discussion with stakeholders will be needed to finalize the design, financing and transition options. This note shows how decisions regarding the transition steps, benefit package and the choice of eligible population affect public Health Insurance (HI) expenditures as Indonesia transitions to UC. This work follows closely the earlier World Bank report health financing in Indonesia; a road map for reform.

Abortion --- Administrative Costs --- Burden of Disease --- Capital Costs --- Child Care --- Child Health --- Cities --- Cost Sharing --- Decision Making --- Developing Countries --- Doctors --- Employment --- Epidemiology --- Expenditures --- Gross Domestic Product --- Health Economics & Finance --- Health Insurance --- Health Monitoring & Evaluation --- Health Outcomes --- Health Policy --- Health Systems Development & Reform --- Health, Nutrition and Population --- Hospitals --- Human Resources --- Informal Sector --- Managed Care --- Maternal Health --- Midwives --- Moral Hazard --- Mortality --- Natural Resources --- Nutrition --- Physicians --- Population Policies --- Private Health Insurance --- Public Health --- Public Hospitals --- Public Spending --- Quality Control --- Social Health Insurance --- Surgery --- Urban Areas --- Vulnerable Groups --- Workers --- World Health Organization