Essays on International Health Economics: The Role of Health Insurance in Health Care Financing in Low- and Middle-Income Countries

Abstract: The thesis consists of an introductory chapter and four independent research papers, summarized as follows. The introductory chapter discusses the role of economics in international health and the policy contributions of each of the particular papers. In addition, the data and the methods that have been used are discussed. Paper I, entitled Community-based health insurance in low-income countries: a systematic review of the evidence, assesses the evidence base for the extent to which community-based health insurance schemes in low-income countries mobilize resources and provide effective protection. Findings suggest that the evidence base is weak and that these schemes raise little resource and provide only moderate protection. Paper II, Catastrophic Health Payments and Health Insurance in Zambia: The Problem to the Answer, assesses the extent to which health care prepayment in Zambia provide protection against the catastrophic effects of health payments compared with paying for care out-of-pocket. The results indicate that prepayment does not provide such protection and that prepayment may even induce catastrophic effects due to its effect on the demand for care. The third paper, Multiple Health Insurance Availability, Health Care Utilization, and Expenditures: Evidence from Jordan, looks at various health insurance programs in Jordan. The analysis suggests that the effect of insurance on utilization and expenditures differ significantly across the various insurance types. Also, the effect of the programs differs across income groups. The final paper, A Note on Insurance Premiums, Price Differentiation, and Moral Hazard, is a theoretical note on insurance premium setting and moral hazard. It is shown that allowing insurance premiums to reflect insurers? ability to pay rather than marginal costs and risks will lead to market inefficiencies. The model and its findings have policy implications in, for example, poor settings where an insurer lets premiums differ so as to not exclude the poorest sections of the population.