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New World Bank publication Scaling up Affordable Health Insurance –Staying the Course

Apr 6, 2013

Good health care for the poor is unaffordable without insurance. Mobilizing resources for needed health services, protecting populations against financial risk, and spending wisely on providers is the central topic of the new World Bank publication Scaling up Affordable Health Insurance –Staying the Course.

The book edited by Alexander Preker, Marianne E. Lindner, Dov Chernichovsky and Onno P. Schellekens was launched March 28 at the World Bank Conference Scaling up Health Insurance and Financial Protection in Health at the International Finance Corporation in Washington D.C.

Insurance has caught the attention in recent years as a way to achieve access to affordable health care, also for the very poor. There has been a flurry of publications and more African countries are implementing insurance schemes. The book is the fifth volume in a series on in-depth reviews of the role of healthcare financing in improving access to good care for everyone. A previous publication -Global Market Place for Private Insurance – Strength in numbers (by Preker, Schellekens and Peter Zweifel)- was the most downloaded publication at the bank’s website, said Alexander Preker, the retiring head of Health Industry and Investment Policy at the World Bank Group, at the book launch. 

The research in this book show that insurance plans -properly designed and coupled with public subsidies, effective regulation and quality standards- can deliver quality care for poor and middle-class households. The volume contains chapters on major policy challenges to create the conditions for scaling up health systems, case studies from the ground from around the world, and research on the challenges in implementation.

“During the past century, health insurance has played a major role in financing health care and protecting people from the financial hardships of illness in Western Europe and other developed regions of the world. This book provides a unique and comprehensive review of the political, economic and the institutional challenges that low- and middle-income countries face in scaling up health insurance coverage and benefits for their populations”, said Kees Storm, chairman of the Health Insurance Fund in an endorsement for the book.

The editors explain the laws of health economics. There is a tight relation between Gross Domestic Product per capita and healthcare expenditures (the first law of health economics), which means that an influx of donor money into the public health sector in a low-income country will not raise the total amount of money in the health system. The extra funding crowds out private funds or substitute for existing local public expenditures (third law of health economics). In poor countries out-of-pocket payments will be high (the second law of health economics), easily pushing people into poverty when they need care.

“People do not trust the providers’ quality will improve. A lack of demand doesn’t encourage investment, while in dysfunctional states run by elites the extra money for health doesn’t benefit the poor”, said Onno Schellekens, managing director of the PharmAccess Group. A different approach is needed, the editors argue, to lower the overall risk. This can be achieved by making the ‘unknown risk of transactions known’ through the leverage of local, existing institutions, social capital, and private sector expertise.




On 12 September 2016, OPIC, Calvert Foundation and two private investors announce expansion
PharmAccess and its German consultancy partner GFA have won a 27.3 million Euros tender from the German development bank KfW to improve access to healthcare for low-income pregnant women in 5 regions of Tanzania.
President Felipe Nyuse of Mozambique officially opened the University Clinic


A population-based study
Date: September, 2015

Research findings on Health Insurance Fund supported programs

Date: February, 2015