Preface

Health insurance is the mechanism used to respond to uncertainty and the risk of the consequences of illness. Health systems, which aim to promote population health and prevent people from financial collapse, are the umbrella structures that accommodate health insurance in each country. The variety of health systems around the world is large and each has its own features. There are public and private health insurances, voluntary or compulsory, and those financed by taxes, social compulsory contributions, or direct payments.

Differences in health insurance are significant between low-middle- and high-income countries. These differences mainly arise from the differences in the ability to finance the health insurance system. While high-income countries are typically able to finance and fund the provision of health care, low-medium-income countries face difficulty. Another challenge for these countries is the provision of universal health coverage (UHC), which is the United Nations' Sustainability Development Goal Target 3.8. As such, several countries are redesigning their health systems and focusing on strengthening them to support the priority of providing UHC.

This book discusses the path to redesign and reform health systems to achieve UHC. It is argued that the health insurance system plays a role in the move toward UHC. This progress may be financed by a combination of taxes and social health insurance contributions, as described in Chapter 1, "Toward Universal Health Coverage: The Role of Health Insurance System". The collected funds from these two sources are to be used in providing a basket of basic health care to satisfy population needs. Chapter 2, "The Advantage of Single-Payer National Insurance", also examines the problem of funding UHC in low-medium-income countries. It discusses different funding alternatives and describes the advantages of a single-payer national health insurance system, which is well-suited for those countries.

In low-medium-income countries, providing UHC under a health insurance system may be problematic because of the significant share of people who have very low incomes or work in the informal sector. Chapter 3, "Health Insurance for Economically Disadvantaged People in LMICs: What are the Best Options?", discusses the inequities emerging in these cases. This chapter proposes some measures to respond to this problem related to large informal sectors and a large share of poor people in the economy and society. Chapter 4, "National Health Insurance, the Informal Sector, and Elements of a New Social Contract in the 2019 UHC Act of the Philippines", presents the example of the Philippines and analyzes the different elements of the social contract for this country. Some of these elements may enhance or break down relationships in informal sector health insurance so that greater health security may be provided within the social contract context. Another area of concern within health systems is the allocation of funds and purchasing of services. Chapter 5, "An Assessment of the Effect National Health Insurance Scheme Capitation Payment to the Healthcare Facilities in Yobe State", presents a case study from Nigeria, the conclusions of which point

to the benefits of the capitation payment mechanism. These benefits will increase competition among providers, reduce out-of-pocket payments, and guarantee the quality of services.

In high-income countries, the problems arising from providing UHC are different from those faced by low-middle-income countries. Chapter 6, "Complementary Health Insurance in Slovenia", presents the case for Slovenia. This country provides UHC financed by a compulsory contribution and a complementary health insurance scheme. The chapter examines the advantages and disadvantages of this special dual financing system. Chapter 7, "Voluntary Private Health Insurance Demand by Older People in a National Health Service, the Case of Portugal", presents the example of Portugal, which has a national health service financed by taxes and provides a UHC. The system faces some difficulties in ensuring the provision of UHC, and private voluntary health insurance is often a possible alternative. However, this alternative is quite limited to seniors. The chapter analyzes the main determinants for Portuguese seniors to buy private voluntary health insurance. Chapter 8, "Health Insurance in the United States: Failure of Private and Multi-Payer Financing", outlines the history of health insurance in the United States since the 1930s. It concludes that the not-forprofit and public single-payer Medicare for All can provide comprehensive coverage based on health care as a human right at affordable costs. Chapter 9, "Value-Based Contracting in Health Care", returns to the topic of concern within health systems about the allocation of funds and purchasing of services in the United States and other high-income countries. The issue examined in this chapter is the risk sharing between providers and payers using value-based contracting. These types of contracts ought to account for aspects such as prices, risk sharing, and outcome evaluation. Finally, Chapter 10, "Socio-Economic Considerations of Universal Health Coverage: Focus on the Concept of Health Care Value and Medical Treatment Price", examines the relationship between the progress of UHC and the socioeconomic factors promoting the sustainable development of health insurance systems. Based on this discussion, the chapter sets out the case of Japanese private clinical practices along with the consideration of the relationship between value and price, which is key to the future development of medical insurance systems.

> **Aida Isabel Tavares** ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal

> > CEISUC - Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal

> > > **1**

Section 1

Universal Health Coverage

Section 1
