Professional Documents
Culture Documents
I Nyoman Sutarsa
Email: sutarsa_71@yahoo.com
0878 6038 0028
Insurance
Reducing risk of
financial loss
Vs.
Security
Promoting ‘wealth’
through systematic
approach
PROFIT SHARING???
Types and Models
Types of Health Model of Health
Insurance Insurance
1. Tripartite Relationship
1. Social Health Model (Insurance
Insurance Providers – Health
2. Private Voluntary Providers – Members)
Health Insurance 2. Bipartite Relationship
3. Regulated Model (Health
Insurance Providers
Voluntary Health
with HMO –
Insurance Members)
Tripartite Relationship Model
Insurance
Providers
Premium Pay
Claim Claim
Ex. USA
Health
Members
Pay Providers
Services
Pay
Health
premium Insurance
Members
Providers
Services
with HMO
1. Tripartite Relationship
1. Social Health Model (Insurance
Insurance Providers – Health
2. Private Voluntary Providers – Members)
Health Insurance 2. Bipartite Relationship
3. Regulated Model (Health
Insurance Providers
Voluntary Health
with HMO –
Insurance Members)
Social Health Insurance (ex. Germany)
Principles Issues
1. Voluntary 1. Health is viewed as ‘social’
service universal
2. Premium based on 2. History: from industrial
income sectors
3. Comprehensive 3. Pool of funding improved
services services and facilities
4. Health compensation 4. Group rating (similar needs
and risks)
provided (for workers) 5. Gradual (ex. Types of risk
5. Government’ roles (Japan, Germany) or numbers
dominant of workers (South Korea)
Private Voluntary Health Insurance (ex. USA)
Principles Issues
1. Voluntary 1. Actuarial analysis based on
2. Premium is absolute individual risks
number based on 2. Highly competitive lots of
provider resulting in lower
contract
members
3. Not comprehensive 3. Risk rating ‘benefit
services (based on package’ (reimbursement or
contract) health benefit package)
4. Government’ roles 4. Adverse/bias selection often
5. Orientation is profit
limited
Regulated Private Voluntary Health Insurance
Principles Issues
1. Voluntary 1. Community rating to prevent
2. Premium is absolute the increase of healthcare
number based on cost
2. Primary purpose is to
contract
complement Social Health
3. Not comprehensive Insurance
services (based on 3. Preventing adverse/bias
contract) selection
4. Government’ roles 4. Primary target is middle to
high income people
dominant
Component SHI PVHI RPVHI
Government +++ + ++
roles
Social Health Insurance
complemented by Regulated Private
Voluntary Health Insurance with
adjustment based on local context
National Health
System