General - Dov Chernichovsky

Brechas regionales de la mortalidad infantil en Colombia Marta C. Jaramillo-Mejía, Dov Chernichovsky, José J. Jiménez-Moleón

Objectives. To study the variations in infant mortality rate (IMR) across Colombia’s 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003- 2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

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מאמר זה פורסם בחודש אפריל האחרון בכתב העת המדעי Health Affairs. המגזין רב היוקרה מתפרסם בארצות הברית ומיועד בעיקר לקובעי המדיניות. אף על פי שהמאמר דן במערכת הבריאות הישראלית, נושא שלכאורה אינו רלוונטי עבור מרבית קוראי כתב העת, עורכיו מצאו עניין מיוחד בניסיון הישראלי, שניתן להגדירו כשבירה חסרת תקדים של "כללי המשחק" במימון מערכות בריאות המעניקות ביטוח בריאות ממלכתי. בשל חשיבותו לציבור הרחב ולקובעי המדיניות בישראל, אישרה מערכת העיתון למרכז טאוב – אשר המאמר מבוסס על עבודה שנכתבה במסגרתו – לפרסם ולהפיץ את תרגום המאמר לעברית, ועל כך נתונה לה תודתנו. "

להורדת הפרסום המלא


המאמר פורסם באנגלית במגזין health affairs

Note to the Reader

This working paper is about the concept and evolution of social health insurance. In its final form, the paper is to be published in
Preker, A., Schellekens, O.P., Linder, M., and D. Chernichovsky. Scaling Up Affordable Health Insurance; Staying the Course. To be published by the World Bank.
See Scaling up Affordable Health Insurance: Staying the Course
Consequently, the paper refers to other papers to be eventually published in the book. These papers are not fully referenced below.

  • Country: General
  • # Pages: 36
  • Publication Year: 2012
  • Type of Media: Chapter

ספר זה ניתן להשגה תמורת דמי משלוח (50ש"ח) בלבד.

Scaling Up Affordable Health Insurance

This book takes the reader on a fascinating historical and global voyage of the pivotal role that health insurance played in expanding access to health care and protecting households from the impoverishing effects of illness from the late 19th to early 21st centuries.

During the early evolution of health insurance at the end of the 19th and beginning of the 20th centuries, the nascent health insurance programs were initiated by professional guilds and communities that helped their members and households weather the loss of income from a breadwinner or critical member of the family rather than pay for health care itself.

When medical interventions became more effective in preventing and treating diseases, the European friendly societies and sickness funds also started to pay for health care itself in addition to the income support they provided to households with sick family members. The state initially played only a marginal role in partially subsidizing premiums for the poor or paying for almshouses and poorhouses.

As time progressed, the role of the state in providing health insurance became more prominent, to the point where in some countries, like the United Kingdom and the great experiment in the former Soviet Union, health insurance was—for a period of time—eliminated altogether. In recent years, even such “noninsurance” countries have reintroduced health insurance for complimentary, supplementary, and even primary coverage.

Although some developing countries tried to leapfrog this process and introduce national health systems or national health insurance programs without fi rst building the social and physical infrastructure that is needed for such systems to work, most low- and middle-income countries are retracing the historical experiences of Europe, North America, and Australia.

The contributing authors conclude this book with a proposal for a new paradigm for health insurance—a pluralistic multipillar system in which both the private sector and the state play a crucial role and in which expansion of health insurance coverage is accompanied by a parallel investment in service delivery to ensure that lofty ideals about equity are matched by access to quality services
on the ground.

I congratulate the contributing authors for the overarching research that went into this volume and the invaluable lessons for developing countries trying to improve health care for their populations.

Willem van Duin
Chairman of the Executive Board of Directors, Achmea
Member of the Board, International Federation of Health Plans

  • Country: General
  • Publication Year: 2013
  • Type of Media: Book