This article discusses the role of private health insurance (PHI) in developing countries. Three broad regional clusters are identified that share similar characteristics and policy challenges for the effective integration of private insurance into national health care systems: (1) Latin America and Eastern Europe, where there are already developed insurance industries facing important market and policy failures; (2) the Middle East/North Africa region and East Asia, where there is a projected strong growth of PHI that needs to be accompanied by efficient regulation; and finally, (3) South Asia and Sub-Saharan Africa, where PHI will only play a marginal role in the foreseeable future while the scaling up of small-scale, nonprofit insurance schemes appears to be of critical importance. Overall, this survey shows that the role of private insurance varies depending on the economic, social, and institutional settings in a country or region. Private health insurance schemes can be valuable tools to complement existing health-financing options only if they are carefully managed and adapted to local needs and preferences.

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Adams, S.
2005
. Vietnam's Health Care System: A Macroeconomic Perspective. Paper prepared for the
International Symposium on Health Care Systems in Asia
, Hitotsubashi University, Tokyo,
January
21-22
.
Ammar, W., H. Fakha, O. Azzam, R. Freiha Khoury, C. Mattar, M. Halabi, D. Aoudat, and K. Srour. 2000. Lebanon National Health Accounts. Geneva: World Health Organization (WHO), Jordan Ministry of Health, and World Bank. www.who.int/nha/docs/en/Lebanon_NHA_report_english.pdf.
Atim, C.
1998
.
Contribution of Mutual Health Organizations to Financing, Delivery, and Access to Health Care: Synthesis of Research in Nine West and Central African Countries
. Partnerships for Health Reform (PHR) Project, Technical Report no. 18. Bethesda, MD: PHR.
Baeza, C. 1998. Taking Stock of Health Sector Reform in Latin America. Working paper. February 19. Washington, DC: World Bank. www.cristian-baeza.com/Papers%20in%20the%20WEB/Taking%20Stock%20of%20Health%20Reform%20in%20LAC.pdf.
Baeza, C., F. Montenegro, and M. Núñez.
2002
.
Extending Social Protection in Health through Community Based Health Organizations: Evidence and Challenges
. Discussion paper, International Labour Organization (ILO), Universitas Programme, Geneva.
Barrientos, A.
2000
. Getting Better after Neo-Liberalism: Shifts and Challenges of Health Policy in Chile. In
Healthcare Reform and Poverty in Latin America
, ed. P. Lloyd-Sherlock,
94
-111. London: Institute of Latin American Studies.
Barrientos, A., and P. Lloyd-Sherlock.
2003
. Health Insurance Reforms in Latin America: Cream Skimming, Equity, and Cost Containment. In
Social Policy Reform and Market Governance in Latin America
, ed. L. Haagh and C. T. Helgo,
183
-199. London: Macmillan.
Campbell, P., K. Quigley, P. Yeracaris, and M. Chaora.
2000
.
Applying Managed Care Concepts and Tools to Middle and Lower Income Countries: The Case of Medical Aid Societies in Zimbabwe
. Data for Decision Making Project, publication 84. Boston, MA: Harvard School of Public Health.
Colombo, F., and N. Tapay.
2004
.
Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems
. Organisation for Economic Co-operation and Development (OECD) Health Working Paper No. 15. Paris: OECD.
Concertation.
2004
.
Inventaire des système d'assurance maladie en Afrique—Synthèse des travaux de recherche dans 11 pays
. Dakar, Senegal: Concertation.
Criel, B.
1998
.
District-Based Health Insurance in Sub-Saharan Africa. Part 2: Case-Studies
. Studies in Health Services Organization and Policy 10. Antwerp: Prince Leopold Institute of Tropical Medicine.
Criel, B., P. van der Stuyft, and W. van Lergerghe.
1999
. The Bwamanda Hospital Insurance Scheme: Effective for Whom? A Study of Its Impact on Hospital Utilization Patterns.
Social Science and Medicine
48
:
897
-911.
Cruz-Saco, M. A.
2002
. Global Insurance Companies and the Privatisation of Pensions and Health Care in Latin America: The Case of Peru. Paper presented at the
Globalism and Social Policy Programme (GASPP) Seminar 5
, Dubrovnik, Croatia,
September
26-28
, 2002.
Desmet, M., A. Q. Chowdhury, and Md. K. Islam.
1999
. The Potential for Social Mobilisation in Bangladesh: The Organisation and Functioning of Two Health Insurance Schemes.
Social Science and Medicine
48
:
925
-938.
Dixon, A., J. Lagenbrunner, and E. Mossialos.
2004
. Facing the Challenges of Health Care Financing. In
Health Systems in Transition: Learning From Experience
, ed. J. Figueras, M. McKee, J. Cain, and S. Lessof,
51
-83. Copenhagen: WHO.
Dror, D. M., and C. Jacquier.
1999
. Micro-insurance: Extending Health Insurance to the Excluded.
International Social Security Review
52
(
1
):
71
-97.
Ekman, B.
2004
. Community-Based Health Insurance in Low-Income Countries: A Systematic Review of the Evidence.
Health Policy and Planning
19
:
249
-270.
Francis, S.
2000
. Health and Medical Services. In
U.S. Industry and Trade Outlook 2000
, U.S. Department of Commerce (USDOC), chap. 43. Washington, DC: USDOC.
Gaál, P.
2004
.
Health Care Systems in Transition: Hungary
. Ed. Annette Riesberg. Copenhagen: European Observatory on Health Care Systems (EOHCS).
Gamkrelidze, A., R. Atun, G. Gotsadze, and L. MacLehose.
2002
.
Health Care Systems in Transition: Georgia
. Ed. L. MacLehose and M. McKee. Copenhagen: EOHCS.
German Agency for Technical Cooperation (Gesellschaft für Technische Zusammenarbeit, or GTZ).
2003
.
Developing Health Insurance in Cambodia—Report of the Appraisal Mission
. Eshborn, Germany: GTZ.
____. 2006. Berlin Recommendations: Final Version. Report on actions recommended by the International Conference on Social Health Insurance in Developing Countries, Berlin, December 5-7, 2005. www.shi-conference.de/downl/Berlin%20Recommendations%20for%20Action_July%202006.pdf.
Halawani, F. al-, D. Banks, T. Fardous, and A. al-Madani.
2000
.
Jordan National Health Accounts
. Partnerships for Health Reform (PHR) Project, Technical Paper 49. Bethesda, MD: PHR and U.S. Agency for International Development.
Höfter, R. H.
2006
. Private Health Insurance and Utilization of Health Services in Chile.
Applied Economics
38
:
423
-439.
Holley, J., O. Akhundov, and E. Nolte.
2004
.
Health Care Systems in Transition: Azerbaijan
. Ed. E. Nolte, L. MacLehose, and M. McKee. Copenhagen: EOHCS.
International Labour Organization (ILO).
2000
.
World Labour Report 2000: Income Security and Social Protection in a Changing World
. Geneva: ILO.
Iriart, C., E. Elías Merhy, and H. Waitzkin.
2001
. Managed Care in Latin America: The New Common Sense in Health Policy Reform.
Social Science and Medicine
52
:
1243
-1253.
Jack, W.
2000
.
The Evolution of Health Insurance Institutions: Four Examples from Latin America
. Development Economics Research Group Paper,
February
. Washington, DC: World Bank.
Jesse, M., and O. Schaefer.
2000
.
Health Care Systems in Transition: Estonia
. Copenhagen: EOHCS.
Jütting, J. P.
2004
. Do Community-Based Health Insurance Schemes Improve Poor People's Access to Health Care? Evidence from Rural Senegal.
World Development
32
:
273
-288.
____.
2005
.
Health Insurance for the Poor in Developing Countries
. Burlington, VT: Ashgate.
Karnitski, G.
1997
.
Health Care Systems in Transition: Belarus
. Copenhagen: EOHCS.
Kiwara, A. D.
1999
. Health Insurance for the Informal Sector in the Republic of Tanzania. In
Social Security for the Excluded Majority: Case Studies of Developing Countries
, ed. W. van Ginneken,
117
-144. Geneva: ILO.
Kumaranayake, L.
1998
. Effective Regulation of Private Sector Health Service Providers. World Bank Working Paper, prepared for the
World Bank Mediterranean Development Forum II
, Marrakech, Morocco,
September
3-6
.
Normand, C., and R. Busse.
2000
. Social Health Insurance Financing. In
Funding Health Care: Options for Europe
, ed. E. Mossialos, A. Dixon, J. Figueras, and J. Kutzin,
59
-79. Buckingham, PA: Open University Press.
Nuri, B.
2002
.
Health Care Systems in Transition: Albania
. Ed. E. Tragakes. Copenhagen: EOHCS.
Nuri, B., and J. Healy.
1999
.
Health Care Systems in Transition: Albania
. Copenhagen: EOHCS.
Okello, F., and F. Feeley.
2004
.
Socioeconomic Characteristics of Enrollees in Community Health Insurance Schemes in Africa
. Commercial Market Strategies Country Research Series 15. Washington, DC: USAID and Commercial Marketing Strategies Program.
Organisation for Economic Co-operation and Development (OECD).
2004
.
Proposal for a Taxonomy of Health Insurance
. OECD Study on Private Health Insurance,
June
.
Pereira, J. M. 2005. Booming South Asian Insurance Market. DAWN, March 21. www.dawn.com/2005/03/21/ebr15.htm.
Phelps, C.
1997
.
Health Economics
. New York: Addison-Wesley.
Preker, A. S., and G. Carrin.
2004
.
Health Financing for Poor People: Resource Mobilization and Risk Sharing
. Washington, DC: World Bank.
Preker, A. S., R. Scheffler, and M. Basset.
2006
.
Private Voluntary Health Insurance in Development: Friend or Foe
? Washington, DC: World Bank.
Savas, B. S., Ö. Karahan, and R. Ö. Saka.
2002
.
Health Care Systems in Transition: Turkey
. Ed. S. Thomson and E. Mossialos. Copenhagen: EOHCS.
Sekhri, N., and W. Savedoff.
2005
. Private Health Insurance: Implications for Developing Countries.
Bulletin of the World Health Organization
83
:
127
-138.
Sekhri, N., W. Savedoff, and S. Tripathi.
2004
. Regulating Private Insurance to Serve the Public Interest: Policy Issues for Developing Countries. Paper presented at the
Economic Research Forum Eleventh Annual Conference
, Beirut,
December
14-16
.
Söderlund, N., and B. Hansl.
2000
. Health Insurance in South Africa: An Empirical Analysis of Trends in Risk-Pooling and Efficiency Following Deregulation. In
Health Policy and Planning
15
:
378
-385.
Stocker, K., H. Waitzkin, and C. Iriart.
1999
. The Exportation of Managed Care to Latin America.
New England Journal of Medicine
340
:
1131
-1136.
Swiss Reinsurance Company.
1998
. Life and Health Insurance in the Emerging Markets: Assessment, Reforms, and Perspectives.
Sigma
, no.
1
.
____.
2002
. Insurance in Latin America: Growth Opportunities and the Challenge to Increase Profitability.
Sigma
, no.
2
.
____.
2003
. Asia's Non - Life Insurance Markets: Recent Developments and the Evolving Corporate Landscape.
Sigma
, no.
6
.
____.
2004a
. Life and Health Insurance in the Emerging Markets: Assessment, Reforms, and Perspectives.
Sigma
, no.
1
.
____.
2004b
. World Insurance in 2003: Insurance Industry on the Road to Recovery.
Sigma
, no.
3
.
____.
2004c
. Exploiting the Growth Potential of Emerging Insurance Markets: China and India in the Spotlight.
Sigma
, no.
5
.
Van Ginneken, W.
1999
. Overcoming Social Exclusion. In
Social Security for the Excluded Majority: Case Studies of Developing Countries
, ed. W. van Ginneken,
1
-36. Geneva: ILO.
Vladescu, C., S. Radulescu, and V. Olsavsky.
2000
.
Health Care Systems in Transition: Romania
. Ed. R. Busse. Copenhagen: EOHCS.
Wiesmann, D., and J. Jütting.
2000
. The Emerging Movement of Community Based Health Insurance in Sub-Saharan Africa—Experiences and Lessons Learned.
Afrika Spektrum
35
:
193
-210.
World Health Organization (WHO).
2004
.
Regional Overview of Social Health Insurance in South-East Asia
. New Delhi: WHO.
____.
2005
.
World Health Report 2005—Make Every Mother and Child Count
. Geneva: WHO.
____.
2006
.
World Health Report 2006—Working Together for Health
. Geneva: WHO.
Zweifel, P.
2005
.
The Purpose and Limits of Social Health Insurance
, University of Zurich, Socioeconomic Institute (SOI) Working Paper 509.
Duke University Press
2007