World Bank Publications

Name: World Bank Publications
Brand: World Bank Publications
Price: 62.75 AUD

Consumer Protection and Prudential Regulation

By: Greg Brunner, Pablo Gottret, Birgit Hansl, Vijayasekar Kalavakonda, Somil Nagpal

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10 June 2012

At a Glance

No. of Pages
130

Dimensions(cm)
26.04 x 18.42 x 0.64

$62.75

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Health insurance can offer protection against catastrophic medical expenses and improve access to health care. There are, however, imperfections in the insurance market that require intervention such as asymmetry of information between the policy holder and the insurance company, moral hazard that can occur on the side of the insured or the provider of health services, risk selection that may lead to cream skim a particular market, and others. To encourage the effective development of Voluntary Private Health Insurance, it will be necessary for policymakers to establish and enforce regulatory standards that will attempt to correct inefficiencies from market failures and that will achieve desired social objectives.

This book is intended to help countries that are contemplating how to design and implement a legal framework for a private health insurance market. First, it provides an overview of private health insurance, the rationale for insurance regulation, and the institutions involved in administering insurance laws. It then reviews the key standards and protections that are often used in regulating private health insurance. As part of the discussion on regulatory standards, options for supervisors in certain areas where policy and regulation approaches vary will be noted. To illustrate international experience, examples of the regulation of private health insurance from several low, middle, and high-income countries will be drawn upon throughout the book.

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You Can Find This Book In

Non-Fiction Law Laws of Specific Jurisdictions Financial Law Insurance Law Medicine Medicine in General Health Systems & Services Economics Development Economics & Emerging Economies Accounting & Finance Finance

Insurance & Actuarial Studies

Foreword	p. vii
Preface	p. ix
Acknowledgments	p. xv
Abbreviations and Acronyms	p. xvi
Background and Overview of Private Health Insurance	p. 1
What Is Private Health' Insurance?	p. 2
Functions of Private Health Insurance	p. 3
Types of Private Health Insurance	p. 5
Note	p. 7
Scope of Regulation	p. 9
Rationale for Regulation	p. 9
Regulatory Framework	p. 13
Notes	p. 23
Prudential Regulation	p. 25
Licensure and Reporting	p. 25
Financial Oversight	p. 33
Management and Governance	p. 45
Monitoring and Enforcement	p. 48
Notes	p. 55
Consumer Protection Standards	p. 57
Access-Related Standards	p. 57
Premium Standards	p. 64
Benefit Standards	p. 69
Disclosure, Complaint Handling, and Appeals	p. 71
Conclusions and Afterword	p. 75
Notes	p. 76
Appendix
Glossary of Terms	p. 77
Note	p. 97
References	p. 99
About the Coauthors	p. 105
Index	p. 109
Boxes
Colombia and India: Integrating Private Health Insurance in Achieving Access to Health	p. 2
Brazil: Duplicate Private Health Insurance	p. 4
Community-Based Health Insurance	p. 6
Chile: Supervision of Prepayment Scheme	p. 16
Mexico: Supervision of Health Insurance Entities	p. 17
IAIS Licensing Principles	p. 27
South Africa and Slovenia: Standards for Brokers, Agents, and Intermediaries	p. 28
Philippines and Brazil: Reporting Requirements	p. 30
Mexico and India: Unearned Premium Reserves	p. 36
EU Solvency Margin Requirements	p. 37
Australia: Requirements for Internal Risk-Management Oversight	p. 40
Chile: Management of Investment Risk	p. 41
Common Forms of Reinsurance Agreements	p. 43
Fit-and-Proper Requirements in South Africa, Chile, and India	p. 46
Examples of Punishable Actions	p. 53
Chile: Risk Selection	p. 58
The Continuum of Access Standards	p. 58
New Jersey: Premium Loss Ratios	p. 65
Tables
The Role of Private Health Insurance in West European Health Systems	p. 5
Principal Elements of Solvency Requirements	p. 34
Examples of Minimum Initial Capital Requirements	p. 35
Limits on Waiting Periods and Exclusions for Coverage, Selected Countries	p. 62
Table of Contents provided by Ingram. All Rights Reserved.

World Bank Publications

Consumer Protection and Prudential Regulation

At a Glance

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How to return your order

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