Financing Rural Insurance Coverage
99
Table 5.1 Proposed Financial, Purchasing, and Delivery Responsibilities by Intervention Type Intervention (1) Population-based “public good–type” public health interventions (e.g., surveillance)
Financing General revenues; no copayments
Purchasing agency
Delivery
CDC, in collaboration with service providers
Cost-effective (2) Public health inter- General CDC, or and commonly ventions (those revenues; no NRCMS required personal with appreciable copayments under interventions “externalities,” e.g., contract immunization) to CDC (3) Purely “private” NRCMS NRCMS personal intervenrevenues tions (e.g., cesaraen (contributions, section, appendec- subsidies) and tomy) limited copayments
Village clinics, THCs, hospitals (county level and above), and potentially private providers
(4) “Catastrophic” personal interventions, of low cost-effectiveness
NRCMS NRCMS revenues (contributions, subsidies) and copayments
THCs, hospitals (county level and above), and potentially private providers
(5) Other personal interventions not covered by NRCMS
Out-of-pocket Private THCs, hospitals payments, pri- insurance (county level vate insurance if any and above), and private providers
Source: Authors.
debatable. It could be. But it might make more sense to delegate this task to NRCMS, which would receive a capitation fee for doing the job. The Center for Disease Control would, however, need to monitor NRCMS’s performance closely. After its reform in 1993 shifted subsidies from the supply side to the demand side, Colombia found that health insurers who had been charged with certain public health responsibilities in exchange for higher demand-side subsidies failed to ensure that the intended interventions were actually delivered (Arbelaez et al. 2004; Escobar 2005). Purely personal health care interventions—including those that are financially catastrophic—would be covered by NRCMS, or left uncovered, or covered by a private insurer. They would be delivered by regular providers, and financed out of NRCMS revenues and copayments, out-of-pocket reimbursements, and health insurance premiums, if applicable.