Dr. Dr. Jens Holst, international consultant - health expert

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16.01.2006

Gesundheitsfinanzierung auf dem Prüfstand

InfoSure Evaluierungsmethode für Krankenversicherungen

Almost half of the world's population is currently excluded from adequate access to health care services. This counts especially for the poor, people living in remote rural areas or men and women working in the informal sector. They are not only often excluded from adequate health services but exposed to a higher than average risk of illness as well. The costs connected to ill health are one of the main reasons for poverty. Without any kind of risk sharing arrangement, like in traditional solidarity networks or modern insurances, a vicious circle is created perpetuating the cycle of illness, poverty, illness. Traditional social protection networks and mechanisms are often collapsing as a consequence of population growth, internal and external migration or a burden exceeding their capacity. Social and healthcare budgets often face tight financial constraints. In many countries, resources are not allocated efficiently and public funds cannot ensure regular payment of the health care staff and supplying necessary drugs and treatments. Thus, in most developing countries an obvious demand for accessible quality healthcare exists, which guarantees reasonable coverage for all socio-economic groups. Health insurance can help making health care accessible. But health insurance is usually designed for rich segments of the population. Tackling this problem more and more communities and companies are developing and testing health insurance products for the poor as well. The evidence base on this experience however is weak and the success achieved barely documented. Those insurances - often small field experiments - need to be evaluated and analyzed in order to make good experience available for replication and up-scaling. A sector project of the German Technical Cooperation (GTZ) responds to this challenge: the project "Elaboration and Introduction of Social Health Insurance Systems in Developing Countries". Together with the Institute for Tropical Medicine (ITG) in Antwerp, Belgium, AOK consult and a number of experts in the field of health system development, the project has designed a health insurance evaluation methodology and information system named InfoSure. InfoSure is more a whole product family rather a single product. It consists of • The InfoSure Offline Data Entry Tool, which offers a guideline for evaluation of health insurance schemes and helps structuring the data gathered. The structured data results in a case study; • The InfoSure Quality Management Tool for quality checking the case studies. The Quality Management Tool also enables translations; • The InfoSure Report and Analysis Tool. This tool is designed for comparing the features of different health insurance schemes. It offers selected aspects of the case studies in a clearly arranged style. • Furthermore, the central knot of InfoSure: the internet-based database for sharing case studies and lessons learned. Case studies and experiences made in health insurance are shared in the public section of the website; the private section of the website helps evaluators and analysts to organize and share their work. This interlinked product family makes InfoSure one of the most comprehensive evaluation tools for health insurance.