Insurance and Healthcare Financing

This book provides an up-to-date overview of healthcare financing, and the role which health financing plays in achieving universal health coverage and broader goals of the health system. It includes a detailed examination of revenue collection and risk pooling methods that are essential for managing financial resources effectively. Additionally, it covers the strategic purchasing of healthcare services, focusing on ensuring that funds are allocated and utilized efficiently to maximize the value of healthcare services delivered. Advanced topics such as setting provider payment methods, pricing, and the role of Health Technology Assessment (HTA) in strategic purchasing are discussed. The book also provides the context of healthcare financing in India, including publicly financed health insurance schemes and the associated challenges of demand-side financing. Fraud management and the importance of robust governance, capacity building, and monitoring and evaluation systems are also covered in detail with lucid examples. The chapters in the book are supplemented with an executive summary, definitions of key terms, learning objectives, and provides recommendations for additional readings for better understanding.

The book is relevant for students in public health, hospital administration, community medicine, economics, and health economics; as well as for insurance professionals, including claims managers and policy analysts, who are directly involved in health insurance and financing. Additionally, it is useful for policymakers and government officials responsible for designing and implementing health financing and insurance policies; as well as for health economists and financial managers seeking to improve healthcare financing and ensure effective resource management.