Abstract
Health reinsurance as a public policy measure aims to off-load the expensive costs of those who are catastrophically ill onto the best risk bearer, often the state. The benefits ripple out, helping not just those with the highest health costs but also the broader public by helping to render health coverage more widely affordable and accessible. The health and human rights discourse ought to include the notion that we all enjoy a core health right to the state’s performance of its reinsurance function.
First, the features of reinsurance map well onto those of the right to health specified in the International Covenant on Economic Social and Cultural Rights and the associated General Comments. These texts suggest particular concern for the vulnerable and give attention to covariant risks, the promotion of equitable distribution, and state action that ensures the underlying conditions for a strong health system. This book chapter explains how government-sponsored health reinsurance also addresses these same concerns and is instrumental in creating stable background conditions for the organization of broad health provision.
I further argue that understanding the core right to health as including reinsurance helps soften certain tensions that afflict the concept of “the minimum core.” Reinsurance helps bridge the tension (1) between context sensitivity and universalizability and (2) between individually claimable rights and broader systemic duties. I illustrate these advantages using the experiences that various countries around the world have had with health reinsurance as a policy.
I wish to thank Christine H. Lee for her superb research assistance.
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- 1.
Barnett et al. (2019), available at https://www.census.gov/library/publications/2019/demo/p60-267.html (noting that in 2018, 67.3% of the population had private insurance coverage).
- 2.
See, e.g., Ho (2017), pp. 756–759.
- 3.
Young (2012), pp. 69–79.
- 4.
Hall (2010), p. 1168.
- 5.
See Blewett et al. (2019).
- 6.
See Glauber and Miranda (1997), available at: https://doi.org/10.2307/1243954.
- 7.
Swartz (2005), pp. vi–vii (discussing Healthy New York, a state reinsurance program), available at: https://www.commonwealthfund.org/publications/fund-reports/2005/jul/reinsurance-how-states-can-make-health-coverage-more-affordable.
- 8.
Swartz (2006), p. 105, available at https://www.russellsage.org/sites/default/files/0871547272text.pdf (also describing another form, quota loss reinsurance, as “not as prevalent in connection with health insurance”).
- 9.
Swartz (2006), p. 102.
- 10.
- 11.
Ibid., p. 24.
- 12.
Ibid.
- 13.
Ibid., p. 26 (describing the vernacular use).
- 14.
Ibid., p. 23.
- 15.
See Monahan and Schwarcz (2013), p. 1966.
- 16.
See Bennett and Ranson (2002) in: Dror, D. and Preker, A. (eds), p. 258 (“Government may set up a reinsurance scheme (or solidarity fund). Participating [insurers may] contribute to this pool..., [g]overnment may establish this fund but not contribute to the pooled resources, or establish the fund and make some contribution to the pooled resources (a combination of reinsurance and subsidy).”). But see Brenzel and Newbrander (2002) in: Dror, D. and Preker, A. (eds), p. 310 (arguing, “[T]his approach is not sustainable, may give negative performance and risk-management incentives, and may perpetuate poor microinsurance designs. Instead of using scarce public resources or donor funding to cover deficits, those resources can be better spent on developing management capacity and management systems and on improving scheme design to reduce financial risk.”).
- 17.
See Glauber and Miranda (1997).
- 18.
Hall (2010), p. 1169.
- 19.
Rothschild and Stiglitz (1976), p. 629, available at: https://www.uh.edu/~bsorense/Rothschild&Stiglitz.pdf.
- 20.
Ibid., p. 641.
- 21.
See Radermacher et al. (2005), available at https://www.ilo.org/employment/Whatwedo/Publications/WCMS_122476/lang%2D%2Den/index.htm.
- 22.
Radermacher et al. (2009), p. 19, available at http://ssrn.com/abstract=1477272.
- 23.
See La Forgia and Nagpa (2012), p. 266.
- 24.
Id., p. 258.
- 25.
Eskridge and Ferejohn (2010), p. 77.
- 26.
See Moss (2004).
- 27.
Dauber (2013), p. 34.
- 28.
Christina S. Ho, With Liberty and Reinsurance for All (unpublished manuscript), available at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3840904.
- 29.
- 30.
See Daschle et al. (2008), p. 57 n. 27 (citing Quadagno, p. 47) (“The unions had a vested interest in government help for the elderly. In the late 1950s and early 1960s, they began to win health benefits for retirees, but these victories came at a high price. With the advent of experience rating, retirees were a significant drain on employers’ finances, soaking up money they might otherwise have spent on wage increases. If the government took responsibility for insuring retirees, the unions would be able to bargain for higher wages and better benefits for current workers.”)).
- 31.
See SSA of 1972, PL 92-603; see also Syzmendera (2009), available at: https://greenbook-waysandmeans.house.gov/sites/greenbook.waysandmeans.house.gov/files/2012/documents/RS22195_gb_0.pdf.
- 32.
See SSA of 1972, PL 92-603, §299I; see also Eggers (2000), available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194691/.
- 33.
See Consolidated Appropriations Act of 2001, PL 106-554; Syzmendera (2009).
- 34.
Lambrew and Montz (2018), available at: http://prospect.org/article/next-big-thing-health-reform-where-start (emphasis added).
- 35.
- 36.
- 37.
See State Health Access Data Assistance Center (SHADAC), available at: http://www.shadac.org/publications/resource-1332-state-innovation-waivers-state-based-reinsurance.
- 38.
- 39.
- 40.
- 41.
The International Covenant on Economic, Social and Cultural Rights requires states to “take steps, individual and through international assistance and co-operation, especially economic and technical, to the maximum of [their] available resources, with a view to achieving progressively the full realization of the rights recognized in the present Covenant by all appropriate means, including particularly the adoption of legislative measures.” ICESCR, Art. 2(1), available at: https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx; see also ibid., Art. 12.
- 42.
Ibid., Art. 2(1).
- 43.
Ibid., Art. 12(2).
- 44.
See Hunt (1996).
- 45.
Ibid.
- 46.
Ibid.
- 47.
Ibid.
- 48.
See De Schutter (2019).
- 49.
United Nations Human Rights Office of the High Commissioner, available at: https://www.ohchr.org/en/hrbodies/cescr/pages/cescrindex.aspx.
- 50.
See Young (2008), p. 143 n.174, available at: https://lawdigitalcommons.bc.edu/cgi/viewcontent.cgi?article=1920&context=lsfp (“Although the legal status of the General Comments is uncertain, the Committee commenced with their publication after an invitation by the Economic and Social Council which was endorsed by the General Assembly. G.A. Res. 42/102, at 202, U.N. GAOR, 42d Sess., 93d plen. mtg., U.N. Doc. A/Res/42/102. (Dec. 7, 1987).”).
- 51.
CESCR General Comment No. 3 (1990), available at: https://www.refworld.org/docid/4538838e10.html.
- 52.
Ibid.
- 53.
Ibid.
- 54.
Ibid.
- 55.
CESCR General Comment No. 14 (2000), available at: https://www.refworld.org/docid/4538838d0.html.
- 56.
Ibid. (emphasis added).
- 57.
Ibid. (emphasis added).
- 58.
See Bennett and Ranson (2002), pp. 255–257.
- 59.
Schoenman (2012), p. 2, available at: https://www.nihcm.org/pdf/DataBrief3%20Final.pdf.
- 60.
Ibid.
- 61.
Institute for Healthcare Improvement (IHCI) (2012), slide 7, available at: https://www.slideshare.net/kingsfund/maureen-bisognano-an-international-perspective-leading-for-better-health-care.
- 62.
Bennett and Ranson (2002), p. 259.
- 63.
See Xu et al. (2019).
- 64.
- 65.
See Forman and Singh (2014), pp. 288–318 (arguing that it was argued but rejected in Grootboom, and then later in Minister of Health v. Treatment Action Campaign 2002 (5) SA 721(CC), 272 (S. Afr.), as well as in Mazibuko v. The City of Johannesburg 2010 (4) SA 1 (CC)).
- 66.
See Young (2012), p. 80.
- 67.
Interim S. Afr. Const., § 33(I)(b).
- 68.
S. Afr. Const., § 36.
- 69.
- 70.
Langford et al. (2007), p. 29 n. 125 (citing V v. Einwohrnergemeine X und Regierunsgrat des Kantons Bern (BGE/ATF 121 I 367, Federal Court of Switzerland, of 27 October 1995)).
- 71.
Alston and Scott (2000), p. 250.
- 72.
Murray and Evans (2003), Chapter 43, pp. 573–75.
- 73.
CESCR General Comment No. 14, Art. 12(c).
- 74.
See Craven (1995) (criticizing the core minimum concept for training its focus primarily on developing countries).
- 75.
LeMaitre and Young (2013), p. 186 (noting that “in 2008, 41.5% of all tutelas claimed protection for the right to Health”).
- 76.
Lamprea (2014), p. 150 (citing Departmento Nacional de Planeacion, Colombia Plan Nacional de Desarrollo [National Development Plan] 2010–2014 (2011)).
- 77.
Ibid. at 149.
- 78.
Ibid. at 146.
- 79.
Ibid., 152.
- 80.
Ibid., 141.
- 81.
Ibid.
- 82.
Ho (2014), pp. 32–33.
- 83.
Ibid., p. 33.
- 84.
Minister of Health v. New Clicks South Africa Pty Ltd. (CCT 59/2004) [2005] ZACC 14, par. 514; see also id. at par. 706 (J. Moseneke, declaring, “Prohibitive pricing of medicine…would in effect equate to a denial of the right of access to health care.”).
- 85.
Dworkin (1977), pp. 89–93.
- 86.
Ibid., p. 91.
- 87.
See Feinberg (1980), p. 155.
- 88.
Government of the Republic of South Africa v. Grootboom Case No. CCT11/00. 2000 (11) BCLR 1169 (4 October 2000).
- 89.
Minister of Health v. Treatment Action Campaign. Case No. CCT 8/02. 2002 (10) BCLR 1033 (5 July 2002).
- 90.
Tushnet (2004), Social Welfare Rights and the Forms of Judicial Review, p. 1906.
- 91.
Tushnet (2008), Weak Courts, Strong Rights, pp. 244–249.
- 92.
Young (2012), Constituting, pp. 74–75.
- 93.
Ibid., 83 (citing Liebenberg (2005), pp. 22–26). She later concedes that this approach would perhaps be “reduced in its effect by the doctrines of standing, ripeness, mootness, and political questions for example.” Ibid., 86.
- 94.
See Lehmann (2006), p. 165.
- 95.
Bennett and Ranson (2002), pp. 258–259.
- 96.
Wibulpolprasert and Fleck (2014), pp. 472–473, available at: https://doi.org/10.2471/BLT.14.030714.
- 97.
Damrongplasit and Melnick (2009), p. 458, available at: https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.28.3.w457.
- 98.
See Center for Global Development, Thailand’s Universal Coverage Scheme, available at: http://millionssaved.cgdev.org/case-studies/thailands-universal-coverage-scheme; see also Wibulpolprasert and Fleck (2014) (interviewing Suwit Wibulpolprasert, who said that the health spending increased from 4% of the budget in the 1980s to 14% by 2014).
- 99.
Pannarunothai et al. (2000), p. 308, available at: https://academic.oup.com/heapol/article/15/3/303/573306.
- 100.
Kanitsorn Sumriddetchkajorn et al. (2019), pp. 415–422, available at https://doi.org/10.2471/BLT.18.223693.
- 101.
Ibid., p. 416.
- 102.
Kisiizi (Jan. 30, 2020), How a Ugandan hospital delivers health insurance through burial groups, available at: https://www.economist.com/middle-east-and-africa/2020/01/30/how-a-ugandan-hospital-delivers-health-insurance-through-burial-groups.
- 103.
Kisiizi Hospital Health Insurance Scheme, available at: http://www.kisiizihospital.org.ug/wp-content/uploadedfiles/2019/06/KISIIZI-HOSPITAL-HEALTH-INSURANCE-SCHEME-article-08-2018.pdf.
- 104.
Bennett and Ranson (2002), p. 257 (citing Musau (1999), available at http://www.phrplus.org/Pubs/te34fin.pdf).
- 105.
Ibid., p. 262.
- 106.
Hai et al. (2019), available at: https://www.bmj.com/content/365/bmj.l2378.
- 107.
Honda (2016), p. 180.
- 108.
Dayrit MM et al., World Health Organization (2018), p. 108, available at: https://apps.who.int/iris/handle/10665/274579; see also Querri et al. (2018), pp. 175–180, available at: https://doi:org/10.5588/pha.18.0046 (Table 3.13 shows the number of patients and amount of claims under these Z benefits).
- 109.
See Gerand, VimoSEWA, India (2005) available at: http://www.ilo.org/wcmsp5/groups/public/@ed_emp/documents/publication/wcms_122472.pdf.
- 110.
Ibid., 19.
- 111.
Ibid., 7.
- 112.
Ibid., pp. 10, 16.
- 113.
Sachs, JD, WHO Commission on Macroeconomics and Health & World Health Organization (2001), available at: https://apps.who.int/iris/handle/10665/42463.
- 114.
Ibid.
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Ho, C.S. (2022). Health Reinsurance as a Human Right. In: Lima Rego, M., Kuschke, B. (eds) Insurance and Human Rights. AIDA Europe Research Series on Insurance Law and Regulation, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-030-82704-5_4
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