Refers to the main decision-making body of a health micro-insurance scheme when the latter is managed in a participatory fashion. In the case of a mutual organization, cooperative or association, the general assembly brings together members or their representatives; in the case of a joint stock company, it brings together shareholders. The general assembly determines the scheme's objectives and overall policy. [ref. 144]
The constant contribution rate applicable infinitely, theoretically guaranteeing that scheme expenditure can always be covered by the contributions collected and the funds accumulated in the reserve. It is calculated by dividing the present value of all future benefits (minus the reserve existing at the valuation date) by the present value of all future contributory earnings. [ref. 8030]
Contributions by the government in order to finance the cost of goods and services provided by the government to protected persons in the form of means-tested benefits, as well as payments to social security institutions to cover deficits and to support expenditure related to guaranteeing minimum benefit levels. [ref. 6622]
Government financing from sources other than ear-marked taxes. [ref. 6622]
A measure of inequality in income distribution, it expresses the size of the area between a theoretical perfect equality Lorenz curve (straight line) and the real concave Lorenz curve of a country or another entity to the size of the area under the equality line. [ref. 8030]
A method of payment according to which health care providers are paid a fixed, comprehensive fee. It may consist of:
- A global fee per cluster of related health services.
Example: A fixed daily rate per hospital day may include charges for accommodation, consultations and examinations performed during the hospital stay.
- A global fee per episode of illness that includes all health services utilized in connection with a single episode of illness or maternity case.
Example: A global maternity fee may include all health services utilized before delivery, during delivery (complicated or uncomplicated) and after delivery (follow-up).
- A global fee per "head", called a capitation payment. This is a comprehensive fee paid for each person covered and for a specified period – often one year – granting entitlement to unlimited utilization of all or some of the health services of a health facility. [ref. 144]
See also: methods of payment
The sum of all consultative and decision-making processes, institutional arrangements and managerial and administrative action by which social protection policies are designed, agreed upon, implemented and supervised. The definition encompasses the first blueprints for a social protection system in government or other institutions, the national consultation process, the legal enactment and finally the managerial and administrative implementation, as well as the national and lower-level supervision of the performance of individual social protection schemes. [ref. 8030]
A provision exempting persons or other entities already engaged in an activity from new rules or legislation affecting that activity, or granting special privileges when including such groups into new legislative provisions. A typical example is special credits (fictitious insurance years) granted to older workers when a new benefit system is being introduced in order to help them fulfil the benefit conditions. [ref. 8030]
An aggregate measure of the production of goods and services within the boundaries of a country. Broadly, the amount of gross income available for distribution to the production factors labour and capital, which, after taxation, constitutes the basis for redistributive state interventions. [ref. 8030]
An insurance contract concluded between an insurer and a group of beneficiaries, such as the employees of an enterprise or the members of an association, cooperative, trade union, etc. Such contracts usually provide insurance coverage in the following areas: health care, retirement pensions, temporary or permanent disability, and death of the breadwinner. [ref. 144]
Synonym: group contract
A fund that a health micro-insurance scheme can call upon in the event of financial difficulty. Generally speaking, the assistance provided by the guarantee fund takes the form of a loan to the requesting scheme. The circumstances in which the guarantee fund may be used are usually specified in detail. The fund's assistance may be made conditional upon changes in the operation of the health micro-insurance scheme. Guarantee funds may be financed by member schemes, the State, financing institutions or support organizations. [ref. 144]
A document proving that a patient is covered by a health micro-insurance scheme; that is, that he or she is enrolled as a member or dependent, is up to date with his or her premiums and has completed the required waiting period. The guarantee letter also indicates the level of coverage to which the patient is entitled. In certain schemes, the person protected by the scheme must obtain a guarantee letter before receiving treatment if he or she wishes to benefit from third-party payment. The guarantee letter helps to eliminate attempts at fraud, limit over-consumption and guarantee health providers that expenses relating to patients' treatment will be paid by the health micro-insurance scheme (third-party payment principle). [ref. 144]