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Notion traditionally referring to the market for financial claims with a long-term time horizon. [ref. 8030]
The stock of all produced and non-produced assets of an economy. In economic theory, one of the two standard production factors. [ref. 8030]
Each time a benefit is awarded, a new case is opened (this refers to the decision of granting a benefit, not to each payment). It is important to distinguish the terms "case" and "beneficiary". While "beneficiary" refers to a person, "case" refers to an administrative procedure. Especially for short-term benefits, it may be that one beneficiary claims benefits more than once during a year, and thus accounts for two or more cases. [ref. 6622]
See also: beneficiary
Transfers are recorded at the time of the actual payment, not at the time of the events that create the related claims and liabilities (see under accrual basis). For example, if, for whatever reason, the old age pension for the month of December 2002 is paid only on January 2003, the year recorded on an accrual basis would be 2002 while the date would be recorded as 2003 on a cash basis. [ref. 6622]
See also: accrual basis
Benefit provided in cash such as income replacement and income support benefits, lump-sum payments from provident funds, allowances and other cash payments which are not reimbursements (i.e. which do not require beneficiaries to show evidence of expenditure). [ref. 6622]
Synonym: cash benefit
Contingency that affects a large segment of the covered population, such as epidemics, and/or those for which the unit costs are high, such as very costly hospitalizations. The occurrence of catastrophic risks may jeopardize the financial viability of a health micro-insurance scheme. [ref. 144]
The ratio between the total amount of earnings subject to the payment of contributions and the total amount of earnings received by insured persons from gainful employment. Theoretically, this ratio equals 1 in case all earning are subject to contribution payment; it should be smaller than 1 in case of a ceiling on insurable earnings or of other exemptions from contribution payment. [ref. 8030]
An employee of the civil service. [ref. 6622]
Period during which a benefit is received. Claims are completed if the receipt of the benefit has ended before or by the end of the reference period. Claims are ongoing if the receipt of the benefit has not been ended by the end of the reference period. [ref. 6622]
The proportion of a benefit that returns to the public budget through the taxation of the benefit. [ref. 8030]
The portion of the cost or quantity utilized of a covered health service that is not borne by the health micro-insurance scheme.
Example: If the scheme covers 100 per cent of consultation fees up to a maximum of 400 Monetary Units (MUs) per consultation, and if the cost of a consultation is 600 MUs, then the amount borne by the scheme is 400 MUs and the amount of the co-payment is 200 MUs.
The introduction of co-payments enables a health micro-insurance scheme to reduce its costs, provided that the average amount for which the scheme is liable is lower as a result, and that insured persons, who must "pay out of their own pockets", are encouraged to limit their consumption of health care to what is strictly necessary. Notwithstanding, if the levels of co-payment are too high, the scheme may fail at ensuring the financial accessibility of health care for all persons.
For examples of co-payments see: flat-rate benefit; numerical deductible; monetary deductible; maximum number of days, cases or sessions; percentage co-payment. [ref. 144]
The set of legislative texts and application decrees governing insurance practices in a given country.
Examples: Some countries have a mutual benefit insurance code that governs the practices of mutual organizations or an insurance code that governs those of commercial insurance companies. [ref. 144]
A group of individuals with (a set of) identical characteristics, e.g. all persons born in the same year. [ref. 8031]
Synonym: premium collection
See: demographic ratio
A system for the provision of coverage against the financial consequences of certain risks, formalized by means of a contract managed by a profit-oriented insurance company. The contract is concluded between an insurer and an insured party (individual or group). In exchange for the payment of premiums, the insurer guarantees the insured party that it will provide a specified level of coverage for expenses resulting from the occurrence of a given risk: fire, flood, theft, accident, illness, loss of harvest, etc. [ref. 144]
- Institutions that directly administer a community-based social protection scheme. Examples are mutual benefit societies, microinsurance schemes, trade-union based schemes, cooperatives, associations, micro-finance institutions, etc.
- Institutions that facilitate the implementation of a statutory or community-based social protection mechanism. Examples are civil-society and trade organizations such as agricultural or other cooperatives, farmers organizations, informal economy organizations, or sectoral associations of workers that play a role of intermediary between the social security scheme and their members
The ratio between the number of persons under a scheme on whose behalf contributions are actually paid and the number of persons who are legally covered for contribution payment by the scheme. [ref. 8030]
A statutory and compulsory system through which the general community assumes responsibility for the health care costs of individuals as part of a State-run universal social security scheme. [ref. 144]
The patient's obligation to seek consultation from a health facility at a given level before being entitled to receive treatment at a higher level. The doctor or nurse at the first health facility refers the patient to the higher level.
Example: In order to be admitted to a district hospital, covered persons are required to have undergone consultation at a health centre and to have been "referred" (or recommended to proceed) to the next higher level. [ref. 144]
See also: level of health infrastructure (or level of the health pyramid)
An invoice that a health facility, which has concluded a third-party payment agreement with a health micro-insurance scheme, sends to the scheme at regular intervals in order to obtain payment. The consolidated invoice lists the charges for treatment delivered to protected persons during a given period. It enables the scheme to pay the provider, after having checked that the information on the invoice is consistent with the corresponding guarantee letters and treatment certificates. [ref. 144]
Consumption of fixed capital is the value of previously created fixed assets used up in the production process as a result of physical deterioration, normal obsolescence or normal accidental damage. Thus, it is a cost of production. It is defined in a way that is theoretically appropriate and relevant for the purposes of economic analysis. Its value may deviate considerably from depreciation as recorded in business accounts or as allowed for taxation purposes, especially during periods of inflation. It is measured by the decrease, between the beginning and the end of the current accounting period, in the present value of the remaining sequence of rentals to be expected from a fixed asset. The extent of the decrease will be influenced not only by the amount by which the efficiency of the asset may have declined during the current period but also by the shortening of its service life and the rate at which its economic efficiency declines over its remaining service life. The actual calculation of the consumption of fixed capital requires that statisticians estimate the present value of the stock of fixed assets, the lifetime of various types of assets, patterns of depreciation, and so on. [ref. 8022, see note]
Rule defining the rights and obligations of the scheme with respect to members and those of members with respect to the scheme. In the case of a mutual organization or an association, the contractual rules are contained in the internal rules. In the case of a health micro-insurance scheme that does not provide for the participation of members in the scheme's management, the contractual rules are contained in the insurance contract. [ref. 144]
The minimum and/or maximum amount of individual wages that is subject to contributions to a scheme. The upper ceiling usually, though not always, reflects the maximum amount of earnings on which benefits are being calculated.
The percentage of the covered insurable earnings that is to be collected to finance the scheme. [ref. 8030]
The ratio of the number of active insured persons (contributors) to the number of insured persons (active and inactive). [ref. 776]
Entitlement to a benefit is based on contributions from insured persons and/or their employer. [ref. 6622]
The ratio of total expenditure of a scheme to total insurable earnings. [ref. 8030]
A policy or practice used to obtain payment from patients for all or part of the cost of the health services provided to them. [ref. 144]
The financial compensation provided by the health micro-insurance scheme to insured persons for contingencies (or risks) defined in the insurance contract or the internal rules up to a prescribed limit. Compensation may be made through the reimbursement of members or through the application of a third-party payment mechanism. [ref. 144]
The ratio between the total number of registered insured persons (persons with an insurance record but not necessarily active) and a suitably chosen reference population, e.g. the labour force. [ref. 8030]
Situation where expansive developments in one sphere reduce activities in another. The traditional use of the term in macroeconomics is the hypothesis that government (deficit) spending discourages ("crowds out") private investment.