Free health insurance for the unemployed in the Western Balkan

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Presentation transcript:

Free health insurance for the unemployed in the Western Balkan Johannes Koettl Jobs Gateway for South East Europe November 30, 2015

Context All countries of former Yugoslavia inherited a system where health insurance was provided to all registered unemployed Today, many registered unemployed are not unemployed Work informally Inactive Serbia: more than 50 percent of registered unemployed are not active jobs seekers

The Problem Many sign up as unemployed because of free health insurance Few conditionalities attached, high reward Consequences: PES is overwhelmed with administrative work PES cannot target support to real job seekers High incentives to not pay for health insurance Essentially, universal health insurance But only very few pay for health insurance Fosters informal employment

How do EU countries provide health insurance to the unemployed? National Health System with universal access, financed from general taxation (DK, FI, LV, IT, UK,..) Social health insurance (AT, BE, BG, DE,…): Free health insurance for unemployed linked with conditionally on job search Free health insurance for the poor (means-tested social assistance beneficiaries)

Possible solutions Objectives: Minimize impact on poverty and public health Minimize incentives for informality Balance administrative burden between agencies Possible solution: Free health insurance for active job seekers (PES) Free health insurance for those who cannot afford to pay (Social Welfare Centers) Self-insurance, possibly subsidized, for health for those who can afford to pay (Health Insurance Fund)

Challenges: Implementation Free health insurance for active job seekers (PES) Capacity to implement conditionality Free health insurance for those who cannot afford to pay (Social Welfare Centers) Means-testing capacity, possibly for a larger share of the population Self-insurance for health for those who can afford to pay (Health Insurance Fund) How can HIF do means-testing? Or even income testing? Political economy challenge

Today’s agenda Presentations from Croatia and Serbia Current challenges in Bosnia and Hercegovina and Kosovo Reflections from a health system perspective Q&A

Thank you! Johannes Koettl Senior Economist Social Protection and Labor Global Practice jkoettl@worldbank.org