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

2. 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

3. 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

4. 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)

5. 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)

6. 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

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

8. Thank you! Johannes Koettl Senior Economist Social Protection and Labor Global Practice