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Health insurance for the poor decreases access to HIV testing in antenatal care: evidence of an unintended effect of health insurance reform in Colombia

Ettenger, Allison; Bärnighausen, Till; Castro, Arachu
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
65.95%
Prevention of mother-to-child transmission of HIV was added to standard antenatal care (ANC) in 2000 for Colombians enrolled in the two national health insurance schemes, the ‘subsidized regime’ (covering poor citizens) and the ‘contributory regime’ (covering salaried citizens with incomes above the poverty threshold), which jointly covered 80% of the total Colombian population as of 2007. This article examines integration of HIV testing in ANC through the relationship between ordering an HIV test with the type of health insurance, including lack of health insurance, using data from the nationally representative 2005 Colombia Demographic and Health Survey. Overall, health-care providers ordered an HIV test for only 35% of the women attending ANC. We regressed the order of an HIV test during ANC on health systems characteristics (type of insurance and type of ANC provider), women’s characteristics (age, wealth, educational attainment, month of pregnancy at first antenatal visit, HIV knowledge, urban vs. rural residence and sub-region of residence) and children’s characteristics (birth order and birth year). Women enrolled in the subsidized regime were significantly less likely to be offered and receive an HIV test in ANC than women without any health insurance (adjusted odds ratio = 0.820...

On the Outskirts of National Health Reform: A Comparative Assessment of Health Insurance and Access to Care in Puerto Rico and the United States

Portela, Maria; Sommers, Benjamin Daniel
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
65.86%
Context: Puerto Rico is the U.S.’s largest territory, home to nearly 4 million American citizens. Yet it has remained largely on the outskirts of U.S. health policy, including the Affordable Care Act (ACA). This paper presents an overview of Puerto Rico’s health care system and a comparative analysis of coverage and access to care in Puerto Rico versus the mainland U.S. Methods: We analyzed 2011-2012 data from the Behavioral Risk Factor and Surveillance System, and 2012 data from the American Community Survey and its counterpart the Puerto Rican Community Survey. Among adults 18 and over, we examined the following outcomes: health insurance coverage; access measures such as having a usual source of care and cost-related delays in care; self-reported health; and the receipt of recommended preventive services such as cancer screening and glucose testing. We used multivariate regression models to compare Puerto Rico and the U.S., adjusted for age, income, race/ethnicity, and other demographic variables. Findings: Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% vs. 15%, adjusted difference -12.0%, p<0.001). Medicaid was far more common in Puerto Rico. Puerto Rican residents were more likely than those in the mainland U.S. to have a usual source of care and a check-up within the past year...

Access to healthcare and financial risk protection for older adults in Mexico: secondary data analysis of a national survey

Doubova, Svetlana V; Pérez-Cuevas, Ricardo; Canning, David; Reich, Michael R
Fonte: BMJ Publishing Group Publicador: BMJ Publishing Group
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
65.99%
Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. Setting: Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). Participants: The study population comprised 18 847 older adults and 13 180 households that have an elderly member. Outcome measures The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. Results: Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (−8.1%...

Increasing Access to Credit through Reforming Secured Transactions in the MENA Region

Alvarez de la Campa, Alejandro
Fonte: Banco Mundial Publicador: Banco Mundial
Português
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65.78%
This paper provides a comparative summary of secured transactions systems related to the use of movable property as collateral in the MENA region vis a vis international practices in countries with modern secured transactions systems. The paper sets out the importance of introducing reforms in the area of secured transactions with the objective of increasing access to credit for businesses, particularly SMEs. The MENA region clearly lags behind all other regions in the introduction of secured transactions reforms. The paper summarizes many of the weaknesses common across the region. The two main critical areas that need urgent reforms are the creation of modern secured transactions laws and electronic movable collateral registries, and the need to improve enforcement mechanisms for security interests in movable property.

Increasing Access to Rural Finance in Bangladesh : The Forgotten "Missing Middle"

Ferrari, Aurora
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Português
Relevância na Pesquisa
75.85%
Increasing access to rural finance is often the last frontier for financial sector development in developing countries. Financial institutions aiming to operate in rural areas in these countries usually have to deal with high transaction costs, low population densities, remote areas, and a heavy focus on agriculture, with related weather and commodity risks. Although Bangladesh is highly vulnerable to natural disasters, its high population density lowers transaction costs considerably. This report seeks to: measure the quantity and quality of access to finance by rural micro, small, and medium-size enterprises (MSMEs) and marginal, small, and medium-size farmesr (MSMFs). In Bangladesh these are also referred to as the missing middle -- a segment not served by banks or microfinance institutions (MFIs). The report also identifies constraints that financial institutions face in serving MSMEs and MSMFs. The institutions analyzed in detail include, Bangladesh Krishi Bank (BKB), Rajshahi Krishi Unnayan Bank (RAKUB), MFIs...

Sri Lanka : Improving Access to Financial Services, Selected Issues

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Português
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65.9%
Sri Lanka has made significant achievements in the provision of financial services in some areas, but there are still critical market segments that remain underserved, especially for small and rural enterprises. Low-income households could also benefit from access to a more diverse set of financial products, such as enhanced remittances and payment services, longer-term savings instruments, insurance products, and improved access to housing finance. The complexity and diversity of the needs suggest that various approaches have to be examined and that a broad range of institutions can be engaged in the delivery of financial services. This report analyzes opportunities for expanding services to key underserved markets. Chapter 2 looks at the expansion of financing opportunities for small businesses. Chapter 3 complements the analysis of Chapter 2 by examining how to improve finance for agriculture through supply chains. Chapter 4 focuses on delivery channels for rural remittances. Remittances to Sri Lanka have been growing rapidly, and the risks posed by informal networks need to be minimized. Moreover, linking migrants to formal financial institutions will yield additional benefits by exposing them to a broad range of financial services (such as savings...

Financial Access 2009 : Measuring Access to Financial Services around the World

Consultative Group to Assist the Poor
Fonte: Consultative Group to Assist the Poor/The World Bank, Washington, DC Publicador: Consultative Group to Assist the Poor/The World Bank, Washington, DC
Português
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85.86%
Financial Access 2009 introduces the latest data from a survey of financial regulators in 139 countries. It presents indicators of access to savings, credit, and payment services in banks, and in regulated nonbank financial institutions. It is intended for a broad audience of policymakers, researchers, practitioners, multilateral and bilateral investors, in order to guide monetary policy, monitor systemic risks, and collect information on the values of deposits and credit. This report reviews three interventions: disclosure requirements, interest rate caps, and methods to address excessive lending that can result in consumer indebtedness. Improved transparency and disclosure allow borrowers to make informed choices and can facilitate competition in financial markets, eventually leading to lower prices and improved products. Policies to restrict interest rates or credit quantity, especially in consumer credit, seem to have limited effect but require further analysis.

Takaful and Mutual Insurance : Alternative Approaches to Managing Risks

Gönülal, Serap O.
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Português
Relevância na Pesquisa
75.98%
Access to insurance, as part of a broad range of essential financial services, is especially important for poor households in order to smooth consumption, build assets, absorb shocks, and manage risks associated with irregular and unpredictable income. Without access to good formal insurance services, the poor depend on less reliable and often far more expensive informal sector mechanisms. Yet, in many majority Islamic countries, accessing and using insur-ance products has been quite limited, as many Muslims avoid such services over concerns about riba (interest), gharar (uncertainty and ambiguity in contracts), and maysir (speculative risk), among other factors. Takaful insurance products are emerging as a central part of the Shariah-compliant family of financial services, helping meet insurance needs in ways that are consistent with the local norms and beliefs of many majority Islamic countries. Takaful has been developing steadily since the first Shariah-compliant insurer was founded in 1979, based on a Shariah-compliant cooperative model resembling mutual insurance. This is based on a group of participants donating funds into a pool that members can then use in the event of specified unfavorable contingencies. While practitioners have applied varying business models and standardization remains a challenge...

Equity, Access to Health Care Services and Expenditures on Health in Nicaragua

Angel-Urdinola, Diego; Cortez, Rafael; Tanabe, Kimie
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
65.83%
Nicaragua has embarked on an ambitious health sector program, which has contributed to significant progress in the health sector over the past decade. Health indicators show gradual but steady improvements: access to basic services such as clean water and sanitation facilities has improved, as have other related performance indicators such as life expectancy, infant/child mortality, immunization rates, and child nutrition among others. Despite these achievements, there are still large inequities in access and quality of health services across socioeconomic groups and regions. Poor individuals living in rural areas (especially in the Central and Atlantic regions), the indigenous population, and individuals living in households engaged in agriculture have average access to health care services and preventive care. The lack of risk mitigation mechanisms such as insurance and social security is causing users in Nicaragua to spend, out-of-pocket, a significant share of their income on health care, especially to buy medications and other non-consultation items such as medical tests. Long distances...

Financial Inclusion for Financial Stability : Access to Bank Deposits and the Growth of Deposits in the Global Financial Crisis

Han, Rui; Melecky, Martin
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
66.01%
In crisis times, depositors get anxious, can run on banks, and withdraw their deposits. Correlated withdrawals of bank deposits could be mitigated if bank deposits are more diversified, that is, held by more individuals. This paper examines the link between the broader access to bank deposits prior to the 2008 crisis and the dynamics of bank deposit growth during the crisis, while controlling for relevant covariates. Employing proxies for access to deposits and the use of bank deposits, the authors find that greater access to bank deposits can make the deposit funding base of banks more resilient in times of financial stress. Policy efforts to enhance financial stability should thus not only focus on macroprudential regulation, but also recognize the positive effect of broader access to bank deposits on financial stability.

Access to Financial Services : A Review of the Issues and Public Policy Objectives

Claessens, Stijn
Fonte: Oxford University Press on behalf of the World Bank Publicador: Oxford University Press on behalf of the World Bank
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
65.87%
This article reviews the evidence on the importance of finance for economic well-being. It provides data on the use of basic financial services by households and firms across a sample of countries, assesses the desirability of universal access, and provides an overview of the macroeconomic, legal, and regulatory obstacles to access. Despite the benefits of finance, the data show that use of financial services is far from universal in many countries, especially developing countries. Universal access to financial services has not been a public policy objective in most countries and would likely be difficult to achieve. Countries can, however, facilitate access to financial services by strengthening institutional infrastructure, liberalizing markets and facilitating greater competition, and encouraging innovative use of know-how and technology. Government interventions to directly broaden access to finance, however, are costly and fraught with risks, among others the risk of missing the targeted groups. The article concludes with recommendations for global actions aimed at improving data on access and use and suggestions on areas of further analysis to identify constraints to broadening access.

Access to Finance for Smallholder Farmers

International Finance Corporation
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Trabalho em Andamento
Português
Relevância na Pesquisa
65.9%
The percentage of smallholders with access to finance is equally difficult to quantify. According to estimates, even promising approaches to expanding smallholder lending, such as value chain finance, are reaching fewer than 10 percent of smallholders, primarily those in well-established value chains dedicated to higher value cash crops. International Finance Corporation (IFC) has been engaged for several years in learning efforts through diverse partnerships to obtain insights into the challenges of agricultural finance. The evidence of microfinance institution (MFI) involvement in financing commercial and semi-commercial smallholders remains anecdotal and lacks specifics on what makes MFI lending to these segments feasible, and what restricts their reach and effectiveness. This IFC study aims to identify and disseminate lessons emerging from the work of MFIs that have implemented agricultural operations targeting agricultural smallholders in Latin America and the Caribbean (LAC) to support replication and expansion of scalable approaches. Through this research...

Bank Competition, Financing Obstacles, and Access to Credit

Beck, Thorsten; Demirguc-Kunt, Asli; Maksimovic, Vojislav
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
Português
Relevância na Pesquisa
65.86%
Theory makes ambiguous predictions about the effects of bank concentration on access to external finance. Using a unique data base for 74 countries of financing obstacles and financing patterns for firms of small, medium, and large size, the authors assess the effects of banking market structure on financing obstacles and the access of firms to bank finance. The authors find that bank concentration increases financing obstacles and decreases the likelihood of receiving bank finance, with the impact decreasing in size. The relation of bank concentration and financing obstacles is dampened in countries with well developed institutions, higher levels of economic and financial development, and a larger share of foreign-owned banks. The effect is exacerbated by more restrictions on banks' activities, more government interference in the banking sector, and a larger share of government-owned banks. Finally, it is possible to alleviate the negative impact of bank concentration on access to finance by reducing activity restrictions.

Access to Financial Services and the Financial Inclusion Agenda around the World : A Cross-Country Analysis with a New Data Set

Ardic, Oya Pinar; Heimann, Maximilien; Mylenko, Nataliya
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
65.86%
Recent empirical evidence highlights that access to basic financial services can make a substantial positive difference in improving poor people's lives. Accordingly, financial sector reforms that promote financial inclusion are increasingly at the core of policymakers agendas. The Consultative Group to Assist the Poor and the World Bank Group, in response, launched the Financial Access project, including a cross-country database on financial inclusion topics and an annual report to inform the policy debate. Using this database, this paper (i) counts the number of unbanked adults around the world at 56 percent, (ii) analyzes the state of access to deposit and loan services as well as the extent of retail networks, and (iii) discusses the state of financial inclusion mandates around the world.

Is Small Beautiful? Financial Structure, Size and Access to Finance

Beck, Thorsten; Demirgüç-Kunt, Asli; Singer, Dorothe
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
65.85%
Combining two unique data sets, this paper explores the relationship between the relative importance of different financial institutions and their average size and firms' access to financial services. Specifically, the authors explore the relationship between the share in total financial assets and average asset size of banks, low-end financial institutions, and specialized lenders, on the one hand, and firms' access to and use of deposit and lending services, on the other hand. Two findings stand out. First, the dominance of banks in most developing and emerging markets is associated with lower use of financial services by firms of all sizes. Low-end financial institutions and specialized lenders seem particularly suited to ease access to finance in low-income countries. Second, there is no evidence that smaller institutions are better in providing access to finance. To the contrary, larger specialized lenders and larger banks might actually ease small firms' financing constraints, but only at low levels of gross domestic product per capita.

The Role of Postal Networks in Expanding Access to Financial Services : Kazakhstan's Postal Finance Services

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Public Sector Study; Economic & Sector Work
Português
Relevância na Pesquisa
65.82%
This paper discusses the role of the postal network in expanding access to financial services in Kazakhstan. It reviews the public postal operator within the postal sector and within the broader context of the communications sector. The roles of the postal network and state and privately-owned banks are also reviewed from the perspective of the financial sector development, with particular focus on payments systems development and microfinance. While this country case on Kazakhstan can stand alone, it is an integral part of this large study of the potential of postal networks to coordinate with financial service providers in 7 countries (Egypt, Kazakhstan, Namibia, Romania, Sri Lanka, Uganda, and Vietnam) and 5 regions (Africa, Asia, Eastern Europe and Central Asia, Latin America and the Caribbean, and the Middle East and Northern Africa). Within Central Asia and the other countries of the former Soviet Union, Kazakhstan's postal network is widely regarded as a leader and pioneer in postal innovation, setting an example for other postal operators in the region. An in-depth assessment of Kazakhstan's postal network development options could also be a model to guide other postal networks.

Vietnam - The Role of Postal Networks in Expanding Access to Financial Services Country case : Vietnam's postal finance services

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Public Sector Study; Economic & Sector Work
Português
Relevância na Pesquisa
65.84%
This paper discusses the role of the postal network in expanding access to financial services in Vietnam. It reviews the public postal operator within the postal sector and within the broader context of the communications sector. The roles of the Vietnam postal network and post bank are also reviewed from the perspective of the financial sector development, with particular focus on payments systems development and micro finance. While this country case on Vietnam can stand alone, it is an integral part of this large study of the potential of postal networks to coordinate with financial service providers in 7 countries (Egypt, Kazakhstan, Namibia, Romania, Sri Lanka, Uganda, and Vietnam) and 5 regions (Africa, Asia, Eastern Europe and Central Asia, Latin America and the Caribbean, and the Middle East and Northern Africa). Five years after its introduction, the Vietnamese Postal Savings Corporation (VPSC) can look back on an impressive record of successes. With its 920 post offices (of 3,000), VPSC operates the second-largest financial service network in the country. It developed as a channel for mobilizing small household deposits...

Improving Access to Health Care Services through the Expansion of Coverage Program : The Case of Guatemala

Lao Pena, Christine
Fonte: World Bank, Washington DC Publicador: World Bank, Washington DC
Tipo: Publications & Research :: Working Paper
Português
Relevância na Pesquisa
65.83%
Since the signing of the 1996 Peace Accords, Guatemala has made efforts to establish economic and political stability, and to improve its social indicators. The country's Constitution states that access to health care is a basic right of all Guatemalans. In practice, however, it has been challenging for the Government of Guatemala to guarantee this right using public facilities. As a result, it has been trying to improve access to health services using both Ministry of Public Health and Social Assistance (MOH) facilities and staff, and alternative health service providers, particularly nongovernmental organizations (NGOs). This case study reviews the experience implementing the Expansion of Coverage Program (Programa de Extension de Cobertura, PEC) that was established by the Government of Guatemala in 1997 to improve coverage of health and nutrition services to poor, rural, and largely indigenous areas by contracting NGOs. It describes its origins; its package of services; contracting, financing, monitoring, and supervision mechanisms; and its contributions to improving access and strengthening primary health care services in Guatemala. It also discusses opportunities and challenges that need to be addressed to continue to improve health services coverage in the country.

CATalytic Insurance : The Case of Natural Disasters

Cordella, Tito; Yeyati, Eduardo Levy
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
66.02%
Why should countries buy expensive catastrophe insurance? Abstracting from risk aversion or hedging motives, this paper shows that catastrophe insurance may have a catalytic role on external finance. Such effect is particularly strong in those middle-income countries that face financial constraints when hit by a shock or in its anticipation. Insurance makes defaults less appealing, relaxes countries' borrowing constraint, increases their creditworthiness, and enhances their access to capital markets. Catastrophe lending facilities providing "cheap" reconstruction funds in the aftermath of a natural disaster weaken but do not eliminate the demand for insurance.

Cambodia : Study on Access to Financial Services for Small and Medium Agribusiness Enterprises in Cambodia

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Financial Sector Study
Português
Relevância na Pesquisa
65.94%
Agriculture has been a mainstay of the Cambodian economy. It has seen significant growth throughout the 2000s and showed a significant resilience against external shocks during the 2008-09 economic and financial crises. Agribusiness enterprises do not operate in isolation from the rest of the economy. The state of production of agricultural raw materials, the state of the financial sector, and the nature of the financial sector's engagement with the real sector activities, as well as broader issues that affect private sector development all impact the development of the agribusiness sector. The current study seeks to analyze some of these linkages. It focuses specifically on the role the financial sector has played in the growth and development of the agribusiness sector. The study builds on the existing analytical work on agricultural and small and medium enterprise (SME) finance in Cambodia. The study was carried out in three major phases. The first phase was to determine a methodology to gather new information on linkages between agribusinesses and financial institutions. The second phase involved a survey of financial institutions (banks...