Social Insurance Assessment Tool (SIAT)
To provide a framework and tools to help countries assess options for expanding social insurance coverage and make decisions about social insurance policies.
The Social Insurance Assessment Tool (SIAT) is a three-part tool composed of a framework, an assessment questionnaire, and a spreadsheet-based model. First, the framework is designed as a guide to help users understand issues related to social insurance, assess their current system and consider options for change in the context of health reform. Second, the assessment questionnaire helps users examine 7 critical areas that must be considered in planning a social insurance system. These critical areas are:
- Examining the “enabling environment” of the health sector
- National policies and regulations that impact on social insurance coverage
- Collection of funds to finance social insurance
- Assuming the function of combining and managing funds to finance social insurance
- Assuming the financial risk of providing defined benefits to a defined population
- Organization and compensation of providers
- Coverage and “voice” of the clients and employers
Each section of the assessment questionnaire includes a checklist so that users can see where potential gaps still exist (i.e. where more information is needed to do a thorough analysis). Lastly, a spreadsheet-based model allows users to plug in country data, do reality testing, and create different possible scenarios given the current situation of a country.
A fictious country example entitled "Social Health Insurance in Centralia: A Case Study" accompanies the tool to illustrate the direct application of its concepts.
Management Sciences for Health in 1999-2000.
Public sector decision-makers and policy-makers at the national level.
This tool is based upon a research study carried out in El Salvador in 1999, and a LAC Health Sector Reform Initiative workshop held in Nicaragua in 2000 with 17 public sector health officials from Ecuador, El Salvador, Honduras, Jamaica, and Nicaragua.
The tool is presented in a complete package and includes background information, directions and the rationale for each section. The spreadsheet model is user-friendly. A case study, "Social Insurance in Centralia", illustrates the direct application of the concepts.
The SIAT model does not present “the answer” to the question of financing social insurance. Rather, the results depend on the assumptions entered into the model. Nevertheless, different scenarios can be entered into the model to produce a range of figures; the model helps to quantify the financial implications of different policy decisions regarding social health insurance.
Recommendations for Users
While the decisions about social health insurance cannot be reduced to an “accounting exercise” and to finding out the cost of different services, it is useful however to have some financial estimates in order to make better decisions about how to allocate scarce resources. If the estimates need to be refined, the model can be used to carry out sensitivity analysis.
Financing is just one aspect of the social health insurance issue, but it is a crucial one; without adequate funding, an insurance program cannot survive. Even though health encompasses much more than revenue or cost, these issues must be part of the discussion if the goal is a feasible and sustainable solution.
Reports and Publications
Eichler and Lewis, Financing Health Reform in El Salvador: Framework for Policy Decisions, Management Sciences for Health, Boston, July 1999.
Available in English and Spanish.
Management Sciences for Health
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Cambridge, MA 02139 USA