Health Insurance in Low Income Countries

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Health Insurance in Low Income Countries

• Shiyan Chao
• Health Economist
• The World Bank

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Content

• Health Financing Options in Low Income Countries
  Challenges
• Main Issues of Community Health Insurance
• Bangladesh Experiences
• Options for Ghana

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Challenges in Low Income Countries

• Low tax revenue collection
• Inadequate administrative capacity
• Irregular income
• Lack of health services resources

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Objectives of community insurance

• Improve access to essential services
• Mobilize resources
• Improve efficiency and equity
• Facilitate community participation

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Common Features

• Insurers as well as providers
• Voluntary membership
• Prepayment contributions

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• Similar objectives
• Increase access to health services
• Benefit the poor
• Social mobilization

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Key Issues -- Risk Pooling

• Size of the pool
• population coverage
• Benefit coverage
• hospital care Vs. primary care

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Key Issues -- Risk Pooling (cont.)

• Risk sharing
• sick and healthy
• rich and poor
• young and old

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Key Issues -- Resources Mobilization

• Ability and willingness to pay
• Premium collection irregular income
• Utilization and actuarial costs of covered
  services

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Key Issues -- Administrative Capacity

• Viable administrative structures
• Management of Funds

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Key Issues -- Social Objectives

• Reaching the poor
• Community participation and ownership
• Increasing access to care

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Summary

• Poor mechanism for risk-sharing
• Limited capacity in mobilizing funds
• Useful tool for community mobilization
• Better than user fees in promoting equity and
  access

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Lessons Learned -- Addressing Adverse Selection

• Join in groups
• at least a whole household membership
• social or economic groups
• villages
• Waiting period for participation

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Lessons Learned -- Provider Incentives

• Based on performance indicators. reward
  productive and high quality providers
• Professional recognition certificates, training,
  career path
• Financial incentives

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Lessons Learned -- Increasing Sustainability

• Enrollment renews automatically unless canceled
• Discount for renewal
• Discount for prompt payment of premium (e.g. last
  month is free)

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Lessons Learned -- Increasing Sustainability

• Convenient premium collecting time (e.g. after
  harvests)
• Referral or coverage of hospitalizations in
  secondary hospitals
• Covering essential services (e.g. emergency
  transport for obstetrical complications)

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Health Financing in Ghana
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Major Financing Issues

• Underfunding of the Health Sector
• Inefficient Allocation and the Use of Resources
• Unequal Benefits Distribution

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Toward Financing Framework

• Strategy for Resource Mobilization
• Increasing Efficiency
• Improving Equity

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Policy Options

• User Fees Reform
• Health Insurance Schemes

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Ghana Health Financing Strategy

• The National Health Insurance
• Community Insurance
• The Multi-scheme Social Insurance System

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Scheme Design
Multi-scheme Health Insurance System
District Health Insurance
Social Insurance
Voluntary Insurance
Formal Sector
Rural Population
Urban Inform Sector
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District-based Social Health Insurance
Source of Funds Govt. Donors
Providers Govt. Mission Private
Contracting
Payment
District Health Funds
Service Provision
District Health Board Communities District
Health Management Team
Consumers
Managing
Premium
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Key Elements for District Health Funds

• A mechanism for channeling donor funds
• Covers only the most essential services and
  limited referral services
• Contracting with mission and private sector

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Next Steps

• Further develop the designs
• Pilot schemes to refine and test promising models
• Evaluation of results (financial and impact on
  poverty alleviation)
• Operations research to improve design

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