Reviewing the impact of health insurance

- Resource mobilisation
- Financial protection
- Service utilisation
- Quality of care
- Social inclusion
- Community empowerment
- National or Social health insurance (SHI) – mostly Asia (Thailand, Philippines, Vietnam) – 86 of 159 studies
- Community-based health insurance (CBHI) – mostly Africa (Ghana, Rwanda, Senegal, Democratic Republic of Congo) – 80 of 159 studies
- Voluntary private health insurance (PHI) – large scale coverage in Brazil, Chile, Namibia, South Africa – 10 of 159 studies.
- Resource mobilisation: strong evidence on the impact of CBHI on resource mobilisation generally positive, but impact of SHI and PHI inconclusive
- Financial protection: strong evidence that CBHI and SHI provide financial protection by reducing out-of-pocket payments
- Service utilisation: strong evidence that CBHI and SHI increase service utilisation of both inpatient and outpatient care
- Quality of care: weak evidence. CBHI schemes in Kenya, Uganda and Tanzania found increased essential drug availability and shorter waiting times, whereas a study of CBHI in Burundi found preferential treatment for cash paying clients
- Social inclusion: weak evidence that both SHI and CBHI have a positive impact on social inclusion. Thailand and the Philippines have achieved this more successfully by subsidising the poor for enrolment, whereas Cameroon, Guinea and Senegal are countries where this has not been achieved because of the poor’s inability to pay premiums
- Community empowerment: inconclusive evidence because of the lack of studies.
Why do you think this is the case? Do you think health insurance is a better alternative than progressive taxation (and why do you say so)?Please comment below.
References
Spaan, E, Mathijssen, J, Tromp, N, McBain, F, Have, AT & Baltussen, R, 2012, ‘The impact of health insurance in Africa and Asia: a systematic review’, Bulletin of the World Health Organization, vol. 90, pp. 685-692.
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