Moving away from out-of-pocket (OOP) payments for healthcare at the time of use to prepayment through health insurance (HI) is an important step towards averting financial hardships associated with paying for health services. Social health insurance (SHI) is mandated for those employed in many developed countries where employment and wage rates are high; this service is extended to those unemployed through subsidy. In low- and middle-income countries (LMICs) some version of SHI has been offered to those in the informal labour sector, who may well comprise the majority of the workforce. A systematic review was carried out of studies reporting on the impact of health insurance schemes that are intended to benefit the poor, mostly employed in the informal sector, in LMICs at a national level, or have the potential to be scaled up to be delivered to a large population.
The review finds no strong evidence to support widespread scaling up of social health insurance schemes as a means of increasing financial protection from health shocks or of improving access to health care. The health insurance schemes must be designed to be more comprehensive in order to ensure that the beneficiaries attain desirable levels of healthcare utilisation and have higher financial protection. At the same time, the non-financial barriers to access to healthcare, such as awareness and distance to healthcare facilities, must be minimised. Further, more rigorous evaluation studies on implementation and the impact of health insurance must be conducted to generate evidence for better-informed policy decisions, paying particular attention to study design, the quality of the data and the soundness of the econometric methods.
Acharya, A.; Vellakkal, S.; Taylor, F.; Masset, E.; Satija, A.; Burke, M.; Ebrahim, S. Impact of national health insurance for the poor and the informal sector in low- andmiddle-income countries: a systematic review. EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, London, UK (2012) 110 pp. ISBN 978-1-907345-34-0