Assessing the feasibility and appropriateness of introducing a national health insurance scheme in Malawi

Global Health Research and Policy

Andrew Kardan¹  Tomas Lievens¹  Adrian Gheorghe¹  Alexandra Murray-Zmijewski¹  Dominic Nkhoma²  Wathando Mughandira³  Deliwe Malema⁴  Denis Garand⁵  Kai Straehler-Pohl⁶ 

[1] 0000 0000 8881 3751, grid.479394.4, Oxford Policy Management Ltd, Level 3 Clarendon House, 52 Cornmarket St, OX1 3HJ, Oxford, UK;0000 0001 2113 2211, grid.10595.38, Health Economics and Policy Unit, College of Medicine, University of Malawi, Lilongwe, Malawi;0000 0004 0433 5123, grid.463341.7, Ministry of Health, Government of Malawi, Lilongwe, Malawi;Independent consultant, Lilongwe, Malawi;Independent consultant, Regina, Canada;Malawi German Health Programme (GIZ), Lilongwe, Malawi;

关键词: Social health insurance;    Malawi;    Strategic purchasing;    Equity;    Assessment;    Feasibility;   

DOI  :  10.1186/s41256-019-0103-5

来源: publisher

【 摘 要 】

BackgroundIn May 2015 the Malawian Ministry of Health (MOH) contacted the German Development Cooperation to seek technical assistance from the P4H Network for Social Health Protection for an “Assessment of the appropriateness and feasibility of National Health Insurance in Malawi” against two alternative options: continuing with a tax (and donor)-funded National Health Service, and introducing a purchaser-provider split without a revenue collection function.MethodsA health financing benchmarking matrix was agreed with MOH, with six domains corresponding to six objectives: revenue mobilisation, technical efficiency, equity, financial risk protection, policy coordination, and health outcomes. The assessment comprised key informant interviews with Malawian stakeholders, a review of the relevant literature and datasets, rapid assessments of the Malawi Revenue Authority (MRA) and the Unified Beneficiary Registry (UBR), and projections of the National Health Insurance Scheme’s (NHIS) revenue collection costs and benefits.ResultsA key finding was that introducing NHIS in Malawi would increase revenues for health, but these would come predominantly from the formal sector and would be unlikely to cover the health sector funding gap. The performance of existing poverty identification and targeting mechanisms was not commensurate with the requirements of a NHIS. Incentives to enrol in NHI are insufficient to reach scale unless service fees be introduced, which would negatively affect equity and financial risk protection. The assessment identified the Purchaser Scenario as the most favourable reform model.ConclusionsAs ever more countries look towards implementing National Health Insurance, the proposed assessment framework can provide an orientation for evidence-based policy making in the area of health financing.

【 授权许可】

CC BY