Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995–2012 and policy implications for progress towards universal health coverage

International Journal for Equity in Health

Research

Luisa M. Pettigrew¹  Inke Mathauer² 

[1] Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK;Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK;Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, Geneva, Switzerland;

关键词: Private health insurance;    Voluntary health insurance;    Universal health coverage;    Low- and middle-income countries;    Health expenditure;   

DOI  :  10.1186/s12939-016-0353-5

 received in 2015-12-02, accepted in 2016-04-04,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundMost low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).MethodsHealth expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995–2012. A literature analysis offered potential reasons for trends in countries and regions.ResultsIn 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC.Discussion and ConclusionReasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.

【 授权许可】

CC BY   
© Pettigrew and Mathauer. 2016