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Health insurance for health system strengthening

Explore the concept of universal health systems, public funding options, and examples of national health insurance programs like NHI in Ghana and South Africa. Learn about financial risk protection and the importance of cross-subsidies in healthcare systems.

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Health insurance for health system strengthening

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  1. Health insurance for health system strengthening Di McIntyre Health Economics Unit University of Cape Town

  2. Overview • Concept of universal health systems • Public funding options (including insurance) • Examples: • National health insurance (NHI) in Ghana • Proposed NHI in South Africa

  3. WHA 2005 resolution • Universal financial risk protection and enabling access to needed health services • Promote cross-subsidies in overall health system: • Everyone should benefit according to need for care • Everyone should contribute according to ability to pay

  4. Catastrophic payments Out-of-pocket payments for health care pushed 2.6m Vietnamese into poverty in 1998. Increased poverty headcount by 23% Wagstaff 2004

  5. Pre-payment funding • Compulsory / mandatory • General tax revenue • Payroll tax / mandatory health insurance (MHI) contribution • Voluntary health insurance (VHI): • Private (usually commercial and covering formal sector workers) • Community-based • “Systems in which the degree of risk pooling is greater, achieve more” (Carrin)

  6. Mandatory HI in Ghana • Goal of universal coverage from outset • District wide mutual insurance schemes, covering formal and informal sectors: • Payroll deduction for formal sector workers • Others contribute directly to scheme • Tax and donor funds subsidise contributions of the poor • Still need risk-equalisation between district schemes

  7. NHI in Ghana

  8. Proposed NHI in SA • Increase tax funding for health services • Hasn’t kept pace with inflation, population growth or burden of disease • Mandatory health insurance contributions for formal sector workers • Single pool from which health services for whole population purchased • Effectively, tax funding used to pay contributions of all outside formal sector employment

  9. Health Economics Unit, University of Cape Town South Africa Tax incidence Ataguba & McIntyre 2009

  10. ART funding requirements 48% Cleary & McIntyre 2009

  11. ART funding requirements 15% 48% Cleary & McIntyre 2009

  12. Key issues • Require improved public funding to build health systems in LMICs • Insurance potentially has an important role to play, but tax (and donor) funds will always be the core • Need to consider mandatory health insurance more actively than in past • Community based pre-payment can have a role if integrated (pooled) with other pre-payment funds

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