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This study examined levels of health insurance coverage in 30 low- and middle-income countries (LMICs), using nationally representative data from the Demographic and Health Surveys (DHS). In eight countries with health insurance coverage exceeding 10 percent, we used propensity score matching and estimated the impact of health insurance status on the use of antenatal care and facility-based delivery care. Health insurance coverage rates were less than 5 percent in most countries. In a few countries (Rwanda, Gabon, Ghana, and Indonesia), more than one-third of interviewed women and men reported coverage of health insurance, with the highest rate found in Rwanda. Educational attainment was associated with a higher likelihood of enrolling in health insurance. Pro-wealthy disparities in health insurance coverage existed in the majority of countries. In Cambodia and Gabon, however, poor women were more likely than the rich to be covered by health insurance, suggesting that in these countries policies focusing on providing insurance for the poor have been effective. Our analysis found significant positive effects of health insurance coverage on at least one measure of maternal health care use in seven of the eight countries evaluated. Indonesia stands out for the most systematic effect of health insurance across all measures, followed by Cambodia, Rwanda, and Ghana. The positive impact of health insurance appeared more consistent on the use of facility-based delivery than use of antenatal care. The analysis provides clear evidence that health insurance has contributed to the increased use of maternal health care services. --
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.
Health Insurance is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United Sates and addresses the impact on the family of not having health insurance. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. It concludes with the finding that uninsured children have worse access to and use fewer health care services than children with insurance, including important preventive services that can have beneficial long-term effects.
The evaluation of reproductive, maternal, newborn, and child health (RMNCH) by the Disease Control Priorities, Third Edition (DCP3) focuses on maternal conditions, childhood illness, and malnutrition. Specifically, the chapters address acute illness and undernutrition in children, principally under age 5. It also covers maternal mortality, morbidity, stillbirth, and influences to pregnancy and pre-pregnancy. Volume 3 focuses on developments since the publication of DCP2 and will also include the transition to older childhood, in particular, the overlap and commonality with the child development volume. The DCP3 evaluation of these conditions produced three key findings: 1. There is significant difficulty in measuring the burden of key conditions such as unintended pregnancy, unsafe abortion, nonsexually transmitted infections, infertility, and violence against women. 2. Investments in the continuum of care can have significant returns for improved and equitable access, health, poverty, and health systems. 3. There is a large difference in how RMNCH conditions affect different income groups; investments in RMNCH can lessen the disparity in terms of both health and financial risk.
Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.
This book presents an in-depth review on the role of health care financing in improving access for low-income populations to needed care, protecting them from the impoverishing effects of illness, and addressing the important issues of social exclusion in government financed programs.
Health insurance is the mechanism used to respond to uncertainty and risk aversion to illness. Health insurance, whether private, public, or mixed, serves as the main structural foundation for health systems across countries. Its objectives are to minimize the financial burden of medical expenses on people and to enhance population health. Globally, there is a great diversity of health systems and even greater variation among them. There are substantial differences in health systems and health insurance between low- and middle-income nations. The primary explanation for this could be the disparities in the resources available to fund the health system. High-income countries have the financing ability to fund the provision of health care, whereas low- and medium-income countries have a harder time funding health care. Another challenge health systems face nowadays is the achievement of the United Nations Sustainable Development Goal 3: healthy lives and promoting well-being for all. To create resilient and sustainable health systems that guarantee healthy lives and foster well-being for people of all ages, many countries are redesigning their healthcare systems by improving financing, access, and coverage. This book discusses these issues in different health systems around the world, in low-, middle-, and high-income countries.
This study provides the most comprehensive and detailed analysis available on factors behind the decline in maternal mortality in Malaysia and Sri Lanka in the past 50 to 60 years and the magnitude of health system expenditures on maternal health. The main findings are that a modest investment in maternal health services, combined with other poverty reduction measures leads to a fairly rapid decline in the maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. The strategies of Malaysia and Sri Lanka changed over time, from an initial emphasis on expanding the provision of services, especially in underserved areas, to increasing utilization and, finally, to emphasizing the improvement of quality. Removing financial barriers to maternal care for clients was an important step in both countries. Professional midwives constitute the backbone of maternal care in Malaysia and Sri Lanka. The MMR reduction in developing countries is feasible with modest public expenditures when appropriate policies are adopted, focused wisely, and adapted incrementally in response to environmental conditions and systems capacity. [World Bank]
Many countries that subscribe to the Millennium Development Goals (MDGs) have committed to ensuring access to basic health services for their citizens. Health insurance has been considered and promoted as the major financing mechanism to improve access to health services, as well to provide financial risk protection. In Africa, several countries have already spent scarce time, money, and effort on health insurance initiatives. Ethiopia, Ghana, Kenya, Nigeria, Rwanda, and Tanzania are just a few of them. However, many of these schemes, both public and private, cover only a small proportion of the population, with the poor less likely to be covered. In fact, unless carefully designed to be pro-poor, health insurance can widen inequity as higher income groups are more likely to be insured and use health care services, taking advantage of their insurance coverage. Despite the many benefits that health insurance may offer, table 1.1 shows that the journey to implement insurance and achieve the benefits is challenging, long, and risky. Policy makers and technicians that support development and scale-up of health insurance must figure out how to increase their country''s financing capacity, extend health insurance coverage to the hard-to-reach populations, expand benefits packages, and improve the performance of existing schemes.