1 / 17

How to develop health insurance targeted to the poor

How to develop health insurance targeted to the poor. Catherine Connor, MBA Abt Associates Inc. June 14, 2010 Global Health Conference. The poor might not eligible The poor are eligible but might not enroll The poor are enrolled, but might not benefit (use services).

edith
Télécharger la présentation

How to develop health insurance targeted to the poor

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. How to develop health insurance targeted to the poor Catherine Connor, MBA Abt Associates Inc. June 14, 2010 Global Health Conference

  2. The poor might not eligible The poor are eligible but might not enroll The poor are enrolled, but might not benefit (use services) How can health insurance be designed to address these obstacles?

  3. Make eligibility an explicit policy and operational objective Most countries begin with the “easy” populations who are not poor How to make the poor eligible for health insurance?

  4. How to enroll the poor and ensure they benefit (use services)? Rural poor, farmers Informal sector workers, small business owners, street vendors Female head of household Orphans

  5. Education, sensitization Subsidize or exempt poor populations from premium payments, user fees, or co-payments Target poor Door-to-door enrollment (Rwanda) Cards or vouchers (India, Bangladesh, Thailand, Philippines) Determine at point-of-service or enrollment (Ghana) NGOs, community or affinity groups (India, West Africa) Incentives for providers to serve the poor (Argentina) Measure performance! How to enroll the poor and ensure they benefit (use services)?

  6. Out-of-pocket expenditures dominate health financing in Africa and Asia What have been some country experiences making health insurance pro-poor?

  7. Built on community-based schemes from 1990s District-level schemes governed by national guidelines Exempt: Under 18, over 70, formal sector employees contributing to Social Security and National Insurance Trust, and “the indigent” Funding: Households pay $9/year, 2.5% VAT; 2.5% of SSNIT contributions, and government budget allocations Country experiences – 2003 National Health Insurance in Ghana

  8. Country experiences – Results in Ghana The good news • 61% of population covered by 2008 • Significant declines in spending from 2004 to 2007* *http://www.healthsystems2020.org/content/resource/detail/2361/

  9. By 2009, about 70% of NHIS members were in the exempt category –sustainable? 50% of those in the richest quintile were insured, compared to less than 20% in the poorest quintile No statistically significant differences in the rates of premium exemptions across wealth quintiles District scheme manager on exemption policy: “When you go to a community, you will realize that they are all farmers. You can’t determine the income level at the end of the day so how do you determine the poor, the poorer and, the poorest in that community? Why not ask everybody to pay the same premium? Ya, so we have decided that they should all pay the same.” Country experiences – Results in Ghana Not so good news

  10. Began with pilot of community-based schemes in 1990s Covers 5.7 million Rwandans, or 75% of the population (2007), mostly rural and informal sector $1.81 per person per year Community outreach by “animateurs de santé” to enroll families 50% premium revenue + 50% government budget and donor funds Country experiences – Community Based Health Insurance (AMC) in Rwanda 1Assurances Maladies Communautaires (AMCs)

  11. Good news: Increased coverage of the rural and informal sector population (from 1.2% in 1999 to 75.6% in 2007) Lower out-of-pocket payments from 24.7% of total health expenditure in 2000 to 15.9% in 2005 Not so good: Premium still a barrier for poorest Annual re-enrollment is costly AMC fund separate from civil service insurance funds Country experiences – Results in Rwanda

  12. Making health insurance pro-poor requires financing Where will funds come from?

  13. Revenue Collection General taxes that are progressive The rich pay higher income or property tax rates No sales tax on staples such as food Earmarked taxes for health that are progressive Payroll taxes Taxes on luxury goods Donor funding How to finance inclusion of the poor? May suppress growth of jobs and formal economy Unpredictable

  14. Pooling – Rich subsidize the poor Mandatory membership so the rich cannot opt out Redistribution among multiple fund pools Rich districts subsidize poor districts Civil servant insurance fund is pooled with rural community insurance fund How to finance inclusion of the poor? Requires social cohesion and political mandate

  15. Efficient Purchasing Rationalize service use Exclude higher-end, expensive, elective care from the benefit package (Ghana, Rwanda, Kyrgyz, ) Shift from inpatient to outpatient care (Kyrgyz) How to finance inclusion of the poor? May face resistance from beneficiaries May face resistance from providers

  16. Summary – How to insure the poor • Not enough to say they are eligible • Purposefully enroll and promote service use • Many options – need to tailor to each country and to different segments of the poor population • Measure performance – be accountable • Don’t forget the financing!

  17. Thank you Reports related to this presentation are available at www.healthsystems2020.org

More Related