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Health insurance for health system strengthening

Health insurance for health system strengthening . Di McIntyre Health Economics Unit University of Cape Town. Overview. Concept of universal health systems Public funding options (including insurance) Examples: National health insurance (NHI) in Ghana Proposed NHI in South Africa.

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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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