Transcript DRAFT AID STRATEGY Jan 2008 – Dec 2008

Health Insurance in lowincome countries
Where is the evidence that it
works?
Esme Berkhout
Health policy advisor
Oxfam Novib
Oxfam International, Action for Global Health, Medecins
du Monde, Save the Children UK, Plan, Global Health
Advocates and Act Up Paris
Content
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Global context
Expectations
National/local reality
Coverage
Main concerns
Recommendations
Global context
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Right to health & social security
1.3 billion people lack access
100 million pushed into poverty
User fees: inequitable
Pre-payment and riskpooling preferred
ILO global campaign (2001), WHA 58.33 (2005) Berlin
conference and plan of action (2005), Paris conference
(2007 & 2008), Africa-EU strategic partnership (2007),
IFC strategy (2007), Providing for Health (G8, 2007)
Expectations
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Increases resources
More predictable
Cross-subsidization
Reduces uncertainty for citizens
Contributes to better quality health care
National/local reality
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Does not live up to expectations
Relatively few people are reached
The poorest & vulnerable: most excluded
Can only work for the poor through:
– strong government stewardship
– sufficient public funding
 NGOs jointly concerned
Private health insurance
 Coverage rate in LICs < 10%
 Premium related to risk profile:
discrimination & exclusion
 Typically cover higher income groups
 Regulation: up to 30% of revenue
Micro health insurance
 Coverage worldwide ~35 million (mostly
Asia)
 Targets poor people
 Low premiums & benefits package (India)
 Can reduce catastrophic health
expenditure
 Has limited effect on reducing OOP
Community based health insurance
 Coverage ~2 million people in Africa
(0.2%)
 Not for profit, based on solidarity among
group of (poor) people
 Excludes poorest and most vulnerable
groups (Armenia, Rwanda)
 Members continue to depend on OOP to
cover 40% of health needs
Social health insurance
 Widespread in OECD, Latin-America and
Eastern Europe
 Mandatory, premiums in proportion to
income
 Difficult to extend to the poor & informal
(Ghana 38% coverage 2006)
 Positive example of Thailand
Main concerns
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Waiting for realization of rights
Policies for achieving universal access?
Public funding too low
Insurance won’t fill funding gap
Potential threat to equity and universal
access
Recommendations
1. Consider Insurance in relation to
universal access, equity and efficiency
2. Set out a timeline towards universal
access, and ensure financing
3. Consultation with civil society, including
the most vulnerable groups
4. Pay particular attention to equity
5. Increase public resources
6. Support abolition user fees
Questions?