DRAFT AID STRATEGY Jan 2008 – Dec 2008
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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
Global context
Expectations
National/local reality
Coverage
Main concerns
Recommendations
Global context
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
Increases resources
More predictable
Cross-subsidization
Reduces uncertainty for citizens
Contributes to better quality health care
National/local reality
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
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?