Summary (English)

This joint NGO briefing paper provides a critical analysis of different forms of health insurance as mechanisms for the financing and provision of healthcare coverage to people living in poverty.

In view of the current debates on the role of health insurance as a key means of financing healthcare in low-income countries, this paper urges for caution on the part of donors and governments; arguing that if a government fails to implement the necessary accompanying measures and to mobilise adequate resources, health insurance mechanisms may even have an adverse effect on the equity and efficiency of healthcare schemes.

This paper suggests that the current practice of assessing insurance schemes in terms of the advantages they bring to their particular membership fails to account for their impact on entire populations, and in particular on people living in poverty who cannot afford prepayments. A revision of evaluation criteria is needed, with greater attention being paid to 'vertical equity' i.e. differential access according to people's different needs in recognition of the existence of vulnerable groups. Insurance schemes should be measured in terms of their contribution to the ultimate end of providing universal access to quality healthcare.

The forms of health insurance discussed in this paper are: Private Health Insurance (PHI), Private for-profit Micro Health insurance, Community Based Health Insurance (CBHI) and Social Health Insurance (SHI). Examining each form of health insurance against the revised criteria in turn, this paper seeks to present what are considered to be the practical challenges confronting each mechanism, giving evidence drawn from case studies of low-income countries (and to a lesser extent those of higher-income countries) in each instance. The third part of this paper discusses the importance of national commitment to public spending on health and the crucial need for global solidarity.