ILO | Social Protection Platform

Baseline

Each year, 100 million people fall into poverty as a result of health care spending, and 800 million spend at least 10 percent of the household budget on health care, a situation that disproportionately affects the poorest.
Two-thirds of the world's population are protected by a social health protection scheme, this proportion is only one-third and one-fifth in lower middle-income and low-income countries, respectively.
The extension of social health protection is therefore a priority to improve access to care, avoid impoverishment and improve productivity.

Key resources

Toolkit on Social Health Protection

ILO/HEALTH Actuarial Platform

Approach and Technical Support

The ILO promotes a rights-based approach to social health protection, with the objective of ensuring effective access to quality health care without hardship and impoverishment. This rights-based approach is rooted in the body of human rights and ILO standards which represent a global consensus to guide the development of social health protection systems.

Coverage

Universal health coverage resulting in effective access to health care services and financial protection can only be achieved if the right to health protection is guaranteed under national and/or local legislation and in turn, if such legislation is fully implemented such that financial protection and essential health services are available and affordable to all.

Legal coverage

Legal frameworks guarantee people’s right to health and social security and their establishment is one of the first steps towards establishing a social health protection floor. Monitoring of legal coverage of social health protection is an urgent imperative globally as coverage gaps help us highlight persistent social-economic inequalities.

Access & Inequity

As enshrined in the ILO Social Protection Floors Recommendation, 2012 (No. 202), the design of social health protection systems and their implementation should follow an approach based on non-discrimination, gender equality and social inclusion so as to leave no one behind. Particular attention should be given to groups historically and commonly marginalized such as women, religious, ethnic/racial as well as sexual and gender minorities, migrant populations, the elderly, low-income groups, people living with disabilities and informal economy workers amongst many others.

Awareness of entitlements and effective protection

Effective awareness of entitlements is required for people to fully enjoy their right to social health protection. Legal coverage might not always translate in practice due to systematic barriers in access and awareness.

Adequacy of benefits

Legal entitlements to adequate benefits

Adequate benefits, guaranteed by law ensure that a basic set of interventions are guaranteed to all as enshrined in ILO’s Social Security (Minimum Standards) Convention, 1952 (No. 102). Progressive increase of such protection levels should be ensured so as to reach a comprehensive protection levels through time, in line with international social security standards.

Service coverage and provision

Particular attention needs to be given to not only which social health protection provisions are covered and guaranteed under the law, but how such provisions are delivered to ensure effective access, quality, availability and responsiveness of social health protection guarantees.

Financing

Sufficient, predictable and sustainable financing for social health protection is key to progress towards UHC. International social security standards recognize a diversity of arrangements for the financing, purchasing and provision of healthcare so as long as they respect key principles, notably, the principles of risk-sharing and solidarity in financing. For this reason, out-of-pocket payments and private insurance schemes which do not foster risk-sharing and mutual support cannot be considered funding models fostering UHC by the ILO. Adequate financing should be made available so as to increase levels of protection and coverage beyond basic levels as more fiscal space is created to ensure universality of coverage over time.

Critical gaps in public financing for social health protection globally

Insufficient funding for social health protection places the financial burden of ill health on households in many parts of the world. Yearly, millions are pushed into poverty as a result of catastrophic health spending making out-of-pocket payments and the lack of financial protection a major poverty risk. The most significant gaps in coverage are often found in countries facing high poverty levels while higher coverage rates are commonly achieved in countries with lower poverty levels.

Socio-economic impact

Social health protection acts as a vector of economic development through the elimination of catastrophic health expenses as healthcare is accessed without financial hardship. Social health protection thus reduces the impoverishment of households, thereby improving their productive and economic capacity. Anchored in the principles of social justice, equity and solidarity, social health protection can also contribute to better social cohesion by reducing inequalities within society.

A key contribution to the SDGs

Social health protection as a tool to reach UHC is central to achieving SDG targets on UHC (SDG 3.8) and universal social protection systems, including floors (SDG 1.3). As a vector of economic development, social health protection also contributes to SDG 8 on promoting promoting sustained, inclusive and sustainable economic growth, full and productive employment and decent work as social health protection improves households productive and economic capacity, thereby reducing impoverishment. Lastly, it also contributes to SDG targets 1.1, 1.2, 10.4 on poverty and 10.4 and 5.6 addressing inequalities, including gendered inequalities in access to healthcare.

Dialogue and Strategy

National dialogue on social health protection and coordination of social policies.
Cost estimate, financial projection and analysis of the fiscal space for the extension of coverage.

Design

Analysis of needs and participation.
Definition of coverage parameters, affiliation modalities, reimbursement methods and financing approach.
Normative framework building through capacity building and formulation of legal frameworks anchoring principles and parameters set out in ILO standards.

Implementation

Economic and actuarial analysis using in-house tools such as the ILO/HEALTH Actuarial Health Model and the ILO/RAP Rapid Assessment Protocol Costing Tool.
Governance and management of operational processes.