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Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995-2012 and policy implications for progress towards universal health coverage.

Pettigrew LM, Mathauer I - Int J Equity Health (2016)

Bottom Line: Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI).Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC.To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

ABSTRACT

Background: Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).

Methods: Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995-2012. A literature analysis offered potential reasons for trends in countries and regions.

Results: In 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC.

Discussion and conclusion: Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.

No MeSH data available.


Related in: MedlinePlus

WPRO Individual country trends of VHI%, 1995–2012, pacific island states
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Fig12: WPRO Individual country trends of VHI%, 1995–2012, pacific island states

Mentions: There are 21 LMIC countries in WPRO (out of the 37 countries and areas that make up the region), with only one country not reporting on VHI expenditure. Nine of these reported a VHI% > 1 % in any one year between 2008 and 2012, five of which were pacific islands. Meanwhile ten countries reported that none of their THE was spent on VHI, the highest number across all the regions. Of the countries included in the country trend analysis, a general upwards trend can be seen in half of the countries (see Figs. 11 and 12). The data has been split into two graphs; non-pacific island states (Fig. 11) and pacific island states (Fig. 12)Fig. 11


Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995-2012 and policy implications for progress towards universal health coverage.

Pettigrew LM, Mathauer I - Int J Equity Health (2016)

WPRO Individual country trends of VHI%, 1995–2012, pacific island states
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4836104&req=5

Fig12: WPRO Individual country trends of VHI%, 1995–2012, pacific island states
Mentions: There are 21 LMIC countries in WPRO (out of the 37 countries and areas that make up the region), with only one country not reporting on VHI expenditure. Nine of these reported a VHI% > 1 % in any one year between 2008 and 2012, five of which were pacific islands. Meanwhile ten countries reported that none of their THE was spent on VHI, the highest number across all the regions. Of the countries included in the country trend analysis, a general upwards trend can be seen in half of the countries (see Figs. 11 and 12). The data has been split into two graphs; non-pacific island states (Fig. 11) and pacific island states (Fig. 12)Fig. 11

Bottom Line: Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI).Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC.To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

ABSTRACT

Background: Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).

Methods: Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995-2012. A literature analysis offered potential reasons for trends in countries and regions.

Results: In 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC.

Discussion and conclusion: Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.

No MeSH data available.


Related in: MedlinePlus