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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

Overview of VHI in 2012 by country income classification
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Fig1: Overview of VHI in 2012 by country income classification

Mentions: The GHED provided information on 193 countries, when data was downloaded. Out of these 55 countries were classified as high-income countries (HIC) and 138 as LMIC in 2012. Figure 1 provides a summary of VHI data availability by country income group. Twenty-seven LMIC (20 %) had no data or more than five years of missing VHI expenditure data; these were excluded from further analysis (listed in Additional file 1). This left 111 LMIC with available data. Seven HIC countries (Antigua and Barbuda, Chile, Latvia, Lithuania, the Russian Federation, Uruguay and Saints Kitts and Nevis) were included in the regional analysis and in the literature search as they had been LMIC for the majority of the 1995–2012 period (Fig. 2). From this total of 118 countries, 20 countries reported zero VHI% throughout the period, and 30 countries reported a VHI% of below 1 % in 2012. Countries with a VHI% of below 1 % in 2012 were excluded from the individual country trend analysis and literature search, unless the VHI% had been above 1 % at some point during the period of 2008–2012, which was the case for five AFRO countries and one WPRO country. In total, 74 countries met the final inclusion criteria for individual country trend analysis.Fig. 1


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)

Overview of VHI in 2012 by country income classification
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig1: Overview of VHI in 2012 by country income classification
Mentions: The GHED provided information on 193 countries, when data was downloaded. Out of these 55 countries were classified as high-income countries (HIC) and 138 as LMIC in 2012. Figure 1 provides a summary of VHI data availability by country income group. Twenty-seven LMIC (20 %) had no data or more than five years of missing VHI expenditure data; these were excluded from further analysis (listed in Additional file 1). This left 111 LMIC with available data. Seven HIC countries (Antigua and Barbuda, Chile, Latvia, Lithuania, the Russian Federation, Uruguay and Saints Kitts and Nevis) were included in the regional analysis and in the literature search as they had been LMIC for the majority of the 1995–2012 period (Fig. 2). From this total of 118 countries, 20 countries reported zero VHI% throughout the period, and 30 countries reported a VHI% of below 1 % in 2012. Countries with a VHI% of below 1 % in 2012 were excluded from the individual country trend analysis and literature search, unless the VHI% had been above 1 % at some point during the period of 2008–2012, which was the case for five AFRO countries and one WPRO country. In total, 74 countries met the final inclusion criteria for individual country trend analysis.Fig. 1

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