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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

AMRO Individual country trends of VHI%, 1995–2012, VHI% > 5 % in 2012
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Fig6: AMRO Individual country trends of VHI%, 1995–2012, VHI% > 5 % in 2012

Mentions: Out of a total of 30 LMIC in AMRO, 26 have VHI data. Figures 6 and 7 present the individual country trends in VHI% from 1995–2012 for the 24 AMRO countries with VHI% above 1 % in any year between 2008 and 2012. Included are also Chile, Uruguay, Antigua and Barbuda, and Saint Kitts and Nevis, which recently became HIC. Together with AFRO, AMRO has a much wider variation in VHI% compared to other regions. It also has the greatest proportion of countries with VHI% >5 %, and so AMRO has had the highest average VHI% throughout the 18 year period (see Fig. 3). Although none of the AMRO countries maintain as high a VHI% as South Africa and Namibia, five AMRO countries maintained a VHI% of >10 % during all of the 18 year period, and only in the Dominican Republic did the VHI% of 15 % in 1995 decline and reach between 8–10 % from 2004 onwards. Likewise, Argentina shows a declining trend since 2000. There are also several countries in AMRO with relatively sharp variations in VHI expenditure data. In the absence of plausible reasons to explain such steep variations, questions around the data itself arise, in particular in Uruguay where there is a significant dip and then return to the previous trend in the early 2000s. The data has been split into two graphs to enable reading with Figure 6 showing countries with VHI% <5 % in 2012 and Figure 7 those >5 % in 2012.Fig. 6


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)

AMRO Individual country trends of VHI%, 1995–2012, VHI% > 5 % in 2012
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: AMRO Individual country trends of VHI%, 1995–2012, VHI% > 5 % in 2012
Mentions: Out of a total of 30 LMIC in AMRO, 26 have VHI data. Figures 6 and 7 present the individual country trends in VHI% from 1995–2012 for the 24 AMRO countries with VHI% above 1 % in any year between 2008 and 2012. Included are also Chile, Uruguay, Antigua and Barbuda, and Saint Kitts and Nevis, which recently became HIC. Together with AFRO, AMRO has a much wider variation in VHI% compared to other regions. It also has the greatest proportion of countries with VHI% >5 %, and so AMRO has had the highest average VHI% throughout the 18 year period (see Fig. 3). Although none of the AMRO countries maintain as high a VHI% as South Africa and Namibia, five AMRO countries maintained a VHI% of >10 % during all of the 18 year period, and only in the Dominican Republic did the VHI% of 15 % in 1995 decline and reach between 8–10 % from 2004 onwards. Likewise, Argentina shows a declining trend since 2000. There are also several countries in AMRO with relatively sharp variations in VHI expenditure data. In the absence of plausible reasons to explain such steep variations, questions around the data itself arise, in particular in Uruguay where there is a significant dip and then return to the previous trend in the early 2000s. The data has been split into two graphs to enable reading with Figure 6 showing countries with VHI% <5 % in 2012 and Figure 7 those >5 % in 2012.Fig. 6

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