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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

EURO Individual country trends of VHI%, 1995–2012
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Fig9: EURO Individual country trends of VHI%, 1995–2012

Mentions: The availability of VHI expenditure data was very limited for the 23 EURO LMIC countries, with only 12 countries reporting VHI expenditure with less than five years of data missing. Out of these, six countries had a VHI% > 1 % in any year between 2008 and 2012 (Georgia, Hungary, Russian Federation, Uzbekistan, Latvia and Turkey). Based on the available data, EURO LMIC show the overall lowest average VHI%, only since 2011 is the average VHI% slightly lower in SEARO LMICs (see Fig. 3). It should be noted that the Russian Federation and Latvia (and Lithuania which did not have a VHI% >1 % between 2008 and 2012, so not included in the trend analysis) became HIC in 2012. All countries included with a VHI% > 1 % (see Fig. 9 for the detailed country analysis) have seen an overall rise in VHI% since 1995, but other than Hungary and Georgia, the VHI% decreases from the early 2000s onwards. Except for Georgia, VHI% remained below 5 % in all countries.Fig. 9


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)

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

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

Fig9: EURO Individual country trends of VHI%, 1995–2012
Mentions: The availability of VHI expenditure data was very limited for the 23 EURO LMIC countries, with only 12 countries reporting VHI expenditure with less than five years of data missing. Out of these, six countries had a VHI% > 1 % in any year between 2008 and 2012 (Georgia, Hungary, Russian Federation, Uzbekistan, Latvia and Turkey). Based on the available data, EURO LMIC show the overall lowest average VHI%, only since 2011 is the average VHI% slightly lower in SEARO LMICs (see Fig. 3). It should be noted that the Russian Federation and Latvia (and Lithuania which did not have a VHI% >1 % between 2008 and 2012, so not included in the trend analysis) became HIC in 2012. All countries included with a VHI% > 1 % (see Fig. 9 for the detailed country analysis) have seen an overall rise in VHI% since 1995, but other than Hungary and Georgia, the VHI% decreases from the early 2000s onwards. Except for Georgia, VHI% remained below 5 % in all countries.Fig. 9

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