The Impact of Health Insurance in Low- and Middle-income Countries

by Escobar, Maria-luisa; Griffin, Charles C.; Shaw, R. Paul

• ISBN13: 9780815705468
• ISBN10: 0815705468
• Format: Paperback
• Copyright: 2011-01-28
• Publisher: Brookings Institution Press

Summary

Over the past twenty years, many low- and middle- income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populations --and if so, how to do it --or to serve them through other means. Using recent household data, this new book assesses the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. These nations are betting that insurance-based health care financing can increase the accessibility of services, improve providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. The contributors also discuss potential design improvements that could increase impact. They provide insights on how to evaluate health insurance reforms using existing data and contribute to a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Author Biography

Maria-Luisa Escobar is lead health economist and health systems program leader at the World Bank Institute. Charles C. Griffin is senior adviser in the European and Central Asia regional office of the World Bank. R. Paul Shaw, a former World Bank lead economist, advises the Bill and Melinda Gates Foundation on health economics.

Table of Contents

Preface	p. xi
Acknowledgments	p. xiii
Why and How Are We Studying Health Insurance in the Developing World?	p. 1
Objectives of this study and how it was conducted	p. 4
Country case selection	p. 6
...and to the book	p. 11
References	p. 12
A Review of the Evidence	p. 13
Impact of health insurance on access and use	p. 17
Impact of health insurance on financial protection	p. 19
Impact of health insurance on health status	p. 22
Heterogeneity of health insurance schemes	p. 25
Moving forward	p. 25
Notes	p. 28
References	p. 29
Studies reviewed but not cited	p. 31
Low-Cost Health Insurance Schemes to Protect the Poor in Namibia	p. 33
Health and the health care sector in Namibia	p. 34
Coping with health shocks when uninsured	p. 39
Analysis	p. 41
Scope for targeting	p. 48
Conclusions	p. 51
Notes	p. 56
References	p. 56
Ghana's National Health Insurance Scheme	p. 58
Ghana's health system	p. 59
Health care financing	p. 59
Early successes and challenges	p. 62
Evaluation of the National Health Insurance Scheme	p. 64
Determinants of enrollment in the National Health Insurance Scheme	p. 65
Effects of National Health Insurance Scheme implementation on health care use and spending	p. 69
Differences in health care use and payment comparing National Health Insurance Scheme-insured and uninsured in 2007	p. 76
Policy implications	p. 78
Challenges for the future	p. 79
Appendix: Details and methods of the evaluation	p. 81
Notes	p. 86
References	p. 87
Impact of Health Insurance on Access, Use, and Health Status in Costa Rica	p. 89
Main characteristics of the Costa Rican health system	p. 90
Who are the uninsured?	p. 93
What are the determinants of insurance status?	p. 99
Impacts of health insurance	p. 99
Conclusions	p. 102
Appendix: Details of the Estimations	p. 103
Notes	p. 105
Health Insurance and Access to Health Services, Health Services Use, and Health Status in Peru	p. 106
The Peruvian health sector	p. 106
Health insurance population coverage in the household surveys	p. 109
Descriptive information	p. 109
The effects of Seguro Escolar Gratuito/Seguro Materno Infantil and Seguro Integral de Salud health insurance coverage on health care results using Demographic and Health Survey data	p. 112
Impact of Seguro Integral de Salud health insurance coverage on health care results using ENAHO data	p. 115
Summary and conclusions	p. 117
Appendix: Model Specifications	p. 119
Notes	p. 121
References	p. 121
The Impact of Health Insurance on Use, Spending, and Health in Indonesia	p. 122
The Indonesian health system	p. 123
Descriptive statistics: the insured and the uninsured	p. 124
Impacts of insurance on adults	p. 125
Impacts of insurance on children	p. 130
Conclusion	p. 134
Notes	p. 136
References	p. 136
The Impact of Rural Mutual Health Care on Hearth Care Use, Financial Risk Protection, and Health Status in Rural China	p. 137
Rural health care in China	p. 138
Rural mutual health care	p. 139
Study design and data	p. 143
The enrolled and the nonenrolled	p. 144
Impacts of the Rural Mutual Health Care Scheme	p. 148
Conclusions	p. 150
References	p. 153
Colombia's Big Bang Health Insurance Reform	p. 155
Main features of the Colombian health sector reform	p. 157
Conceptual framework	p. 159
Health insurance coverage	p. 161
Access and use of services	p. 162
Financial protection	p. 167
Health status	p. 171
Conclusion	p. 173
Notes	p. 175
References	p. 176
Main Findings, Research Issues, and Policy Implications	p. 178
Six general findings	p. 180
Research issues	p. 185
Policy implications	p. 189
Conclusion	p. 197
References	p. 198
Editors and Authors	p. 199
Index	p. 205
Boxes
Impact of health insurance on health-related outcomes in rich countries	p. 5
The key analytical question	p. 14
Robustness of the evidence base	p. 15
Data collection	p. 35
Data and methodology	p. 95
Methodology	p. 124
Data and methodology	p. 154
Figures
Age structure of the insured and uninsured, 2006	p. 95
Health insurance in Colombia, premiums and benefits plans, 2010	p. 156
Colombia's health system, financial flows, and affiliation	p. 157
The distribution of out-of-pocket spending by households using health services, thousand pesos, 2003	p. 167
Factors diminishing the measured impact of health insurance	p. 186
Tables
Income and health finance indicators for select country groupings, 2007	p. 3
Indicators for the country cases, 2007	p. 7
Individuals enrolled in a medical aid fund	p. 36
Reported prevalence of chronic disease, acute illness, or injury-and incidence of hospitalization among the insured and uninsured (%)	p. 37
Use of health services for acute illness or injury and hospitalization	p. 38
Average per capita annual out-of-pocket health expenditures	p. 39
Average per capita annual out-of-pocket health expenditures for the uninsured, by quintile	p. 40
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