This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status.
As co-sponsor and host of the workshop, “Equity in Universal Coverage: How to Reach the Poorest”, in Marrakech, Morocco from September 24-27, 2012, the Moroccan Ministry of Health was clear about the importance of organizing a workshop that acknowledged and linked the political dimension of achieving universal health coverage (UHC), to the discussion and debate on technical achievements and challenges. As RAMED, Morocco’s medical assistance scheme for the poor, moves to rapidly scale-up, ensuring continued government commitment is as critical to the success of the program as getting technical nuts and bolts issues resolved. RAMED needs the support of the Moroccan government to address its challenge of long-term financial sustainability and to continue to elevate affordability and quality in health service delivery as key priorities.
My experience at the equity in universal healthcare coverage workshop in Marrakech, Morocco
Between 24th and 27th September 2012, I participated, as part of Ghana’s team, in a workshop themed “Equity in Universal Healthcare Coverage: How to reach the Poorest” jointly organized in Marrakech, Morocco by the Moroccan Ministry of Health, the Financial Access to Health Services Community of Practice (FAHS CoP) and the Joint Learning Network for Universal Health Coverage (JLN).
The workshop provided an opportunity to review efforts by countries in Africa and Asia in their march towards universal health coverage for their populations. As the theme of the 2011 World Health Report, as well as of a number of international and regional conferences over the past 18 months.
The September 24-27, 2012 workshop on “Equity in Universal Health Coverage: How to Reach the Poorest”
As these events go, the workshop on “Equity in Universal Health Coverage: How to Reach the Poorest” hosted last month by the Moroccan Government, the Financial Access to Health Services Community of Practice (FAHS CoP), and the Expanding Coverage Track of the Joint Learning Network for Universal Health Coverage (JLN), in Marrakech, Morocco was more than just your average seminar, symposium, convention, round table or even workshop.
Over 90 participants – including country delegations and individuals from Benin, Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, Kenya, Mali, Morocco, Nigeria and Senegal came together over the course of four days to engage in peer-to-peer learning and to share their experiences in designing, implementing, managing and advocating for programs to improve access to health care for the poorest. Participants left the workshop with renewed commitment to tackling the challenges they face in reaching the poorest, fresh ideas, and new partnerships.
JLN member countries convene in Morocco to discuss “Equity in universal health coverage: how to reach the poorest”
In co-operation with the Moroccan Government and the Financial Access to Health Services Community of Practice (FAHS CoP), the Expanding Coverage Track of the Joint Learning Network for Universal Health Coverage (JLN) recently organized a workshop in Marrakech, Morocco on the subject of “Equity in universal health care coverage: how to reach the poorest”. Immediately following the four day workshop which took place from September 24-27, 2012, the JLN hosted a one day session member on September 28, 2012 for JLN member countries from Sub-Saharan Africa to review action plans developed over the course of the workshop and to collectively brainstorm potential areas for peer and JLN support.
This was the first time that a JLN sponsored event supported the participation of parliamentarians focusing on the health sector.
An interview with Mr. Richard Kerich, CEO of Kenya's National Health Insurance Fund
News of Kenya’s exciting and aggressive plans to expand universal health coverage (UHC) began making headlines in early 2012. The National Health Insurance Fund (NHIF) announced a new partnership with the Kenya National Union of Teachers – one of the largest unions in Kenya – whereby NHIF will provide an affordable and comprehensive package of in and out-patient benefits to more than 1,300,000 teachers and their family members.
In addition, NHIF is offering unlimited out and in-patient benefits for approximately 1,100,000 civil servants and their family members beginning on January 1, 2012. The NHIF is also seeking to extend the unlimited in and out-patient care benefits to the informal sector in a phased out manner.
Health Minister Aaron Motsoaledi unveiled South Africa’s national health insurance (NHI) plan last Friday that seeks to extend universal health coverage to all citizens by 2025. The plan will be phased in over the next 14 years, starting with pilot schemes in 10 areas in April 2012. The idea of extending coverage to all was first discussed at the African National Congress’s (ANC) 52nd Annual Conference in December 2007 and reinforces South Africa’s Bill of Rights provision that “everyone has the right to have access to healthcare services, including reproductive healthcare.”
Under South Africa’s current two-tiered approach, health care is heavily skewed towards the private sector. Though only 20% of South Africans seek care in the private sector, the majority of resources are concentrated there and it has effectively distorted pricing across the public sector.
Health Systems 20/20 features Health economist Dr. Hong Wang and the Joint Learning Network's workshop "Expanding Coverage to the Informal Sector" held in Mombasa, Kenya in June 2011.
Health economist Dr. Hong Wang did not come to the “Expanding Coverage to the Informal Sector” workshop to share a chapter from his book—he came to empower others. National policymakers from 13 developing countries took center stage at the four-day workshop hosted by the Joint Learning Network for Universal Health Coverage (JLN), sharing accomplishments and challenges to providing health coverage to poor and informal sector populations.
During the event in Mombasa, Kenya this June, Health Systems 20/20’s Dr.