Compare: Service delivery system

Joint Learning Network for Universal Health Coverage

The Joint Learning Network for Universal Health Coverage systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.


Compare various dimensions of country reform efforts using our interactive tool.


Program Service delivery system Public providers Non-state providers Service delivery system
Nigeria: National Health Insurance System
  • Both Public & Non-state

The National Health Insurance system (NHIS) accredits both service providers and the Health Maintenance Organizations (HMOs) that interface between providers, the NHIS and its beneficiaries. To receive accreditation, health facilities must meet a number of requirements for the physical facility and the personnel, including:

  • All medical professionals must be in possession of the current license to practice;
  • The facility must be appropriate for service delivery;
  • Facility must be registered with state authorities;
  • Facility and staff must possess malpractice insurance.
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The National Health Insurance system (NHIS) accredits both service providers and the Health Maintenance Organizations (HMOs) that interface between providers, the NHIS and its beneficiaries. To receive accreditation, health facilities must meet a number of requirements for the physical facility and the personnel, including:

  • All medical professionals must be in possession of the current license to practice;
  • The facility must be appropriate for service delivery;
  • Facility must be registered with state authorities;
  • Facility and staff must possess malpractice insurance.

In addition, an accreditation fee is required. Currently 61 HMOs have been accredited and registered by NHIS in addition to about 6,000 primary care providers, 1,000 ancillary providers, and over 600 secondary and tertiary providers. Recently the NHIS announced the suspension of accreditation of new HMOs and providers because there is a need to strengthen the scheme and improve quality of healthcare services delivery through reaccreditation.

In general, the service delivery system in Nigeria is organized on a tiered basis:

  • Tertiary facilities are operated by the central government and form the highest level of health care and serve as referral centers for patients;
  • Secondary facilities are managed by state governments and provide some specialized health services;
  • Primary facilities are run by local governments and provide the most basic entry point to the health care system at health centers, clinics, and dispensaries.

The service delivery system is mixed between private and public providers. The private health care system has grown substantially since the 1980s, to currently provide about 80% of the total health services. This sector, however, is not well regulated or supported. Of all the private facilities in Nigeria, about 50% are for-profit. Despite the large number of service providers, coverage of most key preventative and curative health services is relatively low. There are large disparities in geo-political zones, between rural and urban zones, and with regard to socio-economic status; the poorest fifth of the population are much less likely to receive medical services than their counterparts in the wealthiest 20% of the population.

National Health Insurance System

Service delivery system

Types of Providers Empanelled: Both Public & Non-state
Number of public providers:
Number of non-state providers:

The National Health Insurance system (NHIS) accredits both service providers and the Health Maintenance Organizations (HMOs) that interface between providers, the NHIS and its beneficiaries. To receive accreditation, health facilities must meet a number of requirements for the physical facility and the personnel, including:

  • All medical professionals must be in possession of the current license to practice;
  • The facility must be appropriate for service delivery;
  • Facility must be registered with state authorities;
  • Facility and staff must possess malpractice insurance.

In addition, an accreditation fee is required. Currently 61 HMOs have been accredited and registered by NHIS in addition to about 6,000 primary care providers, 1,000 ancillary providers, and over 600 secondary and tertiary providers. Recently the NHIS announced the suspension of accreditation of new HMOs and providers because there is a need to strengthen the scheme and improve quality of healthcare services delivery through reaccreditation.

In general, the service delivery system in Nigeria is organized on a tiered basis:

  • Tertiary facilities are operated by the central government and form the highest level of health care and serve as referral centers for patients;
  • Secondary facilities are managed by state governments and provide some specialized health services;
  • Primary facilities are run by local governments and provide the most basic entry point to the health care system at health centers, clinics, and dispensaries.

The service delivery system is mixed between private and public providers. The private health care system has grown substantially since the 1980s, to currently provide about 80% of the total health services. This sector, however, is not well regulated or supported. Of all the private facilities in Nigeria, about 50% are for-profit. Despite the large number of service providers, coverage of most key preventative and curative health services is relatively low. There are large disparities in geo-political zones, between rural and urban zones, and with regard to socio-economic status; the poorest fifth of the population are much less likely to receive medical services than their counterparts in the wealthiest 20% of the population.
Philippines: PhilHealth
  • Both Public & Non-state

The service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers.

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The service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers. In order to achieve accreditation, all in-network hospitals and day-surgery centers must be licensed by the Department of Health.

The network includes hospitals, day surgery centers, maternity care clinics, midwife-operated clinics, freestanding dialysis centers, physician clinics, dentists doing procedures in hospitals and day surgeries, government-run health centers for primary care benefits, TB DOTS and malaria, and private TB-DOTS clinics.

Non-hospitals and day-surgery centers are not required to be licensed by the DOH; however, all facilities are evaluated by an accreditation team from PhilHealth.

PhilHealth

Service delivery system

Types of Providers Empanelled: Both Public & Non-state
Number of public providers:
Number of non-state providers:

The service delivery system includes both public and private centers; on average, the network is comprised of 61% private and 39% public providers. In order to achieve accreditation, all in-network hospitals and day-surgery centers must be licensed by the Department of Health.

The network includes hospitals, day surgery centers, maternity care clinics, midwife-operated clinics, freestanding dialysis centers, physician clinics, dentists doing procedures in hospitals and day surgeries, government-run health centers for primary care benefits, TB DOTS and malaria, and private TB-DOTS clinics.

Non-hospitals and day-surgery centers are not required to be licensed by the DOH; however, all facilities are evaluated by an accreditation team from PhilHealth.
Thailand: Universal Coverage Scheme
  • Both Public & Non-state

The UCS service delivery network includes both public and private health care facilities. However, prior to registration, private health facilities must submit required documentation and are investigated according to standard criteria of the UCS. No similar process exists for public health care facilities and they are automatically registered in the delivery network.

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The UCS service delivery network includes both public and private health care facilities. However, prior to registration, private health facilities must submit required documentation and are investigated according to standard criteria of the UCS. No similar process exists for public health care facilities and they are automatically registered in the delivery network.

The Thai insurance system is based on the health system that is founded on the principles of primary care. For UCS in particular, primary care provider units (PCUs) have been designated as gatekeepers to provide care for UCS beneficiaries. As gatekeepers, PCUs are expected to provide people in their catchment areas with continuous and comprehensive care with a holistic approach. According to the services provided, health facilities under the UCS can be classified into three groups:

  • Contracting unit for primary care: These CUPs are primary health facilities offering curative, promotive, preventive, and rehabilitative services such as ambulatory care, home care, and community care. They can be facilities ranging from community hospitals to tertiary care public or private hospitals. Each CUP has its own catchment area and population.
  • Contracting unit for secondary care: The CUSs are health facilities that offer secondary care, mainly in patient health services. They can be facilities ranging from community hospitals to tertiary care public or private hospitals.
  • Contracting unit for tertiary care: The CUTs provide expensive care and specialized care with high technologies. They can be regional hospitals, university hospitals, or specialized health institutes.

Private health facilities are investigated by the UCS before contracts are signed. There is no such investigation for public health care facilities as they are automatically registered in the delivery network.

In principle, UCS beneficiaries are free to choose their primary providers. However, because of limited number of primary providers in rural areas, beneficiaries are assigned mainly to public primary providers close to their communities or their workplaces.

Universal Coverage Scheme

Service delivery system

Types of Providers Empanelled: Both Public & Non-state
Number of public providers:
Number of non-state providers:

The UCS service delivery network includes both public and private health care facilities. However, prior to registration, private health facilities must submit required documentation and are investigated according to standard criteria of the UCS. No similar process exists for public health care facilities and they are automatically registered in the delivery network.

The Thai insurance system is based on the health system that is founded on the principles of primary care. For UCS in particular, primary care provider units (PCUs) have been designated as gatekeepers to provide care for UCS beneficiaries. As gatekeepers, PCUs are expected to provide people in their catchment areas with continuous and comprehensive care with a holistic approach. According to the services provided, health facilities under the UCS can be classified into three groups:

  • Contracting unit for primary care: These CUPs are primary health facilities offering curative, promotive, preventive, and rehabilitative services such as ambulatory care, home care, and community care. They can be facilities ranging from community hospitals to tertiary care public or private hospitals. Each CUP has its own catchment area and population.
  • Contracting unit for secondary care: The CUSs are health facilities that offer secondary care, mainly in patient health services. They can be facilities ranging from community hospitals to tertiary care public or private hospitals.
  • Contracting unit for tertiary care: The CUTs provide expensive care and specialized care with high technologies. They can be regional hospitals, university hospitals, or specialized health institutes.

Private health facilities are investigated by the UCS before contracts are signed. There is no such investigation for public health care facilities as they are automatically registered in the delivery network.

In principle, UCS beneficiaries are free to choose their primary providers. However, because of limited number of primary providers in rural areas, beneficiaries are assigned mainly to public primary providers close to their communities or their workplaces.