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 | Primary source of funding | Secondary source of funding | Contributing Populations | Types of Contributions | Funding |
|---|---|---|---|---|---|
| Vietnam: Compulsory and Voluntary Health Insurance Schemes |
|
|
|
|
The central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget. Read full sectionThe central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget. Funding for Vietnam’s various universal coverage schemes varies greatly by population segment. The following presents an overview of each program’s financing: Compulsory program (CHI)
Note that when the insurance program was initially introduced, there was no cost sharing. In 1998, cost sharing was introduced, with a 20 percent coinsurance rate but no deductible. In 2005, the 20 percent coinsurance rate was eliminated, only to be reintroduced again since January 1, 2010. Copayment is exempted for some groups, such as people of merit. Compulsory and Voluntary Health Insurance SchemesFunding Primary Source of Funding: General government revenues
Secondary Source of Funding: None
Contributing Populations: Formal Sector
Types of Contributions: Premiums The central Vietnamese government is responsible for financing the bulk of the cost. Provincial governments, however, also contribute a smaller percentage of funds to the program. Poor beneficiaries do not pay premiums and are exempt from copayments. The entire cost of the scheme, 4.5% of minimum wage, is covered by revenues from the state budget. Funding for Vietnam’s various universal coverage schemes varies greatly by population segment. The following presents an overview of each program’s financing: Compulsory program (CHI)
Note that when the insurance program was initially introduced, there was no cost sharing. In 1998, cost sharing was introduced, with a 20 percent coinsurance rate but no deductible. In 2005, the 20 percent coinsurance rate was eliminated, only to be reintroduced again since January 1, 2010. Copayment is exempted for some groups, such as people of merit. |
| Indonesia: Jamkesmas |
|
|
|
|
The Jamkesmas scheme is funded by the central government from general tax revenue. Beneficiaries are not responsible for premium payments nor are they charged a copayment at the time of visit. Read full sectionThe Jamkesmas scheme is funded by the central government from general tax revenue. Beneficiaries are not responsible for premium payments nor are they charged a copayment at the time of visit. A paramount question of importance in Indonesia is the solvency of the Jamkesmas program. Increasing utilization of health care will concurrently increase the cost of health insurance, particularly for the poorest populations covered by Jamkesmas as currently there is no co-payment provision within the program. While utilization of Puskesmas services has increased, the capacity of local service delivery may not be able to keep pace with increasing demands without further collaboration with private primary health care providers. Currently, it is the responsibility of the local government to finance the gap between the actual cost of insuring its population and what the central government provides via Jamkesmas reimbursements. Without further support for the poorest localities, this growing responsibility will become more problematic. The central government recognizes this problem, and in order to continue to strive towards universal coverage, it is considering how it might introduce strategies to develop further approaches to co-finance service delivery at the local level. The proposed funding requirements for the operational costs of preventive and promotive service delivery is under active consideration within the parliament at this time and known as the “BOK” fund. JamkesmasFunding Primary Source of Funding: General government revenues
Secondary Source of Funding: None
Contributing Populations: All populations
Types of Contributions: Premiums, Co-payments The Jamkesmas scheme is funded by the central government from general tax revenue. Beneficiaries are not responsible for premium payments nor are they charged a copayment at the time of visit. A paramount question of importance in Indonesia is the solvency of the Jamkesmas program. Increasing utilization of health care will concurrently increase the cost of health insurance, particularly for the poorest populations covered by Jamkesmas as currently there is no co-payment provision within the program. While utilization of Puskesmas services has increased, the capacity of local service delivery may not be able to keep pace with increasing demands without further collaboration with private primary health care providers. Currently, it is the responsibility of the local government to finance the gap between the actual cost of insuring its population and what the central government provides via Jamkesmas reimbursements. Without further support for the poorest localities, this growing responsibility will become more problematic. The central government recognizes this problem, and in order to continue to strive towards universal coverage, it is considering how it might introduce strategies to develop further approaches to co-finance service delivery at the local level. The proposed funding requirements for the operational costs of preventive and promotive service delivery is under active consideration within the parliament at this time and known as the “BOK” fund. |
| : Taiwan: National Health Insurance |
|
|
|
|
Revenue for the National Health Insurance (NHI) system comes primarily from individual payroll deductions and employer contributions, supplemented by governmental funds from general revenue. A small proportion of revenue also comes from a “sin tax” on cigarette sales. The working population pays premiums that are split with employers while non-working individuals pay a flat rate which is subsidized by the government. Read full sectionRevenue for the National Health Insurance (NHI) system comes primarily from individual payroll deductions and employer contributions, supplemented by governmental funds from general revenue. A small proportion of revenue also comes from a “sin tax” on cigarette sales. The working population pays premiums that are split with employers while non-working individuals pay a flat rate which is subsidized by the government. The share of premiums paid by the insured, employers, and government varies greatly within the different population subgroups and also varies based on how many dependents an individual has. For public or private employees the government pays 10%, the employer 60%, and the employee 30% through a payroll deduction. The non-poor self-employed pay 100% of their income-based premium without a government subsidy. For the poor who are unable to pay the premium and for military personnel, the government subsidizes 100% of the premium from general government revenues.
In 2002, the Supreme Court in Taiwan ruled that no one could be denied care because of lack of ability to pay. For those temporarily unable to pay, the Bureau of National Health Insurance (BNHI) has a fund from which such people may take out interest-free loans to pay premiums. Taiwan’s economy has advanced to a stage where most workers were employed in the formal sector, so a compulsory NHI can effectively collect premiums through employers. The government also has the revenue to subsidize the coverage of the poor, veterans, and farmers. Taiwan also has the organizational ability and human resources to manage national health insurance. The premiums are supplemented by out-of-pocket payments. Regular office visits have co-payments that are fixed and unvaried by the person’s income in the realm of about 10% of the cost of an inpatient visit—adjusted according to type of wards and length of stay—and 20% for an outpatient visit. Both co-payments and premiums are waived for the very poor and veterans. To help cope with NHI budget pressures, patient cost sharing increased in 2001 and again in 2002 for certain kinds of visits, drugs, inpatient care, lab tests and examinations. These copayments are unvaried by income to avoid the burden of administering a complex individual income-related-cost-sharing program. Though out-of-pocket payments fell from 48% of the total amount spent on health care in 1993 to 30% in 2000, critics still argue that the copayments are regressive, putting the burden primarily on the sick that are already disadvantaged and are often poor.
National Health InsuranceFunding Primary Source of Funding: Member contributions
Secondary Source of Funding: General government revenues, Employer contributions
Contributing Populations: Formal Sector, Government Employees, Informal Sector
Types of Contributions: Premiums, Co-payments Revenue for the National Health Insurance (NHI) system comes primarily from individual payroll deductions and employer contributions, supplemented by governmental funds from general revenue. A small proportion of revenue also comes from a “sin tax” on cigarette sales. The working population pays premiums that are split with employers while non-working individuals pay a flat rate which is subsidized by the government. The share of premiums paid by the insured, employers, and government varies greatly within the different population subgroups and also varies based on how many dependents an individual has. For public or private employees the government pays 10%, the employer 60%, and the employee 30% through a payroll deduction. The non-poor self-employed pay 100% of their income-based premium without a government subsidy. For the poor who are unable to pay the premium and for military personnel, the government subsidizes 100% of the premium from general government revenues.
In 2002, the Supreme Court in Taiwan ruled that no one could be denied care because of lack of ability to pay. For those temporarily unable to pay, the Bureau of National Health Insurance (BNHI) has a fund from which such people may take out interest-free loans to pay premiums. Taiwan’s economy has advanced to a stage where most workers were employed in the formal sector, so a compulsory NHI can effectively collect premiums through employers. The government also has the revenue to subsidize the coverage of the poor, veterans, and farmers. Taiwan also has the organizational ability and human resources to manage national health insurance. The premiums are supplemented by out-of-pocket payments. Regular office visits have co-payments that are fixed and unvaried by the person’s income in the realm of about 10% of the cost of an inpatient visit—adjusted according to type of wards and length of stay—and 20% for an outpatient visit. Both co-payments and premiums are waived for the very poor and veterans. To help cope with NHI budget pressures, patient cost sharing increased in 2001 and again in 2002 for certain kinds of visits, drugs, inpatient care, lab tests and examinations. These copayments are unvaried by income to avoid the burden of administering a complex individual income-related-cost-sharing program. Though out-of-pocket payments fell from 48% of the total amount spent on health care in 1993 to 30% in 2000, critics still argue that the copayments are regressive, putting the burden primarily on the sick that are already disadvantaged and are often poor.
|
