Compare: Population covered

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 Target population Coverage Population covered
Estonia: Estonian Health Insurance Fund
  • All populations
 1.28 million

Health insurance through EHIF is mandatory. There are three main categories of enrollees:

  • Those who make their own contributions: These enrollees contribute 13% of their wages. They primarily include employees and the self-employed. This group makes up 51% of the systems’ enrollees.
  • Those whose contributions are covered by the state: these enrollees are composed of individuals on parental leave, the unemployed, the disabled, military personnel, and dependent spouses of diplomats. This group makes up 2.5% of the systems’ enrollees.
  • Those who are eligible for coverage without contributing: these enrollees include children up to 19 years of age, pensioners, disabled people with special pensions, students, non-working spouses of insured individuals, and non-working pregnant women. This group makes up 46.5% of the systems’ enrollees.
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Health insurance through EHIF is mandatory. There are three main categories of enrollees:

  • Those who make their own contributions: These enrollees contribute 13% of their wages. They primarily include employees and the self-employed. This group makes up 51% of the systems’ enrollees.
  • Those whose contributions are covered by the state: these enrollees are composed of individuals on parental leave, the unemployed, the disabled, military personnel, and dependent spouses of diplomats. This group makes up 2.5% of the systems’ enrollees.
  • Those who are eligible for coverage without contributing: these enrollees include children up to 19 years of age, pensioners, disabled people with special pensions, students, non-working spouses of insured individuals, and non-working pregnant women. This group makes up 46.5% of the systems’ enrollees.

In order to receive services, patients must show their national identification card to providers. An online information system is used to verify that the card is valid and to provide details of insurance status and family doctor.

Estonian Health Insurance Fund

Population covered

Target Populations: All populations
Coverage Level: 1.28 million

Health insurance through EHIF is mandatory. There are three main categories of enrollees:

  • Those who make their own contributions: These enrollees contribute 13% of their wages. They primarily include employees and the self-employed. This group makes up 51% of the systems’ enrollees.
  • Those whose contributions are covered by the state: these enrollees are composed of individuals on parental leave, the unemployed, the disabled, military personnel, and dependent spouses of diplomats. This group makes up 2.5% of the systems’ enrollees.
  • Those who are eligible for coverage without contributing: these enrollees include children up to 19 years of age, pensioners, disabled people with special pensions, students, non-working spouses of insured individuals, and non-working pregnant women. This group makes up 46.5% of the systems’ enrollees.

In order to receive services, patients must show their national identification card to providers. An online information system is used to verify that the card is valid and to provide details of insurance status and family doctor.
Kyrgyz Republic: Mandatory Health Insurance Fund (MHIF)
  • All populations
 5.2 million

Kyrgyzstan offers free primary health care services to all citizens through the State Guaranteed Benefits Package (SGPB) regardless of insurance status. By 2003, 98% of the population was enrolled with a Family Group Practice (FGP) for their primary health care needs.

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Kyrgyzstan offers free primary health care services to all citizens through the State Guaranteed Benefits Package (SGPB) regardless of insurance status. By 2003, 98% of the population was enrolled with a Family Group Practice (FGP) for their primary health care needs. Enrollees choose a FGP of their choice and are free to move between FGPs once per year during the annual registration period.

Population groups covered by the MHIF include formal sector employees, civil servants, pensioners, the registered unemployed, children and students under age 21, welfare benefit recipients, farmers, and the self-employed. In 2001, over 80% of the population was covered by the MHIF.

Table 3: Coverage additions (1997-2001): Population groups, sources of financing and benefits

Population groupYearSource of financingServices provided (depth of coverage)
Formal sector employees, except civil servants19972% from the wage bill administered by the Social Fund (SF)Drugs at hospital level, salary bonuses
1998Emergency care at the primary level
2000Additional/outpatient drug package
Civil servants19982% from the wage bill administered by the SFDrugs at hospital level, salary bonuses
2000Additional/outpatient drug package
Pensioners1997Value of 1.5x minimum salary administered by the SF (Pension Fund)Drugs at hospital level, salary bonuses
1998Emergency care at primary level
2000Additional/outpatient drug package
2003Republican budgetCoverage unchanged
Registered unemployed1997Value of 1.5x minimum salary administered by SF (Unemployment Fund)Drugs at hospital level, salary bonuses
1998Republican budgetEmergency care at primary level
2000Additional/outpatient drug package
2002Effectively not covered: no funding provided this group by Republican budget
Children and students under 212000Value of 1.5x minimum salaryDrugs at hospital level, salary bonuses
Republican budgetEmergency care at the primary level
Additional/outpatient drug package
Welfare benefits recipients2000Value of 1.5 minimum salaryDrugs at hospital level, salary bonuses
Republican budgetEmergency care at the primary level
Additional/outpatient drug package
Farmers19972% of the land tax administered by SF (5% in 2000, 6% in 2003)Drugs at hospital level, salary bonuses
Emergency care at primary level
2002Health insurance policies (400 KGS = US $10/year) administered by MHIFCoverage unchanged
Self-employed19982% of the value of 3x minimum salaryDrugs at hospital level, salary bonuses
Emergency care at primary level
2000Additional/outpatient drug package
2002Health insurance policies (400 KGS = US$10/year) administered by the MHIFCoverage unchanged

Source: Jakab, M., and Manjieva, E.

Mandatory Health Insurance Fund (MHIF)

Population covered

Target Populations: All populations
Coverage Level: 5.2 million

Kyrgyzstan offers free primary health care services to all citizens through the State Guaranteed Benefits Package (SGPB) regardless of insurance status. By 2003, 98% of the population was enrolled with a Family Group Practice (FGP) for their primary health care needs. Enrollees choose a FGP of their choice and are free to move between FGPs once per year during the annual registration period.

Population groups covered by the MHIF include formal sector employees, civil servants, pensioners, the registered unemployed, children and students under age 21, welfare benefit recipients, farmers, and the self-employed. In 2001, over 80% of the population was covered by the MHIF.

Table 3: Coverage additions (1997-2001): Population groups, sources of financing and benefits

Population groupYearSource of financingServices provided (depth of coverage)
Formal sector employees, except civil servants19972% from the wage bill administered by the Social Fund (SF)Drugs at hospital level, salary bonuses
1998Emergency care at the primary level
2000Additional/outpatient drug package
Civil servants19982% from the wage bill administered by the SFDrugs at hospital level, salary bonuses
2000Additional/outpatient drug package
Pensioners1997Value of 1.5x minimum salary administered by the SF (Pension Fund)Drugs at hospital level, salary bonuses
1998Emergency care at primary level
2000Additional/outpatient drug package
2003Republican budgetCoverage unchanged
Registered unemployed1997Value of 1.5x minimum salary administered by SF (Unemployment Fund)Drugs at hospital level, salary bonuses
1998Republican budgetEmergency care at primary level
2000Additional/outpatient drug package
2002Effectively not covered: no funding provided this group by Republican budget
Children and students under 212000Value of 1.5x minimum salaryDrugs at hospital level, salary bonuses
Republican budgetEmergency care at the primary level
Additional/outpatient drug package
Welfare benefits recipients2000Value of 1.5 minimum salaryDrugs at hospital level, salary bonuses
Republican budgetEmergency care at the primary level
Additional/outpatient drug package
Farmers19972% of the land tax administered by SF (5% in 2000, 6% in 2003)Drugs at hospital level, salary bonuses
Emergency care at primary level
2002Health insurance policies (400 KGS = US $10/year) administered by MHIFCoverage unchanged
Self-employed19982% of the value of 3x minimum salaryDrugs at hospital level, salary bonuses
Emergency care at primary level
2000Additional/outpatient drug package
2002Health insurance policies (400 KGS = US$10/year) administered by the MHIFCoverage unchanged

Source: Jakab, M., and Manjieva, E.
Korea, Rep.: National Health Insurance Program
  • All populations
 50 million

All South Koreans are eligible and required to have health coverage under the National Health Insurance Program (NHIP). NHIP is managed by the National Health Insurance Corporation, which is responsible for enrollment and communication. NHIC uses local branches to enroll individuals and to collect premiums. The insured are divided into two groups: employee insured and self-employed insured. The employee insured category composes about 59% of the total number of insured.

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All South Koreans are eligible and required to have health coverage under the National Health Insurance Program (NHIP). NHIP is managed by the National Health Insurance Corporation, which is responsible for enrollment and communication. NHIC uses local branches to enroll individuals and to collect premiums. The insured are divided into two groups: employee insured and self-employed insured. The employee insured category composes about 59% of the total number of insured. Those in the self-employed insured category include about 41% of the total insured population.

Population coverage of health insurance

National Health Insurance Program

Population covered

Target Populations: All populations
Coverage Level: 50 million

All South Koreans are eligible and required to have health coverage under the National Health Insurance Program (NHIP). NHIP is managed by the National Health Insurance Corporation, which is responsible for enrollment and communication. NHIC uses local branches to enroll individuals and to collect premiums. The insured are divided into two groups: employee insured and self-employed insured. The employee insured category composes about 59% of the total number of insured. Those in the self-employed insured category include about 41% of the total insured population.

Population coverage of health insurance
Nigeria: National Health Insurance System
  • All populations
 5 million

Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees.

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Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees.

In the Informal Sector Program, the self-employed and individuals living in rural communities enroll themselves. The self-employed must join with at least 500 other members who are occupation based (ie: taxi drivers) to qualify. Rural dwellers have a similar modus operandi, but participants need to belong to the same community rather than the same occupational group. These Social Health Insurance Schemes are self-governed, with elections held to determine who will represent the community. In order to stay enrolled, members are expected to make a monthly contribution actuarially determined based on the benefits package of their choice. Participants requiring specialist or longer treatment would need to pay for the balance from what they are entitled from the common pool. These schemes are expected to cover more than 60% of the rural and self-employed population, though due to poor data collection, the exact population enrolled is difficult to determine.

The enrollment levels in private insurance is uncertain, but based on submissions from private insurers to NHIS, less than 1 million people are privately insured.

The NHIS utilizes 61 Health Maintenance Organizations (HMOs) as health managers for paying healthcare providers, quality assurance, and registration of enrollees and sensitization of participants as part of improving transparency of the system. HMOs contract with the NHIS to manage the enrollment of individuals in health insurance schemes; to collect their payments; pay the healthcare providers; and to provide basic quality management of the health insurance scheme that covers formal employees.

National Health Insurance System

Population covered

Target Populations: All populations
Coverage Level: 5 million

Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees.

In the Informal Sector Program, the self-employed and individuals living in rural communities enroll themselves. The self-employed must join with at least 500 other members who are occupation based (ie: taxi drivers) to qualify. Rural dwellers have a similar modus operandi, but participants need to belong to the same community rather than the same occupational group. These Social Health Insurance Schemes are self-governed, with elections held to determine who will represent the community. In order to stay enrolled, members are expected to make a monthly contribution actuarially determined based on the benefits package of their choice. Participants requiring specialist or longer treatment would need to pay for the balance from what they are entitled from the common pool. These schemes are expected to cover more than 60% of the rural and self-employed population, though due to poor data collection, the exact population enrolled is difficult to determine.

The enrollment levels in private insurance is uncertain, but based on submissions from private insurers to NHIS, less than 1 million people are privately insured.

The NHIS utilizes 61 Health Maintenance Organizations (HMOs) as health managers for paying healthcare providers, quality assurance, and registration of enrollees and sensitization of participants as part of improving transparency of the system. HMOs contract with the NHIS to manage the enrollment of individuals in health insurance schemes; to collect their payments; pay the healthcare providers; and to provide basic quality management of the health insurance scheme that covers formal employees.
Brazil: Unified Health System (SUS)
  • All populations
 143 million

Brazil’s health system is based on the notion of free, universal care. In 1998, 71.2% of the population reported that they had a regular-use service. In 2003, this number had increased to 80%. This is significant, since it means that individuals have a service which they use as an entry point into the health system. While 100 % of the population is able to receive services under the SUS, approximately 25% opt for private insurance coverage.

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Brazil’s health system is based on the notion of free, universal care. In 1998, 71.2% of the population reported that they had a regular-use service. In 2003, this number had increased to 80%. This is significant, since it means that individuals have a service which they use as an entry point into the health system. While 100 % of the population is able to receive services under the SUS, approximately 25% opt for private insurance coverage.

The Brazilian Supplementary Health System (SHS) served 33 million Brazilians in 2002, or 19% of the population. By 2007, it accounted for more than 50% of health care expenditure, yet it served less than 30% of the population. Health care operators within the SHS are grouped into categories by the Agency for Supplementary Health within the MOH, depending on their economic and financial status. Ordered by market share in 2002, these categories are group medicine, medical cooperatives, health insurance, charity, self-management, group dentistry, and dentistry cooperatives. Most of these plans are connected to employment. The majority of these plans tend to be small or medium in size and operate mostly through contractual arrangements with doctors’ offices and hospitals. In 2002, group medicine, medical cooperatives and health insurance served around 80% of supplementary users and accounted for 90% of billing. Initially, private prepayment plans had an incentive not to provide comprehensive coverage to enrollees, as high-cost procedures were usually funneled to the SUS for treatment. However, in 1999, the government instituted a norm that allows it to recover the costs associated with services rendered by the SUS to beneficiaries of private health plans. This norm is implemented through the National Supplementary Health Council (CNSS).

Unified Health System (SUS)

Population covered

Target Populations: All populations
Coverage Level: 143 million

Brazil’s health system is based on the notion of free, universal care. In 1998, 71.2% of the population reported that they had a regular-use service. In 2003, this number had increased to 80%. This is significant, since it means that individuals have a service which they use as an entry point into the health system. While 100 % of the population is able to receive services under the SUS, approximately 25% opt for private insurance coverage.

The Brazilian Supplementary Health System (SHS) served 33 million Brazilians in 2002, or 19% of the population. By 2007, it accounted for more than 50% of health care expenditure, yet it served less than 30% of the population. Health care operators within the SHS are grouped into categories by the Agency for Supplementary Health within the MOH, depending on their economic and financial status. Ordered by market share in 2002, these categories are group medicine, medical cooperatives, health insurance, charity, self-management, group dentistry, and dentistry cooperatives. Most of these plans are connected to employment. The majority of these plans tend to be small or medium in size and operate mostly through contractual arrangements with doctors’ offices and hospitals. In 2002, group medicine, medical cooperatives and health insurance served around 80% of supplementary users and accounted for 90% of billing. Initially, private prepayment plans had an incentive not to provide comprehensive coverage to enrollees, as high-cost procedures were usually funneled to the SUS for treatment. However, in 1999, the government instituted a norm that allows it to recover the costs associated with services rendered by the SUS to beneficiaries of private health plans. This norm is implemented through the National Supplementary Health Council (CNSS).
Thailand: Universal Coverage Scheme
  • All populations
 50 million

The Universal Coverage Scheme enrolls those not covered by either the Civil Servant Medical Benefit Scheme (CSMBS) or the Compulsory Social Security Scheme (SSS) – about 74% of the entire population. To be enrolled in UCS, all members must register with a contracting unit (CUP) and receive a card for care in their home area. When first implemented, potential beneficiaries were identified by health volunteers and medical personal, as well as through mass communications and media campaigns.

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The Universal Coverage Scheme enrolls those not covered by either the Civil Servant Medical Benefit Scheme (CSMBS) or the Compulsory Social Security Scheme (SSS) – about 74% of the entire population. To be enrolled in UCS, all members must register with a contracting unit (CUP) and receive a card for care in their home area. When first implemented, potential beneficiaries were identified by health volunteers and medical personal, as well as through mass communications and media campaigns.

A centralized registration database, which is updated regularly, is also a useful tool in identifying and enrolling beneficiaries in the USC scheme. The central registration database consolidates information on the entire Thai population, and includes registration information of the CSMBS, the SSS and the UCS. When patients seek care, their entitlements are checked with the centralized online database to ensure that they are enrolled in an insurance scheme. If the database shows that that are not members of the CSMBS or the SSS, they are asked to register for the UCS at that time.

Universal Coverage Scheme

Population covered

Target Populations: All populations
Coverage Level: 50 million

The Universal Coverage Scheme enrolls those not covered by either the Civil Servant Medical Benefit Scheme (CSMBS) or the Compulsory Social Security Scheme (SSS) – about 74% of the entire population. To be enrolled in UCS, all members must register with a contracting unit (CUP) and receive a card for care in their home area. When first implemented, potential beneficiaries were identified by health volunteers and medical personal, as well as through mass communications and media campaigns.

A centralized registration database, which is updated regularly, is also a useful tool in identifying and enrolling beneficiaries in the USC scheme. The central registration database consolidates information on the entire Thai population, and includes registration information of the CSMBS, the SSS and the UCS. When patients seek care, their entitlements are checked with the centralized online database to ensure that they are enrolled in an insurance scheme. If the database shows that that are not members of the CSMBS or the SSS, they are asked to register for the UCS at that time.