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
Vietnam: Compulsory and Voluntary Health Insurance Schemes
  • All populations
 36.5 million

It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.

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It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.

When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates.

Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI.

Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement.

Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval.

Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance.

Compulsory and Voluntary Health Insurance Schemes

Population covered

Target Populations: All populations
Coverage Level: 36.5 million

It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance.

When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates.

Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI.

Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement.

Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval.

Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance.
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.
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.