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
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.
Kenya: National Hospital Insurance Fund
  • All populations
 2.7 million

To be a member of the National Hospital Insurance Fund (NHIF), one must simply be a Kenyan resident age 18 or older. NHIF covers certain dependents of the primary policy holder automatically, including spouses, children under the age of 18, students (even if over the age of 18), and disabled dependents. Other adult family members require separate premium contributions to be covered. NHIF is responsible for enrolling and registering all eligible members from the formal and informal sectors.

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To be a member of the National Hospital Insurance Fund (NHIF), one must simply be a Kenyan resident age 18 or older. NHIF covers certain dependents of the primary policy holder automatically, including spouses, children under the age of 18, students (even if over the age of 18), and disabled dependents. Other adult family members require separate premium contributions to be covered. NHIF is responsible for enrolling and registering all eligible members from the formal and informal sectors.

Total membership in NHIF rose from about 206,000 in 1998 to 1,372,000 in 2006. By 2011 about 2.7 million people were insured by NHIF, 2.1 million of which are employed in the formal sector. Approximately 88% of the people with insurance in Kenya are insured by the NHIF. However, currently only about 25% of the poor have medical coverage. Recently, NHIF has embarked on a program to work with community-based organizations to expand informal sector membership.

National Hospital Insurance Fund

Population covered

Target Populations: All populations
Coverage Level: 2.7 million

To be a member of the National Hospital Insurance Fund (NHIF), one must simply be a Kenyan resident age 18 or older. NHIF covers certain dependents of the primary policy holder automatically, including spouses, children under the age of 18, students (even if over the age of 18), and disabled dependents. Other adult family members require separate premium contributions to be covered. NHIF is responsible for enrolling and registering all eligible members from the formal and informal sectors.

Total membership in NHIF rose from about 206,000 in 1998 to 1,372,000 in 2006. By 2011 about 2.7 million people were insured by NHIF, 2.1 million of which are employed in the formal sector. Approximately 88% of the people with insurance in Kenya are insured by the NHIF. However, currently only about 25% of the poor have medical coverage. Recently, NHIF has embarked on a program to work with community-based organizations to expand informal sector membership.
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).