Microinsurance and Rural Health

2019 ◽  
Author(s):  
Syed Abdul Hamid
Keyword(s):  
South Asia ◽  
Low Income ◽  
Informal Economy ◽  
Financial Risk ◽  
Access To Healthcare ◽  
Low Income Countries ◽  
Financial Protection ◽  
Health Shocks ◽  
Financial Risk Protection ◽  
Risk Protection

Health microinsurance (HMI) has been used around the globe since the early 1990s for financial risk protection against health shocks in poverty-stricken rural populations in low-income countries. However, there is much debate in the literature on its impact on financial risk protection. There is also no clear answer to the critical policy question about whether HMI is a viable route to provide healthcare to the people of the informal economy, especially in the rural areas. Findings show that HMI schemes are concentrated widely in the low-income countries, especially in South Asia (about 43%) and East Africa (about 25.4%). India accounts for 30% of HMI schemes. Bangladesh and Kenya also possess a good number of schemes. There is some evidence that HMI increases access to healthcare or utilization of healthcare. One set of the literature shows that HMI provides financial protection against the costs of illness to its enrollees by reducing out-of-pocket payments and/or catastrophic spending. On the contrary, a large body of literature with strong methodological rigor shows that HMI fails to provide financial protection against health shocks to its clients. Some of the studies in the latter group rather find that HMI contributes to the decline of financial risk protection. These findings seem to be logical as there is a high copayment and a lack of continuum of care in most cases. The findings also show that scale and dependence on subsidy are the major concerns. Low enrollment and low renewal are common concerns of the voluntary HMI schemes in South Asian countries. In addition, the declining trend of donor subsidies makes the HMI schemes supported by external donors more vulnerable. These challenges and constraints restrict the scale and profitability of HMI initiatives, especially those that are voluntary. Consequently, the existing organizations may cease HMI activities. Overall, although HMI can increase access to healthcare, it fails to provide financial risk protection against health shocks. The existing HMI practices in South Asia, especially in the HMIs owned by nongovernmental organizations and microfinance institutions, are not a viable route to provide healthcare to the rural population of the informal economy. However, HMI schemes may play some supportive role in implementation of a nationalized scheme, if there is one. There is also concern about the institutional viability of the HMI organizations (e.g., ownership and management efficiency). Future research may address this issue.

scholarly journals Coping with healthcare costs for chronic illness in low-income and middle-income countries: a systematic literature review

2019 ◽  
Vol 4 (4) ◽  
pp. e001475 ◽  
Author(s):  
Adrianna Murphy ◽  
Catherine McGowan ◽  
Martin McKee ◽  
Marc Suhrcke ◽  
Kara Hanson
Keyword(s):  
Chronic Illness ◽  
Coping Strategies ◽  
Low Income ◽  
Financial Risk ◽  
Long Term Effects ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Protection

BackgroundExperiencing illness in low-income and middle-income countries (LMICs) can incur very high out-of-pocket (OOP) payments for healthcare and, while the existing literature typically focuses on levels of expenditure, it rarely examines what happens when households do not have the necessary money. Some will adopt one or more ‘coping strategies’, such as borrowing money, perhaps at exorbitant interest rates, or selling assets, some necessary for their future income, with detrimental long-term effects. This is particularly relevant for chronic illnesses that require consistent, long-term OOP payments. We systematically review the literature on strategies for financing OOP costs of chronic illnesses in LMICs, their correlates and their impacts on households.MethodsWe searched MEDLINE, EconLit, EMBASE, Global Health and Scopus on 22 October 2018 for literature published on or after 1 January 2000. We included qualitative or quantitative studies describing at least one coping strategy for chronic illness OOP payments in a LMIC context. Our narrative review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.ResultsForty-seven papers were included. Studies identified coping strategies for chronic illness costs that are not traditionally addressed in financial risk protection research (eg, taking children out of school, sending them to work, reducing expenditure on food or education, quitting work to give care). Twenty studies reported socioeconomic or other correlates of coping strategies, with poorer households and those with more advanced disease more vulnerable to detrimental strategies. Only six studies (three cross-sectional and three qualitative) included evidence of impacts of coping strategies on households, including increased labour to repay debts and discontinuing treatment.ConclusionsMonitoring of financial risk protection provides an incomplete picture if it fails to capture the effect of coping strategies. This will require qualitative and longitudinal research to understand the long-term effects, especially those associated with chronic illness in LMICs.

scholarly journals Households forgoing healthcare as a measure of financial risk protection: an application to Liberia

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jacopo Gabani ◽  
Lorna Guinness
Keyword(s):  
Health Expenditure ◽  
Financial Risk ◽  
Household Survey ◽  
Poverty Line ◽  
Healthcare Services ◽  
World Health ◽  
Health Shocks ◽  
Financial Risk Protection ◽  
Simple Method ◽  
Risk Protection

Abstract Introduction Access to Liberia’s health system is reliant on out-of-pocket (OOP) health expenditures which may prevent people from seeking care or result in catastrophic health expenditure (CHE). CHE and impoverishment due to OOP, which are used by the World Bank and World Health Organization as the sole measures of financial risk protection, are limited: they do not consider households who, following a health shock, do not incur expenditure because they cannot access the healthcare services they need (i.e., households forgoing healthcare (HFH) services). This paper attempts to overcome this limitation and improve financial risk protection by measuring HFH incidence and comparing it with CHE standard measures using household survey data from Liberia. Methods Data from the Liberia Household Income and Expenditure Survey 2014 were analysed. An OOP health expenditure is catastrophic when it exceeds a total or non-food household expenditure threshold. A CHE incidence curve, representing CHE incidence at different thresholds, was developed. To overcome CHE limitations, an HFH incidence measure was developed based on CHE, OOP and health shocks data: households incurring health shocks and having negligible OOP were considered to have forgone healthcare. HFH incidence was compared with standard CHE measures. Results CHE incidence and intensity levels depend on the threshold used. Using a 30% non-food expenditure threshold, CHE incidence is 2.1% (95% CI: 1.7–2.5%) and CHE intensity is 37.4% (95% CI: 22.7–52.0%). CHE incidence is approximately in line with other countries, while CHE intensity is higher than in other countries. CHE pushed 1.6% of households below the food poverty line in 2014. HFH incidence is approximately 4 times higher than CHE (8.0, 95% CI, 7.2–8.9%). Conclusion Lack of financial risk protection is a significant problem in Liberia and it may be underestimated by CHE: this study confirms that HFH incidence can complement CHE measures in providing a complete picture of financial risk protection and demonstrates a simple method that includes measures of healthcare forgone as part of standard CHE analyses. This paper provides a new methodology to measure HFH incidence and highlights the need to consider healthcare forgone in analyses of financial risk protection, as well as the need for further development of these measures.

Public Insurance and Financial Risk Protection: Lessons from Thailand

2010 ◽  
Author(s):  
Phusit Prakongsai ◽  
Vuthiphan Vongmomgkol ◽  
Warisa Panich-Kriangkrai ◽  
Walaiporn Patcharanarumol ◽  
Viroj Tangcharoensathien
Keyword(s):  
Financial Risk ◽  
Financial Risk Protection ◽  
Public Insurance ◽  
Risk Protection

Making Thailand’s UHC ‘SAFE’ (sustainable, affordable, fair and efficient)

2020 ◽  
Vol 20 (2) ◽  
pp. 231-236
Author(s):  
Somsak Chunharas
Keyword(s):  
Health Services ◽  
Financial Risk ◽  
National Development ◽  
Financial Risk Protection ◽  
Thai Population ◽  
Health Security ◽  
Strategic Purchasing ◽  
Strategic Approach ◽  
Public Sector Health ◽  
Risk Protection

Thai UHC has been established through national efforts to learn from international as well as national development of how to build a system-wide financial risk protection for the Thai population while also ensuring effective coverage of health services. One of the key strategic approach is establishing a strategic purchasing organization called national health security office (NHSO) since 2002. Many lesson have been learnt and shared here hoping that they are generic enough to guide actions and policy decisions either for countries starting UHC or those who have had some models going on. For example, a professionally run strategic purchasing body with certain degree of autonomy is key but the needs to harmonize multiple schemes are also challenging, technically as well as politically. The effective use of and support for existing public sector health services systems is another key lesson. The challenge of making the systems sustainable, affordable fair and efficient have been with us since the very beginning and we shares some of the approaches to address this issue to ensure that UHC will be properly supported politically, professionally managed while maintaining a well balanced demand side with the view to ensure that UHC is creating better health and not merely more access to services.

scholarly journals Global Surgery, Obstetric, and Anesthesia Indicator Definitions and Reporting: An Utstein Consensus Report

2021 ◽  
Author(s):  
Justine Ina Davies ◽  
Adrian W. Gelb ◽  
Julian Gore-Booth ◽  
Janet Martin ◽  
Jannicke Mellin-Olsen ◽  
...  
Keyword(s):  
Low Income ◽  
Data Science ◽  
Health Indicators ◽  
Obstetric Care ◽  
Global Surgery ◽  
Low Income Countries ◽  
Financial Risk Protection ◽  
Current Time ◽  
Timely Access ◽  
Data Points

Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define - for the first time - the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a two day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high, middle, and low income countries. Considering each of the six indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2-5 (intermediate) and >5 year (full) timeframes. We removed one of the original six indicators (one of two financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. Conclusions To track global progress toward timely access to quality SAO care, these indicators – at the basic level - should be implemented universally. Intermediate and full evolutions will assist in developing national surgical plans, and collecting data for research studies.

scholarly journals Spatiotemporal variation and socioeconomic factors of financial hardships of out-of-pocket health expenditure in Pakistan

2021 ◽  
Vol 27 (10) ◽  
pp. 962-973
Author(s):  
Ashar Muhammad Malik ◽  
Iqbal Azam ◽  
Amir Khan ◽  
Faisal Rifaq ◽  
Kinza Chaudhary
Keyword(s):  
Socioeconomic Factors ◽  
Rural Areas ◽  
Health Expenditure ◽  
Financial Risk ◽  
National Level ◽  
Spatiotemporal Variation ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Services Delivery ◽  
Risk Protection

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan’s four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans. Aims: In this paper, we estimate financial hardship of OPHE in Pakistan. Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE. Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (–1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (–2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE. Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans.

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