News / Africa

Expanding Health Insurance in Developing Countries

Rwanda will host regional conference on health insurance.Rwanda will host regional conference on health insurance.
x
Rwanda will host regional conference on health insurance.
Rwanda will host regional conference on health insurance.

Multimedia

Audio
  • Listen to De Capua report on health insurance in developing countries

TEXT SIZE - +
Joe DeCapua
Rwanda will host a regional conference next week (9-11/13), with a focus on health insurance. Rwanda has been praised for moving toward universal coverage for its population. But many say it’s a complicated issue that does not have a one-size-fits-all solution.

The Conference on Social Health Protection in the East African Community will consider various approaches to providing universal health coverage in Rwanda, Uganda, Kenya, Tanzania and Burundi.

Universal coverage is the subject of a new study that reviewed health systems in 12 African and Asian countries.

The World Health Organization’s Joe Kutzin says universal coverage is more of a “direction than a destination.”

“What it means you want to move towards universal coverage, which means you want to improve access. You want to improve financial protection and you want to improve quality. And in that sense, those are goals for every country in the world. So it’s relevant to every African country, every European country, the U.S. and so on, to make progress towards those goals,” he said.

Kutzin is coordinator of health financing policy and analyzed the study published in the Bulletin of the World Health Organization.

Dr. Ernst Spaan, one of the authors, said, “There is a lot of debate going on on how to finance health services in developing countries. In Asia and Africa there is a lot of debate on should they focus on social health insurance or community-based health insurance? And we actually looked into that and we found out there are a lot of studies, but it’s a bit patchy. So we decided to do a systematic review of the literature.”

Spaan is a senior researcher and lecturer in public health at the Radboud University Nijmegen Medical Center in the Netherlands.

The study looked at what he calls impact indicators. These include the way financial resources are collected to fund insurance plans, the amount of coverage provided to recipients, whether that coverage is provided to all segments of society and whether there’s been an improvement in the quality of life.

It says social and community health insurance plans “hold untapped potential” for achieving universal coverage. But Spaan says for that to happen, funding issues need to be addressed. For example, he says social plans are generally mandatory and may be funded through payroll deductions.

“That of course poses a problem in many developing countries because of the fact that the informal sector is quite large. Sometimes even 60 percent of the population or higher is not in formal employment. Also because of the large agricultural sector income is dependent on harvest times, so it’s also very erratic,” said Spaan.

WHO’s Kutzin said some insurance systems may also require a user fee that’s paid at the time of medical services.

“When people have to pay a lot at the time they use services it poses a real, severe economic risk to their households. Very often you find cases where, for example, people have to sell off their assets, whether that is in cash or in animals.  Whatever may be the main source of wealth, people are selling off their assets in order to raise the money to pay for care,” he said.

Spaan and his colleagues also looked at community insurance plans.

“These are organized, generally, on a smaller scale. And in many countries you find these schemes are linked to, for instance, one hospital or even to a school. So they insure school children, for instance, or they insure the people around a certain health facility. But what is more important is that it’s a certain scheme where the local population is more involved in the set-up of the scheme. And least that’s the ideal,” said Spaan.

He added that the study’s findings “back the World Health Organization’s view that pre-paid financing mechanisms, such as health insurance, are a key route to universal coverage.”

But Kutzin said there are many ways to provide health coverage besides those presented in the study.

“One of the best known cases we have is from Thailand, which in 2002 instituted a program called the Universal Health Coverage Scheme. It’s neither community-based nor is it contributory. It is a system where the government using general tax revenues puts all of that money into a single pool. And anyone is entitled to sign-up for the program. They don’t have to contribute anything. That pool pays for services on behalf of the entire population,” he said.

He said Rwanda uses a multiple funding approach for its mandatory health coverage, including general tax revenues and donor funding. And it uses its community-based systems in a coordinated way.

Universal health coverage has been a controversial topic here in the United States, but not in many other countries. Kutzin said that’s because there has not been a clear discussion about what universal coverage is trying to achieve. He says the main question is whether two people, one rich and one poor, with the same medical condition, have access to the same treatment?

You May Like

Multimedia Relatives of South Korean Ferry Victims Fire at Authorities

46 people are confirmed dead, but some 250 remain trapped inside sunken ferry More

War Legacy Haunts Vietnam, US Relations

$84 million project aims to clean up soil contaminated by Agent Orange More

Wikipedia Proves Useful for Tracking Flu

Technique gave better results than Center for Disease Control (CDC) and Google’s Flu Trends More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Ukraine, Russia, United in Faith, Divided in Politicsi
X
Michael Eckels
April 19, 2014
There is a strong historical religious connection between Russia and Ukraine. But what role is religion playing in the current conflict? In the run-up to Easter, Michael Eckels in Moscow reports for VOA.
Video

Video Ukraine, Russia, United in Faith, Divided in Politics

There is a strong historical religious connection between Russia and Ukraine. But what role is religion playing in the current conflict? In the run-up to Easter, Michael Eckels in Moscow reports for VOA.
Video

Video Face of American Farmer is Changing

The average American farmer is now 58 years old, and farmers 65 and older are the fastest growing segment of the population. It’s a troubling trend signaling big changes ahead for American agriculture as aging farmers retire. Reporter Mike Osborne says a new report from the U.S. Census Bureau is suggesting what some of those changes might look like... and why they might not be so troubling.
Video

Video Donetsk Governor: Ukraine Military Assault 'Delicate But Necessary'

Around a dozen state buildings in eastern Ukraine remain in the hands of pro-Russian protesters who are demanding a referendum on self-rule. The governor of the whole Donetsk region is among those forced out by the protesters. He spoke to VOA's Henry Ridgwell from his temporary new office in Donetsk city.
Video

Video Drones May Soon Send Data From High Seas

Drones are usually associated with unmanned flying vehicles, but autonomous watercraft are also becoming useful tools for jobs ranging from scientific exploration to law enforcement to searching for a missing airliner in the Indian Ocean. VOA’s George Putic reports on sea-faring drones.
Video

Video New Earth-Size Planet Found

Not too big, not too small. Not too hot, not too cold. A newly discovered planet looks just right for life as we know it, according to an international group of astronomers. VOA’s Steve Baragona has more.
Video

Video Copts in Diaspora Worry About Future in Egypt

Around 10 percent of Egypt’s population belong to the Coptic faith, making them the largest Christian minority in the Middle East. But they have become targets of violence since the revolution three years ago. With elections scheduled for May and the struggle between the Egyptian military and Islamists continuing, many Copts abroad are deeply worried about the future of their ancient church. VOA religion correspondent Jerome Socolovsky visited a Coptic church outside Washington DC.
Video

Video Critics Say Venezuelan Protests Test Limits of Military's Support

During the two months of deadly anti-government protests that have rocked the oil-rich nation of Venezuela, President Nicolas Maduro has accused the opposition of trying to initiate a coup. Though a small number of military officers have been arrested for allegedly plotting against the government, VOA’s Brian Padden reports the leadership of the armed forces continues to support the president, at least for now.
Video

Video More Millenials Unplug to Embrace Board Games

A big new trend in the U.S. toy industry has more consumers switching off their high-tech gadgets to play with classic toys, like board games. This is especially true among the so-called millenial generation - those born in the 1980's and 90's. Elizabeth Lee has more from an unusual café in Los Angeles, where the new trend is popular and business is booming.
Video

Video Google Buys Drone Company

In its latest purchase of high-tech companies, Google has acquired a manufacturer of solar-powered drones that can stay in the air almost indefinitely, relaying broadband Internet connection to remote areas. It is seen as yet another step in the U.S. based Web giant’s bid to bring Internet to the whole world. VOA’s George Putic reports.
AppleAndroid