Providing health insurance for the poor

This is a guest blog by Erin Schiavone of Abt Associates Inc., Bethesda, Maryland, where she supports Health Systems 20/20, USAID’s global health project working to strengthen health systems in developing countries.

Hong Wang at briefing.

WASHINGTON — What brings Washington’s global health professionals out of their offices on a cold rainy afternoon? For some, the opportunity to try to answer one of the most pressing questions in public health — how to finance affordable health care in developing countries.

During the monthly brownbag session on Thursday, Oct. 14 hosted by the Global Health Council and sponsored by Health Systems 20/20, Senior Economist Hong Wang and Technical Officer Kimberly Switlick-Prose tackled the challenge of providing priority services (defined as the most important and critical services for a given population) in health insurance and making it available for the world’s poor.

Wang used examples from Ghana, Nigeria and Rwanda to address the barriers that prevent the poor from accessing health insurance — the most obvious being cost. Wang revealed that the poor are less willing to pay for health insurance and less likely to enroll, and those who do are more likely to drop out. The poor with health insurance are less likely to seek services because they are less likely to perceive illness. This means that when the poor contribute to the cost of health insurance, through mechanisms such as community-based health financing, the less poor still receive the greatest benefit.

Subsidies, vouchers, door-to-door enrollment and provider incentives are methods utilized to encourage deliver of priority services to the poor and potentially save lives.

Switlick-Prose mentioned several health insurance success stories affecting children under five years of age. In Senegal, insured children were three times more likely to seek care upon falling ill than uninsured children and, in Mali, children experiencing fever were almost five times more likely to seek care within 48 hours. After the introduction of health insurance in Colombia, physician-assisted births increased a jaw-dropping 66%. See the presentation for more data

Including priority services in health insurance has its barriers: operational complexity, administrative expenses of increased claims, lack of infrastructure to support the influx of patients and provider payment complications. That being said, Wang is dedicated to the cause.

“The poor have a great need for priority services and priority services should target the poor. Health insurance is a powerful means to bring them together,” he said.

The next event in this series will be Thursday, Nov. 4 when we will examine “Community Engagement in Health Governance: Lessons from the Philippines.” Your thoughts on all this are welcome, and can be submitted below.