As governments from all over the world meet in Paris to discuss social health protection in developing countries, a group of NGOs has issued a report warning that health insurance continues to exclude the poor. The argument that health insurance could fill financing gaps to ensure health care in poor countries is now being strongly promoted by northern governments and international institutions. The paper, Health insurance in low income countries: Where is the evidence that it works?, says that while these insurance schemes can have a positive effect on the accessibility and on reducing catastrophic health expenditure for parts of the population, they can also pose a threat to equity and efficiency of health systems.
In its report, the NGOs argue that even insurance mechanisms made specifically for developing countries often exclude the poorest and most vulnerable groups. NGOs argue that most health insurance schemes developed for the poor seem unable to finance a comprehensive benefits package. Therefore poor people often continue to depend on the ability to pay 40% of their health needs – out-of-pocket – even when they are a member of an insurance scheme. “Far from being a magic bullet, health insurance schemes can exclude the poorest from health services. The money for health must not come from the pockets of poor people. The best way for countries like France and Germany to provide healthcare for the poor is by delivering on the aid they’ve promised,” said Luc Lampriere of Oxfam France - Agir Ici.
NGOs also call on countries and donors to respect their commitment to boost investments in health care. Only about a third of sub-Saharan African countries are allocating ten per cent or more of their national budgets to the health sector – despite a previous commitment known as the Abuja target, to invest 15 percent spending on health. The report says that all countries and donors should evaluate insurance mechanisms not just in terms of advantages to the populations they serve but also with regards to the contribution they make towards universal access.
“Health Insurance mechanisms are often promoted based on the assumption that they can fill financing gaps and contribute positively to universal coverage. But without significant public funding for the health sector and strong government stewardship, insurance mechanisms can actually increase inequity,” said Nicolas Guihard of Médecins du Monde. A specific focus is needed, the report continues, on the needs of vulnerable groups, such as women, poor and elderly people, and people living with HIV, who are most likely to be excluded by insurance mechanisms must also remain at the centre of any schemes and the overall debate.