2001年-世界发展银行全球_Health_Insurance_for_the_Informal_Sector_in_Africa___Design_Features_Risk_Protection_and_Resource_Mobilization_61页_493kb

Summary of "Health Insurance for the Informal Sector in Africa: Design Features, Risk Protection, and Resource Mobilization"

Core Content

This paper, authored by Dyna Arhin-Tenkorang, explores the design features, risk protection, and resource mobilization of health insurance schemes targeting the informal sector in Africa. It presents a conceptual framework and evaluates the performance of several community-based health insurance schemes, emphasizing their potential and limitations in improving access to health care and financial protection for low-income populations.

Main Viewpoints

• Community Health Insurance (CHI) is a promising approach for providing financial protection to the informal sector, particularly in low-income countries where formal health insurance is limited.
• Design features of CHI schemes significantly influence their performance in terms of risk protection and resource mobilization.
• Institutional and technical factors are crucial in determining the success of these schemes, including governance structures, management capacity, and the use of appropriate data and methodologies.
• Risk protection is evaluated through indicators such as affordability, payment schedules, completeness of the health care package, and level of access.
• Resource mobilization is assessed based on the ability of schemes to collect contributions and provide adequate funding for health services, rather than just meeting financial obligations.

Key Information

Design Features

• Scheme specifications such as required contributions and benefit packages should be based on data on willingness to pay (WTP) and projected health care costs.
• Operating modalities should facilitate cost-effective interactions between formal organizations and individuals in informal environments, often through direct and infrequent transactions.
• Models include:
  • Provider Insurance Model (e.g., CAM in Burundi, Nkoranza in Ghana, Bwamanda in former Zaïre)
  • Mutual Benefit Society Model (e.g., Abota in Guinea-Bissau)
  • Mutual-Provider Partnership Model (e.g., CHF in Tanzania, Dangme West in Ghana)

Risk Protection Performance

• CAM (Burundi): Provides significant financial risk protection with affordable premiums and full access to care.
• CHF (Tanzania): Offers modest financial risk protection, with some exclusions and variable payment schedules.
• Abota (Guinea-Bissau): Provides significant financial risk protection, with community-determined contribution levels and benefit packages.
• Nkoranza (Ghana): Shows suboptimal financial risk protection due to unaffordable premiums and inappropriate payment schedules.
• Bwamanda (former Zaïre): Offers suboptimal financial risk protection, with affordable premiums but unaffordable co-payments for distant households.
• Dangme West (Ghana): Provides suboptimal financial risk protection, with low initial participation and inappropriate payment schedules.

Resource Mobilization

• Most schemes mobilize between 30% and 100% of members' health care expenditures, despite the low income of participants.
• Subsidies and reinsurance are key mechanisms to enhance resource mobilization and improve the sustainability of CHI schemes.
• Management capacity building and linkages with formal health financing systems are essential for the long-term success of these schemes.

Policy Implications

• Governments and donors should support subnational health insurance schemes to improve access to health care for the informal sector.
• Subsidies are necessary to ensure participation of the poorest populations.
• Reinsurance can help enlarge the risk pool and improve financial stability.
• Technical support is vital for strengthening the management and monitoring of local schemes.
• Linkages with formal health systems should be established to integrate community-based schemes into broader health financing mechanisms.

Conclusion

Community health insurance schemes in Africa have the potential to improve financial protection and access to health care for the informal sector. However, their design must be informed by data on WTP and projected health costs, and they must incorporate cost-effective operating modalities. The paper emphasizes the need for complementary public policies to support the implementation and institutionalization of these schemes.

Key Policies for CHI Schemes

1. Subsidies to support low-income populations
2. Reinsurance to expand the size of risk pools
3. Management capacity building to improve scheme operations
4. Linkages with formal financing and provider networks to enhance integration and effectiveness

Selected Schemes and Their Performance

Figures and Tables

• Figure 1: Stages of Financial Protection and Supporting Policies
• Table 1: Financial Risk-Protection Performance of Selected African Community Health Insurance Schemes

Institutional and Technical Considerations

• Congruence between scheme principles and local norms is essential for community participation.
• Health provider experiences with third-party payments and contracts influence scheme effectiveness.
• Regulatory frameworks are important but not the focus of this paper.

This paper provides a comprehensive analysis of the challenges and opportunities in designing and implementing health insurance schemes for the informal sector in Africa, offering a roadmap for improving their performance and sustainability.