2021-06-10-世界卫生组织-Community_Health_Insurance_And_Universal_Coverage_3页_69kb

Summary of WHO Technical Brief on Community Health Insurance (CHI)

What is Community Health Insurance (CHI)?

Community Health Insurance (CHI) refers to community-based financing mechanisms primarily found in low- and middle-income countries. These mechanisms are based on concepts of insurance, credit, or saving and emphasize solidarity at the community level. They are largely community-initiated, owned, and operated. Policy makers advocate CHI as a tool to improve healthcare access and protect individuals from financial risks, often integrating it into national strategies for universal coverage.

Why CHI Matters?

CHI has been part of health financing in low- and middle-income countries for over two decades and is common in Africa and Asia. It contributes variably to health systems financing and financial protection by reaching disadvantaged households, though its effectiveness differs. CHI can serve as an additional financing mechanism when designed properly.

How CHI Contributes to Universal Coverage?

CHI addresses three dimensions of universal coverage: (i) population coverage, (ii) service coverage, (iii) direct cost coverage.

• Population coverage: Aims to extend financial protection to the uninsured, though challenges remain for the poorest, often requiring subsidies (e.g., in Rwanda and India's Karuna Trust via donor funding).
• Service coverage: Typically focuses on primary and referral care but is limited in covering expensive interventions like surgery due to small risk pools.
• Direct cost coverage: Varies by design and health service provider payments; in some cases, CHI members may face higher direct costs compared to non-members, limiting affordability.

Globally, CHI often achieves low population coverage and marginal impact at the national level, but it promotes prepayment and solidarity, supporting broader universal coverage efforts.

What Policy Makers Need to Think About?

National strategies for CHI integration vary by country and require a systemic approach:

• Integration: CHI can be part of fragmented strategies (coexisting with other financings, e.g., Senegal, Mali) or nationwide models (e.g., Ghana, Rwanda). No templates exist, so suitability depends on context.
• Regulation: For financial protection, service demand must be controlled (e.g., lessons from China's New Cooperative Medical System show challenges in translating population to financial coverage).
• Subsidies: Essential for expanding coverage, especially for the poor; domestic cross-subsidizing or donor funds are options, needing political will and solidarity.
• Risk pooling and solidarity: Schemes can join forces (e.g., Mali) or enforce mandatory affiliation (e.g., Ghana, Rwanda) to scale up, but voluntary solidarity may need legal support without fully solving informal sector issues.
• Equity and empowerment: CHI has transformative potential by empowering vulnerable groups (e.g., women and poor urban dwellers), though this area requires more study.

Overall, successful CHI implementation relies on strong political commitment at national and international levels.