Peter Leslie Annear, Liz Comrie-Thomson, Prarthna Dayal
Asia Pacific Observatory on Health Systems and Policies’ policy brief, v. 4, n. 3 2015.
Published online: November, 2015
Overview / Visión general:
Although universal coverage, in principle, means providing financial protection to the whole population, it requires the introduction of some form of prepayment for health service charges, especially in low- and middle-income income countries, where resources are constrained and per capita health expenditures are low. Prepayment mechanisms have been defined as a means of distributing the financial risk associated with different individuals’ health-care expenditures over time and across populations.
The implementation of prepayment mechanisms for non-poor informal workers in LMICs is a relatively new policy area and faces many challenges. There are concerns on whether compulsory schemes such as social health insurance are effective in covering non-poor informal workers, whether voluntary schemes such as community based health insurance can be used to scale-up coverage of non-poor informal workers, and whether complete subsidization of non-poor informal workers can create perverse incentives for remaining in or moving into informal employment. Approaches to coverage of non-poor informal workers vary depending on the political, economic or cultural context within each LMIC. In conceptual terms, there are three broad, practical approaches to providing coverage of non-poor informal workers: extend coverage downward from the formal sector; extend coverage upward from schemes subsidizing the poor; or use a combination of prepayment and tax-based subsidies.
What is the problem / Cual es el problema:
In pursuing the goal of universal coverage, governments and policy-makers in low- and middle-income countries (LMICs) in Asia face a particular challenge in providing access to health services for non-poor informal workers through some form of prepayment (Tangcharoensathien et al., 2011; Lagomarsino et al., 2012). There is general recognition that providing coverage for the poor requires tax-funded subsidies, and many governments have begun to implement social health insurance (SHI) for the formally employed. Only a few LMICs have found the means to cover non-poor informal workers (Langenbrunner and Somanathan, 2011).
Informal workers have been defined as those outside formal employment, comprising all those employed informally whether in the formal, informal or household sectors (Bitran, 2014). Our special concern here is with the coverage of informal workers who are above the poverty line, that is, non-poor informal workers. In principle, universal coverage means providing financial protection to the whole population. In practice, universal coverage cannot be achieved at once, but involves progress along a path towards achieving full population coverage (Kutzin, 2013). This is especially true in low- and middle-income income countries, where resources are constrained and per capita health expenditures are low. Universal coverage requires the introduction of some form of prepayment for health service charges. Prepayment mechanisms have been defined as a means of distributing the financial risk associated with different individuals’ health-care expenditures over time and across populations (Acharya et al., 2012)…
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Keywords / Palabras clave:
Universal Coverage; Social Health Insurance; Workers Health; Low- and Middle-income Countries; Asia