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Making Health Systems Work in Low and Middle Income Countries Disentangling Its Complexities
from Section 2 - Transforming Health Systems: Confronting Challenges, Seizing Opportunities
Published online by Cambridge University Press: 08 December 2022
Pre-payment arrangements including social health insurance (SHI) and national health insurance (NHI) are crucial in ensuring the financial protection goal of UHC. Many low and middle-income countries (L&MIC) are exploring and evolving context relevant modalities of SHI as they reform their health financing systems towards UHC. This evolution usually starts with L&MICs implementing SHIs linked to employment and financed by employers’ and employees’ contributions/premiums, similar to what had been practiced in High-Income Countries. However, the prevalent informal sector and significant number of people in a state of poverty made it difficult to cover the whole population and advance UHC. In response, many L&MIC governments use general tax revenues to subsidise those who are unable to contribute to the formal SHI arrangement. We refer to such advanced mixed form of SHI as National Health Insurance (NHI). Today, many countries are designing and implementing NHI schemes as their primary mechanism to pursue and achieve UHC. NHI arrangements have many advantages, but countries need to build up health system capacities to implement these insurance programs/schemes.
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