Health insurance coverage in low-income and middle-income countries: progress made to date and related changes in private and public health expenditure

Abstract

IntroductionSeveral low-income and middle-income countries (LMICs) have implemented health insurance programmes to foster accessibility to healthcare and reduce catastrophic household health expenditure. However, there is little information regarding the population coverage of health insurance schemes in LMICs and on the relationship between coverage and health expenditure. This study used open-access data to assess the level of health insurance coverage in LMICs and its relationship with health expenditure.MethodsWe searched for health insurance data for all LMICs and combined this with health expenditure data. We used descriptive statistics to explore levels of and trends in health insurance coverage over time. We then used linear regression models to investigate the relationship between health insurance coverage and sources of health expenditure and catastrophic household health expenditure.ResultsWe found health insurance data for 100 LMICs and combined this with overall health expenditure data for 99 countries and household health expenditure data for 89 countries. Mean health insurance coverage was 31.1% (range: 0%–98.7%), with wide variations across country-income groups. Average health insurance coverage was 7.9% in low-income countries, 27.3% in lower middle-income countries and 52.5% in upper middle-income countries. We did not find any association between health insurance coverage and health expenditure overall, though coverage was positively associated with public health spending. Additionally, health insurance coverage was not associated with levels of or reductions in catastrophic household health expenditure or impoverishment due to health expenditure.ConclusionThese findings indicate that LMICs continue to have low levels of health insurance coverage and that health insurance may not necessarily reduce household health expenditure. However, the lack of regular estimates of health insurance coverage in LMICs does not allow us to draw solid conclusions on the relationship between health insurance coverage and health expenditure.

Effects of a free health insurance programme for the poor on health service utilisation and financial protection in Senegal

“…First, in the Niakhar area, there was a large gap between the proportion of households benefiting from the PNBSF cash transfer programme (55%) and the proportion of households who had at least one member who benefited from the PNBSF free health insurance enrolment (11%). Besides confirming the low health insurance enrolment rates usually reported in Senegal (voluntary health insurance coverage was even lower),2 3 and in sub-Saharan Africa in general,32 33 this suggests a dysfunction of the PNBSF, which is supposed to provide fully subsidised membership to all members of households registered in the programme (ie, receiving the cash transfer). Even more problematically, our results indicated that, among those individuals belonging to a household that received at least once the cash transfer from the PNBSF and were not members of a CBHI, 69% did not know about the existence of CBHI before the survey (and therefore had no information about their right to free PNBSF-subsidised CBHI membership).…”

Cost Burden of Rigid Internal Fixation in Craniomaxillofacial Trauma Care in Low‐ and Middle‐Income Countries

“…This burden is exacerbated by the comparative rarity of medical insurance in LMICs. Where most patients in the United States are shielded from a significant proportion of the material cost by insurance, only a minority of LMICs have national medical insurance programs that subsidize costs 12. Indeed, health care system refinancing is needed in LMICs.…”

Differentiation of expenditure on health and life insurance in households in 2006–2020

“…The citizens of each country bear private health expenditures. In low-and middle-income countries, along with the increase in the national wealth, the amount of expenditure, mainly from public funds, also increases (Hooley, Afriyie, Fink and Tediosi, 2022). Interestingly, the authors found that spending on health is usually not correlated with having private health insurance -patients may simply cover such expenses directly from household budgets.…”