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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model

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Policy Options for Contributory Health Insurance Schemes in Low and Lower-Middle Income Countries to Enable Progress

Agnes Gatome-Munyua¹, Joseph Kutzin², Cheryl Cashin³

¹Results for Development, Kenya.

Health Systems and Reform

|January 23, 2025

Summary

Contributory health insurance often fails to fund health sectors equitably in low-income nations. Policy options include merging schemes, increasing budget transfers, and unifying benefits for universal health coverage (UHC).

Keywords:

Contributory health insurance healthcare financing national health insurance purchasing universal health coverage

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Area of Science:

Health Economics
Health Policy
Public Health Systems

Background:

Contributory health insurance (CHI) in low- and lower-middle-income countries (LMICs) often fails to provide sustainable funding.
CHI can worsen health inequities due to contribution-linked entitlements, fragmenting health systems.
Reversing existing, fragmented financing schemes is often politically and technically infeasible.

Purpose of the Study:

To propose policy options for LMICs with fragmented health financing to advance towards universal health coverage (UHC).
To address challenges posed by existing contributory health insurance schemes that exacerbate inequities.

Main Methods:

Analysis of existing health financing structures in LMICs.
Proposal of three complementary policy strategies: scheme consolidation, strengthening existing mechanisms, and reframing insurance agency roles.
Focus on improving equity and efficiency in health care access and financing.

Main Results:

Policy option 1: Merging fragmented schemes to consolidate pooling and purchasing.
Policy option 2: Reducing contribution reliance via budget transfers and strengthening purchasing capacity.
Policy option 3: Unifying data systems and universalizing core benefits across all patient visits.

Conclusions:

Countries should critically review fragmented health financing schemes to prevent further system compromise.
Implementing a strategic, sequential approach can expand equitable coverage.
Consolidating institutional capacity for purchasing and unifying data systems are crucial for effective health system performance and UHC.