An analysis of three national health insurance proposals in Sub‐Saharan Africa

Abstract

AbstractThe financing and/or provision of health insurance by government has a theoretical basis: it stems from market failure in the private health insurance market; and, from externalities in the consumption of health care by the poor. Government health insurance, or national health insurance (NHI) may be analysed by using five criteria: who are the beneficiaries?; efficiency effects; the equity of financing; the level of administrative costs; and, political acceptability. In the last five years, Ghana, Zimbabwe and Nigeria have each considered proposals for NHI. However, each proposal shows design flaws, when analysed in the light of the five criteria above. This article first considers types of health insurance in Sub‐Saharan Africa, and why NHI, with cost recovery as an essential component, might be desirable. A following section present an outline of the NHI proposals in Ghana, Zimbabwe and Nigeria and points out the design flaws. A final section builds upon the theoretically‐good aspects of the three proposals, and considers some alternate approaches to NHI that these three countries and other countries in the Sub‐Sahara might want to consider.