Is there a case for social insurance?

Abstract

Social insurance is an increasingly popular policy reform in developing countries. Thailand and Vietnam have longstanding efforts to achieve universal coverage through social insurance. Kenya is currently implementing such a reform. Caribbean countries have been debating the merits of ‘National Health Insurance’ since the mid-1990s; and many other countries in Asia and Africa are following suit. It is variously championed as providing a ‘new source’ of funding for health, of ‘protecting’ the poor against risk of major illness, and of reinvigorating public health services. However, social insurance as it is being debated and implemented is probably a bad idea for most countries because it is likely to raise costs and increase inequities. It is notable that the one region of the world with little movement on introducing social insurance is Latin America, where such programmes have a history of more than 50 years and where promises of universal and equitable access remain out of reach (with the notable exceptions of the region’s costliest systems ‐ Costa Rica, Uruguay and Chile).