Abstract
BackgroundOut of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings can be applied in the Pakistani setting.MethodsWe conducted a systematic search for published literature using the search terms “Community based health insurance AND developing countries”, “Micro health insurance AND developing countries”, “Mutual health insurance AND developing countries”, “mutual OR micro OR community based health insurance” “Health insurance AND impact AND poor” “Health insurance AND financial protection” and “mutual health organizations” on three databases, Pubmed, Google Scholar and Science Direct (Elsevier). Only those records that were published in the last ten years, in English language with their full texts available free of cost, were considered for inclusion in this review. Hand searching was carried out on the reference lists of the retrieved articles and webpages of international organizations like World Bank, World Health Organization and International Labour Organization.ResultsTwenty-three articles were eligible for inclusion in this systematic review (14 from Asia and 9 from Africa). Our analysis shows that MHI, in the majority of cases, has been found to contribute to the financial protection of its beneficiaries, by reducing out of pocket health expenditure, catastrophic health expenditure, total health expenditure, household borrowings and poverty. MHI also had a positive safeguarding effect on household savings, assets and consumption patterns.ConclusionOur review suggests that MHI, targeted at the low-income households and tailored to suit the cultural and geographical structures in the various areas of Pakistan, may contribute towards providing protection to the households from catastrophe and impoverishment resulting from health expenditures. This paper emphasizes the need for further research to fill the knowledge gap that exists about the impact of MHI, using robust study designs and impact indicators.
Highlights
Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected
As described above, from the list of 28 articles, originally shortlisted after title/abstract review, 11 were excluded either due to lack of evidence on financial protection being directly attributed to Micro health insurance (MHI), the health insurance scheme not meeting the definition of MHI in terms of premiums paid by the insured or in terms of voluntary participation, or the effect being evaluated in the paper being the impact on health center costs and not the enrolled households
Study setting and target population Out of the 23 studies/reports included in this review, five are from China, all reporting the financial protection provided by the New Cooperative Medical Scheme (NCMS) in China
Summary
Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. Financial catastrophe and impoverishment as a result of medical expenses, especially out of pocket (OOP) expenditures, has been a concern globally, more so, in developing countries [1] where the inadequacy of state provided health system results in alarmingly excessive OOP expenditure [2]. OOP payments for health care comprise 4-5.5 % of total household consumption in China, India, Bangladesh and Vietnam. This estimate is much lower, 1.4-2.7 % for Malaysia, Thailand, the Philippines, Sri Lanka and Hong Kong, as these countries are more economically stable than the first four countries, that are more heavily dependent on OOP spending for healthcare [3]. In the event of illness, many low-income households obtain sub-optimal care or forgo medical care altogether [9,10,11]
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