The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries : A Systematic Review
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World Bank, Washington, DC
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This paper summarizes the literature on
the impact of state subsidized or social health insurance
schemes that have been offered, mostly on a voluntary basis,
to the informal sector in low- and middle-income countries.
A substantial number of papers provide estimations of
average treatment on the treated effect for insured persons.
The authors summarize papers that correct for the problem of
self-selection into insurance and papers that estimate the
average intention to treat effect. Summarizing the
literature was difficult because of the lack of (1)
uniformity in the use of meaningful definitions of outcomes
that indicate welfare improvements and (2) clarity in the
consideration of selection issues. They find the uptake of
insurance schemes, in many cases, to be less than expected.
In general, we find no strong evidence of an impact on
utilization, protection from financial risk, and health
status. However, a few insurance schemes afford significant
protection from high levels of out-of-pocket expenditures.
In these cases, however, the impact on the poor is weaker.
More information is needed to understand the reasons for low
enrollment and to explain the limited impact of health
insurance among the insured.
Palabras clave
ACCESS TO HEALTH CARE, ACCESS TO HOSPITAL, ADVERSE SELECTION, AGING, AGRICULTURAL INSURANCE, ANXIETY, AVAILABILITY OF CARE, BASIC HEALTH CARE, BENEFICIARIES, CATASTROPHIC EXPENDITURES, CATASTROPHIC HEALTH EXPENDITURE, CHECK UPS, CHILD HEALTH, CHILDREN, CHOICE, COINSURANCE, COMMUNITY HEALTH, COMMUNITY INSURANCE, COMPULSORY INSURANCE, COOPERATION, COST-SHARING ARRANGEMENTS, COSTS, CREDIT, DEATH, DIABETES, DOCTORS, DRUGS, ECONOMIC REVIEW, ECONOMICS OF HEALTH, EMPLOYMENT, EPIDEMIOLOGY, EQUILIBRIUM, EQUITY, EQUITY IN ACCESS, EVALUATION, EXPENDITURES, EXPERT OPINIONS, FAMILIES, FEES, FINANCIAL PROTECTION, FINANCIAL RISK, FINANCIAL RISK PROTECTION, FINANCING, FREE CARE, GLUCOSE, GOVERNMENT INSURANCE, HEALTH, HEALTH AFFAIRS, HEALTH CARE, HEALTH CARE CENTERS, HEALTH CARE COSTS, HEALTH CARE COVERAGE, HEALTH CARE FACILITIES, HEALTH CARE FINANCE, HEALTH CARE FINANCING, HEALTH CARE NEEDS, HEALTH CARE PROVISION, HEALTH CARE SYSTEM, HEALTH CARE USE, HEALTH CARE UTILIZATION, HEALTH CENTERS, HEALTH CONDITIONS, HEALTH COSTS, HEALTH ECONOMICS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FINANCING, HEALTH INSURANCE, HEALTH INSURANCE PROGRAM, HEALTH INSURANCE SCHEME, HEALTH INSURANCE SCHEMES, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICY, HEALTH PROFESSIONALS, HEALTH PROJECT, HEALTH SERVICE, HEALTH SERVICES, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HEALTH-CARE, HOSPITAL CARE, HOSPITAL SERVICES, HOSPITALIZATION, HOSPITALS, HUMAN DEVELOPMENT, HYGIENE, ILLNESS, IMPACT EVALUATIONS, IMPERFECT INFORMATION, IMPLEMENTATION, INCENTIVE STRUCTURES, INCENTIVES, INCIDENCE, INCOME, INCOME COUNTRIES, INCOME GROUPS, INFANT MORTALITY, INFANT MORTALITY RATES, INFORMAL SECTOR, INFORMAL SECTOR WORKERS, INPATIENT CARE, INPATIENT HOSPITAL, INSURANCE MARKETS, INSURANCE PREMIUMS, INSURANCE PRODUCTS, INSURANCE SYSTEM, INTEREST, KNOWLEDGE, LIVING STANDARDS, LOSS, LOW INCOME, LOW-INCOME COUNTRIES, MANAGED CARE, MARGINAL COST, MEASUREMENT, MEDICAL CARE, MEDICAL EXPENSES, MEDICAL INSURANCE, MORAL HAZARDS, MORBIDITY, MORTALITY, NATIONAL HEALTH, NATIONAL HEALTH INSURANCE, NATIONAL HEALTH SERVICE, NUTRITION, ORAL HEALTH, OUTPATIENT CARE, OUTPATIENT SERVICES, PATIENT, PATIENTS, PHYSICIAN, POLICY DISCUSSIONS, POLICY RESEARCH, POPULATION, POVERTY, PREGNANCY, PREGNANT WOMEN, PREVENTIVE CARE, PRICE OF HEALTH CARE, PRICES, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE CARE, PRIVATE HEALTH INSURANCE, PRIVATE INSURANCE, PRIVATE SECTOR, PROBABILITY, PROGRAMS, PUBLIC HEALTH, PUBLIC HEALTH INSURANCE, PUBLIC HEALTH POLICY, PUBLIC PROVIDERS, PUBLIC SECTOR, RANDOMIZED CONTROLLED TRIALS, RISK AVERSION, RISK SHARING, SAVINGS, SCHOOL HEALTH, SOCIAL HEALTH INSURANCE, SOCIAL INSURANCE, SOCIAL RESEARCH, SOCIAL SECURITY, SOCIAL SECURITY HEALTH INSURANCE, SOCIAL SECURITY HOSPITALS, SOCIAL STUDIES, SURGERY, UNINSURED PEOPLE, USE OF HEALTH CARE SERVICES, USE OF HEALTH SERVICES, VISITS, WELFARE, WORKERS