Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in AsiaReport as inadecuate

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International Journal for Equity in Health

, 15:165

First Online: 04 October 2016Received: 25 January 2016Accepted: 06 September 2016DOI: 10.1186-s12939-016-0436-3

Cite this article as: Vilcu, I., Probst, L., Dorjsuren, B. et al. Int J Equity Health 2016 15: 165. doi:10.1186-s12939-016-0436-3


BackgroundMany low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage UHC, especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund.

This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress.

MethodsThis regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements.

ResultsSuch financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria.

ConclusionsOverall, government subsidized health insurance type arrangements can be effective mechanism to help countries progress towards UHC, yet there is potential to improve on institutional design features as well as implementation.

KeywordsUniversal health coverage Vulnerable population groups Government subsidization of health insurance Financial protection AbbreviationsAskesAsuransi Kesehatan scheme for civil servants in Indonesia

CNYChinese yuan renminbi currency

CGHSCentral Government Health Scheme scheme for central government employees in India

CSMBSCivil Servant Medical Benefit Scheme scheme for civil servants in Thailand

DRGDiagnosis related group

ESISEmployees’ State Insurance Scheme India

HEFsHealth Equity Funds Cambodia

ILOInternational Labour Organization

JamkesmasJaminan Kesehatan Masyarakat Indonesia

JamsostekJaminan Sosial Tenaga Kerja scheme for formal sector workers in Indonesia

MFAMedical Financial Assistance China

MNTMongolian tugrik currency

NRCMSNew Rural Cooperative Medical Scheme China

OOPOut-of-pocket expenditure

PhilHealthPhilippine Health Insurance Corporation

Rp.Indonesian rupiah currency

Rs.Indian rupee currency

RSBYRashtriya Swasthya Bima Yoana India

SHISocial health insurance

SSSSocial Security Scheme scheme for formal sector workers in Thailand

SUBOGovernment Subsidy Scheme Cambodia

UCSUniversal Coverage Scheme Thailand

UEBMIUrban Employee Basic Medical Insurance China

UHCUniversal health coverage

URBMIUrban Resident Basic Medical Insurance China

US$United States dollar currency

VNDVietnamese dong currency

WHOWorld Health Organization

Electronic supplementary materialThe online version of this article doi:10.1186-s12939-016-0436-3 contains supplementary material, which is available to authorized users.

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Author: Ileana Vilcu - Lilli Probst - Bayarsaikhan Dorjsuren - Inke Mathauer


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