2.2.1.2. Relevant scheme
models
Health insurance schemes are arrangements in which officials
formally hold a fund that consists of payments by insured participants and use
resultant resource pools to finance all parts of members' healthcare costs. In
African countries that have schemes for the informal sector, most plans fall
into the first three of the following four models, where the officials are
members of an identifiable group whose contributions make up the pools, and are
responsible for management activities such as determining benefits and
contributions, the model is a mutual benefit society model. In a variant of
these mutual and provider model, the officials are responsible for managing the
insurance product and providing healthcare and are drawn from members of mutual
society as well as a healthcare provider organization, (Arhin and Carrin G,
2003:43).
Such a model may be termed as mutual-provider partnership
model and correlates in general to the concept of mutual-based insurance put
forward to test the hypothesis of feasibility of insurance for households in
the formal sector. (Arhin and Carrin G, 2003:43).
2.2.1.3. Micro insurance in
Rwanda
Micro insurance: is voluntary group self-help scheme for
social health insurance. The underpinning of micro insurance is that excluded
populations have not covered under the existing health insurance schemes
because of two concurrent forces. The first is that Insurers have done little
to include these population segments. The second factor has been that excluded
beneficiaries have forgone claiming access because of their disempowerment
within society. (Dror and Jacquier 1999:78).
2.2.1.4. Experience of mutual health insurance in African
countries
Similar to the whole insurance industry, private commercial
health insurance is hardly developed in Africa. Nevertheless, private prepaid
schemes are a significant source of total health financing in a couple of
countries. Once again, the health insurance market is well established in South
Africa, where 42.3% of all expenditure on healthcare gets channeled through a
private health insurance intermediary. Relative to total health expenditure,
PHI also plays a significant role in Namibia and Zimbabwe. However, the high
share of PHI spending is not reflected in equally significant coverage rates;
i.e., only 8% of the populations in Zimbabwe are estimated to have private
health insurance (Campbell et al., 2000:2).
Increasing the access of African population to healthcare is
one of the formidable challenges facing the global community. During the 1980s
and 1990s, African governments with the endorsements of their international and
bilateral donor partners, implemented health sector reforms intended to improve
the efficiency of health systems and the quality of care. In many countries,
these reforms included the introduction or the consolidation of cost recovery
mechanisms, in particular out of pocket fees, paid at the time of illness (user
fees), which had an intended effect on decreasing the poor's access to
healthcare (J. M 1997:5).
As most functional health insurance schemes in Africa are
associated with formal sector employment-requiring regular contributions
compatible with formal sector earnings- the majority of individuals are not
insured. Hellman, C. (1990:3) concludes that the formal sector schemes
effectively cover members of the relatively small upper and middle classes.
Uncertainty about the timing of illness, the unpredictability of healthcare
costs during illness, and the low and irregular income of individuals mean that
it is virtually impossible for households to make financial provision for
illness related expenditures. (Hellman, C. 1990:3) Users contribute a major
part of such expenditures. As consequence user fees have been and still are a
major contributing factor to the high incidence of out-of-pocket payment by
individuals and households at the time of illness. Furthermore, most households
cannot obtain credit from formal banking system. (Hellman C.1990:3)
Thus user fees, in addition to having been largely
unsuccessful in raising significant resources, have contributed significantly
to increasing the exposure of poor households to financial risks associated
with illness. Individuals are subject to illness-related financial risks
correlated with healthcare prices and their disable incomes. As ratios of
healthcare prices to incomes rise, households' probabilities of illness-related
loss of wealth and assets increase. Consequently in many situations of low per
capita incomes, ranking households into income groups is of little use for
policy formulation aimed at providing universal access to effective healthcare.
(Hellman, C.1990:3)
Rather, public provision of financial protection becomes a
crucial element of strategies to reduce poverty for all households' poor
communities such as those in rural areas and slums, irrespective of their
incomes relative to others in those areas. Ernst & Young (2003) estimate
PHI coverage to reach 18% among the total South African population. The
government provides basic healthcare services to the poor and is committed to
achieve universal coverage. (World Health Organization report 2003:54)
In almost all African countries, international donors remain a
very important part of the healthcare system, especially in the Sub-Saharan
region where countries often obtain more than 25% of total resources through
these channels. Again, this number is notably greater for some countries (e.g.,
Mozambique with donor contributions accounting for 52% of total health
expenditure) while others may not receive any international funding. (World
Health Organization report 2003:54)
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