Paying to improve health

The organizers of this year’s 5th International Microinsurance Conference, held last week in Dakar, wisely included “Providing health insurance to the poor” as one of the main themes. Health events - whether they are unanticipated emergencies, or even foreseeable events like giving birth - are among the main financing challenges for poor households. When you’re living on $1 or $2 a day, better health financing mechanisms have the potential to make a huge difference. Too often, they’re literally life and death issues. 

Health financing tries to achieve two objectives: i) to act as a poverty reduction tool that provides financial protection, and ii) to act as a financing tool to improve healthcare (these ideas were presented in an excellent discussion by Cheryl Scott from the Gates Foundation). The two objectives are not mutually exclusive, but they point to different health financing mechanisms. If an institution’s focus is poverty reduction, then the health financing tool must protect against costly catastrophic events. A health insurance scheme that covers hospitalization and in-patient care falls within this domain – this is the structure of the majority of health microinsurance schemes globally. 

Health financing as a means to improve healthcare entails a different set of solutions. One has to think about outpatient care, integration with the public health system, nutrition and so forth. One mechanism being tested right now is a link between savings accounts and insurance where the savings element is used to pay for out-patient care while the insurance component bears the risk and covers the cost of in-patient care.

Even insurers who cover only in-patient care can improve access to better healthcare. At the conference I presented preliminary results from a health insurance and quality of care study where we examined whether access to health insurance can improve the quality of care available to the insured clients. We found that insured clients who sought advice from the health scheme before selecting their providers ended up going to health providers with better infrastructure and more qualified doctors compared to an uninsured group. But both insured and uninsured reported a similar level of patient satisfaction and health outcomes. We hope to disentangle this puzzle as we examine the evidence some more. 

The conference included a host of other presentations on health financing approaches, ranging from community-based health mutuals to government-sponsored national health insurance schemes. You can access the conference agenda and speaker presentations here.