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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region

Authors: Inke Mathauer, Mareike Theisling, Benoit Mathivet, Ileana Vilcu

Published in: International Journal for Equity in Health | Issue 1/2016

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Abstract

Background

Many low-and middle-income countries (LMIC) of the World Health Organization (WHO) European Region have introduced social health insurance payroll taxes after the political transition in the late 1980s, combined with budget transfers to allow for exempting specific population groups from paying contributions, such as those outside formal sector work and in particular vulnerable groups. This paper assesses the institutional design aspects of such financing arrangements and their performance with respect to universal health coverage progress in LMIC of the European region.

Methods

The study is based on a literature review and review of secondary databases for the performance assessment.

Results

Such financing arrangements currently exist in 13 LMIC of that region, with strong commonalities in institutional design: This includes a wide range of different eligible population groups, mostly mandatory membership, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. Performance is more varied. Enrolment rates range from about 65 % to above 95 %, and access to care and financial protection has improved in several countries. Yet, inequities between income quintiles persist.

Conclusions

Budget transfers to health insurance arrangements have helped to deepen UHC or maintain achievements with respect to UHC in these European LMICs by covering those outside formal sector work, and in particular vulnerable population groups. However, challenges remain: a comprehensive benefit package on paper is not enough as long as supply side constraints and quality gaps as well as informal payments prevail. A key policy question is how to reach those so far uncovered.
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Metadata
Title
State budget transfers to health insurance funds: extending universal health coverage in low- and middle-income countries of the WHO European Region
Authors
Inke Mathauer
Mareike Theisling
Benoit Mathivet
Ileana Vilcu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0321-0

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