The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries : A Systematic Review

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 paper...

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Bibliographic Details
Main Authors:	Acharya, Arnab, Vellakkal, Sukumar, Taylor, Fiona, Masset, Edoardo, Satija, Ambika, Burke, Margaret, Ebrahim, Shah
Format:	Policy Research Working Paper
Language:	English en_US
Published:	World Bank, Washington, DC 2013
Subjects:	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
Online Access:	http://documents.worldbank.org/curated/en/2013/01/17187939/impact-health-insurance-schemes-informal-sector-low--middle-income-countries-systematic-review http://hdl.handle.net/10986/12163

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Summary:	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.

The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries : A Systematic Review

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