The Impact of Health Insurance in Low- and Middle-income Countries

Over the past twenty years, many low- and middle- income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populations --and if so, how to do it --or to serve them through other means. Using recent household data, this new book assesses the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. These nations are betting that insurance-based health care financing can increase the accessibility of services, improve providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. The contributors also discuss potential design improvements that could increase impact. They provide insights on how to evaluate health insurance reforms using existing data and contribute to a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Maria-Luisa Escobar is lead health economist and health systems program leader at the World Bank Institute. Charles C. Griffin is senior adviser in the European and Central Asia regional office of the World Bank. R. Paul Shaw, a former World Bank lead economist, advises the Bill and Melinda Gates Foundation on health economics.