Informal sector health insurance

Impact of health insurance for the informal sector in developing countries: a systematic review

October 26, 2011

Speaker: Dr. Arnab Acharya, LSHTM

The paper by Dr. Arnab Acharya summarises the literature on the impact of subsidised 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 provided estimations of average treatment on the treated effect for those insured; we summarise those papers that corrected for the problem of self-selection into insurance and a few that estimated the average intention to treat effect. We find the uptake of the insurance schemes in many cases to be less than expected and inconclusive evidence on impact on utilisation, protection from financial risk and health status. However, once taken up, a few insurance schemes afford significant protection from incurring high level of out-of-pocket expenditure. Protection for the poorest is lower from many of the schemes. More information is needed to understand the reasons for low enrolment and why the insured poor do not seem to have consistently lower out-of-pocket expenditure than those who are uninsured. Summarising the literature was difficult due to the lack of (i) uniformity in use of meaningful definitions of outcomes that indicate welfare improvements and (ii) clarity in how selection issues were taken into account.

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