Table 3 Overview of health financing systems in case study countries

Costa Rica

• Tax funds pooled with mandatory insurance contributions in the Caja Costarricense de Seguro Social (CCSS), which was established in 1941

• CCSS purchases primary and hospital care for the entire population, irrespective of whether they make contributions to CCSS or not

• CCSS population coverage reached 88% in early 2000’s

Georgia

• General government revenue finances the Medical Insurance for the Poor (MIP) program

• Private Insurance Companies (PICs), contracted by the government, purchase health services for MIP members

• A proxy means-tested system is used to identify MIP beneficiaries (i.e., poor households)

• The MIP benefit package includes: (1) emergency care and planned in-patient services; (2) chemotherapy and radiation therapy; (3) outpatient visits and limited diagnostic and laboratory tests; (4) compensation for delivery costs; and (5) outpatient prescription drugs

• Of the Georgian population, 20.5% are covered by MIP, 3.6% by civil servant insurance, 6.5% by other insurance (mainly private, voluntary), and 69.4% are not covered by insurance

India

• Under the Rashtriya Swasthya Bima Yojana (RSBY), households on the national ‘Below Poverty Line’ list can join the insurance scheme for a premium that is heavily subsidised by the government (individuals pay $0.6 per family per year)

• Insurance companies purchase inpatient care for RSBY members from hospitals. State nodal agencies oversee insurance companies

• The RSBY package covers inpatient care up to $600 per family per year

• RSBY covers 30 million people (about 55% of those below the poverty line)

• Hospitals are paid on a diagnosis-related group (DRG) basis

Malawi

• The health system in Malawi is mainly financed by government tax revenue and high levels of donor funding

• Purchasing mainly undertaken through Ministry of Health (MoH)-established SLAs with the CHAM facilities at the district level

• Government tax funding subsidises Christian Health Association of Malawi (CHAM) facilities as specified in Service Level Agreement (SLA) contracts

• MoH pays CHAM clinical staff salaries and provides medicines and other supplies

• SLAs aim to deliver free health care to the most vulnerable and under-served population through CHAM facilities

Nigeria

• 4% of the population, mainly federal government employees and their families, are covered by mandatory insurance through the National Health Insurance Scheme (NHIS) introduced in 2005. Although expansion of the scheme to state government employees was intended, only 3 states have done so

• Purchasing mainly through NHIS allocation of funds to Health Maintenance Organisations (HMOs) for the purchase of services from public and private providers for those covered by the NHIS

• NHIS is financed by contributions from employees (5% of basic salary) and employers (10% of employees’ basic salary)

• Payment made by capitation for primary care services and fee-for-service for other levels of care (referral care must be pre-approved by HMOs)

• The NHI benefit package includes: out-patient care, prescriptions and diagnostic tests, maternity care, preventive medical and dental care, specialist consultation, in-patient care, eye examination and care, access to prostheses

Tanzania

• The National Health Insurance Fund (NHIF) was established in 1999 to cover civil servants and their dependents (about 5% of the population)

• CHF purchase health services on behalf of members

• The Social Health Insurance Benefit (SHIB) of the National Social Security Fund (NSSF), established in 2005, covers mainly private sector employees (about 1% of the population)

• Benefit packages vary between CHFs, but usually only cover primary care outpatient services

• The Community Health Fund (CHF), rolled out nationally in 2001, focuses on those outside the formal sector in rural areas and a similar scheme called TIKA for the informal sector in urban areas (covers about 5% of the population)

• The NHIF and SHIB-NSSF purchase relatively comprehensive services from accredited public and private providers

• The remainder of the population pay user fees when using a health service

• CHF is funded by member contributions. Matching funds, provided by Ministry of Health and Social Welfare, provides subsidies. Co-payment for the utilization of health services is required

Thailand

• Three mandatory insurance schemes operate: the Civil Servant Medical Benefit Scheme (CSMBS) established in 1978; Social Security Scheme (SSS) for public and private sector employees; and the Universal Coverage Scheme (UCS), which covers the rest of the population (approximately 30%), established in 2002

• UCS purchases services from registered contractor providers, most commonly the district health system

• The benefit package is relatively comprehensive

• The UCS is funded by general Government tax revenue

• Providers are paid by capitation for outpatients; and global budget and DRG for inpatients

• The UCS initially had a 30 Baht co-payment, but this was removed in 2007

• The CSMBS and SSS similarly purchase comprehensive services for their members