Study on the Role of Financial Risk Pooling of Different Health Security Mechanisms in Low and Middle Income Counties_Chinese Journal of Evidence-Based Medicine

Authors：

 YU Baorong ¹ , GAO Jing ¹ , GONG Xifei ¹ , CHU Jinhua ¹ , GAO Jun ² , YAN Yun ¹ , GUO Li ¹ , MENG Qingyue ¹

1.Center for Health Management and Policy, Shandong University, Jinan 250012, China;2.Center for Health Statistics and Information, Ministry of Health, Beijing 100044, China;

Corresponding author：

YU Baorong, Email: bryu@sdu.edu.cn

Keywords：

Health security mechanism; Financial risk from illness; Low-and-middle income countries; Systematic review

DOI：

10.7507/1672-2531.20080187

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives 　Through a systematic review, to summarize and describe various health security mechanisms of protecting financial risk from illness in low and middle income countries (LMICs), and to analyze causes that lead to different effects in financial risk protecting.
Methods 　Search words were chosen by both health policy experts and search coordinators after discussion and pilot. Twenty-four electronic databases, websites of 11 health institutions, and the search engine Google were searched. Any original study to evaluate the role of financial protection of health security mechanism in LMICs was included. Pre-designed data extraction form was used for collecting strategies and study method of included studies, and extracted information was analyzed and described.
Results 　Fifty-two studies were included, and 56 specific health security mechanisms were categorized into 6: community-based health insurance, social health insurance, health sector reform, subsidy, user fee, and new rural cooperative medical scheme (NRCMS) in China. Forty-two mechanisms had positive effect in financial protection, 6 were negative, 5 had no effect and the effect of the other 2 was unclear.
Conclusion 　 Mechanisms that produced positive effect can be summarized as: setting up of co-payment rate, design of benefit packages, providing free care for vulnerable population, delivering primary health care directly in remote area, and Chinese NRCMS. Mechanisms to protect the poor from financial risk of illness include: government provides health insurance, providing free care and setting up different co-payment rate according to income. The failure of health security mechanisms can be ascribed the deviation from its original goal of health security mechanism design, due to various inner or external causes.

Citation： YU Baorong,GAO Jing,GONG Xifei,CHU Jinhua,GAO Jun,YAN Yun,GUO Li,MENG Qingyue. Study on the Role of Financial Risk Pooling of Different Health Security Mechanisms in Low and Middle Income Counties. Chinese Journal of Evidence-Based Medicine, 2008, 08(10): 833-841. doi: 10.7507/1672-2531.20080187 Copy

1.	ILO. Extending social protection in health through communitybased health organizations evidence and challenges. DiscussionPaper 2002. Access from: www.ilo.org/publns.
2.	Lagarde M. Evidence from systematic reviews to inform decisionmaking regarding financing mechanism that improve access tohealth services for poor people.
3.	Ekman B. Community-based health insurance in low-incomecountries: a systematic review of the evidence. Health Policy Plan, 2004, 19 (5): 249-270.
4.	WHO Regional Office for South-East Asia. Social Health Insurance.
5.	Wagstaff A, Lindelow M. Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China. The World Bank USA, 2005.
6.	Zhu L. Effects of Rural Medical Financial Assistance in China. China & World Economy, 2007, 15(2): 16-28.
7.	王桂林, 孟庆跃, 成刚, 等. 沈阳市和成都市贫困医疗救助项目实施效果评价. 中国卫生经济, 2005, 24(10): 74-75.
8.	Sun XY, Jackson S, Carmichael G, et al. Catastrophic Paymentand Health Protection in Rural China-Impact of New CooperativeMedical Scheme in Shandong Province. Discussion Paper No.344, 2007.
9.	Jackson S, Sleigh AC, Peng L, et al. Low Premium Insurance Compared to the Out-of-Pocket System.
10.	徐润龙, 叶真, 曾国经, 等. 浙江省三县新型农村合作医疗方案对解决“因病致贫”问题的作用评价. 中国卫生经济, 2006, 25(278).
11.	朱伟明. 宝山区新型农村合作医疗筹资、运行机制研究. 中国农村卫生事业管理, 2005, 25(9): 8-10.
12.	常文虎, 赵劲红, 邹声金, 等. 大病医疗统筹对农民灾难性卫生支出作用的案例研究. 中国初级卫生保健, 2005, 228(2): 2-6.
13.	张继伟, 杨永萌, 张红丽, 等. 黑龙江省新型农村合作医疗试点县补偿方式调查研究. 中国卫生经济, 2005, 24(4): 56-59.
14.	钟邃, 周晓媛, 曹念东, 等. 成都市新型农村合作医疗家庭账户效果分析. 现代预防医学, 2006, 33(1): 18-20.
15.	王承利, 郭泅梅. 平阴县玫瑰镇实行新型农村合作医疗情况分析.社区医学, 2006, 4(1): 3.
16.	贾晓蓉, 陈兴宝, 张文忠, 等. 上海市郊区新型农村合作医疗防止因病致贫能力研究. 卫生经济研究, 2006, (1): 34-35.
17.	胡善联. 全国新型农村合作医疗制度的筹资运行状况. 中国卫生经济, 2004, 23(9): 24-25.
18.	魏晶晶, 吕柏, 斯日尔格楞, 等. 新疆地区6个试点县合作医疗筹资水平及补偿方案分析. 中国卫生事业管理, 2006, 6: 367-368.
19.	陈迎春, 徐锡武, 王蓉, 等. 新型农村合作医疗减缓“因病致贫”效果测量. 中国卫生经济, 2005, 24(8): 26-28.
20.	颜媛媛, 张林秀, 罗斯高, 等. 新型农村合作医疗的实施效果分析——来自中国5省101个村的实证研究. 中国农村经济, 2006,(5): 64-71.
21.	崔欣, 罗力, 李春芳, 等. 新型农村合作医疗降低就医经济风险的作用. 中国卫生资源, 2005, 8(6): 253-255.
22.	Devadasan N, Criel B, Van Damme W, et al. Indian communityhealth insurance schemes provide partial protection againstcatastrophic health expenditure. BMC Health Services Research, 2007.
23.	Ranson MK. The SEWA Medical Insurance Fund in India. HealthFinancing for Poor People, 2004, 275-292.
24.	Ranson MK. Reduction of catastrophic health care expendituresby a community-based health insurance scheme in Gujarat, India:current experiences and challenges. Bulletin of the World HealthOrganization, 2002, 80(8): 613-621.
25.	Gumber A. Hedging the health of the poor: the case for communityfinancing in India. The International Bank for Reconstruction andDevelopment/ The World Bank, 2001.
26.	Gumber A. The Potential Role of Community Financing in India.The world bank, 2004.
27.	Ranson MK. The impact of sewa’s medical insurance fundon hospital utilization and expenditure health. Nutrition andPopulation Discussion Paper, 2001.
28.	Wagstaffa A. Health Insurance for the Poor: Initial Impacts ofVietnam’s Health Care Fund for the Poor. World Bank PolicyResearch Working Paper, 2007.
29.	Wagstaff A, Pradhan M. Health Insurance Impacts on Health and Nonmedical Consumption in a Developing Country. World BankPolicy Research Working Paper, 2005.
30.	Sepehri A, Sarma S, Simpson W. Does non-profit health insurancereduce financial burden? Evidence from the Vietnam Living Standards Survey panel. Paper to be presented at the 38th Annual Meetings of the CEA at Ryerson University Toronto, 2004.
31.	Castano RA, Arbelaez JJ, Giedion UB, et al. Equitable financing, outof-pocket payments and the role of health care reform in Colombia. Health Policy and Planning, 2002, 17(1): 5-11.
32.	Ruiz F, Amaya L, Venegas S. Progressive segmented healthinsurance: Colombian health reform and access to health services. Health Econmy, 2007, 16: 3-18.
33.	Castaco R, Zambrano A. Financial protection for the poor in Colombia: the effects of a subsidized health insurance scheme. Economa No 12, 2007.
34.	Koren R, Steinberg DM. The impact of filipino micro health insurance units on income-related equality of access to healthcare. Health Policy, 2006, 77: 304-317.
35.	Gertler P, Solon O. Who Benefits From Social Health Insurance? Evidence from the Philippines, 2002.
36.	Gotsadzea G, Zoidze A, Vasadze O. Reform strategies in Georgia andtheir impact on health care provision in rural areas: evidence from ahousehold survey. Social Science & Medicine, 2005, 60: 809-821.
37.	Gotsadze G, Bennett S, Ranson K, et al. Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia. HealthPolicy Plan, 2005, 20(4): 232-242.
38.	Derriennic Y, Wolf K, Kiwanuka-Mukiibi P. An Assessment of Community-Based Health Financing Activities in Uganda. The Partners for Health Reformplus Project (PHRplus), 2005.
39.	Xu K, Evans DB, Kadama P, et al. Understanding the impactof eliminating user fees: utilization and catastrophic healthexpenditures in Uganda. Soc Sci Med, 2006, 62(4):866-876.
40.	Schneider P, Diop F. Community-Based Health Insurance inRwanda. The world bank, 2004.
41.	Schneider P, Diop F. Synopsis of Results on the Impact of Community-Based Health Insurance on Financial Accessibility to Health Care in Rwanda. Discussion Paper, Health, Nutrition andPopulation (HNP), 2001.
42.	Jütting JP. Financial Protection and Access to Health Care in Rural Areas of Senegal. Health Financing for Poor People--ResourceMobilization and Risk Sharing, 2004, chapter6: 232-247.
43.	Asfaw A, Jütting JP. The Role of Health Insurance in Poverty Reduction: Empirical Evidence From Senegal. Intl Journal of PublicAdministration, 2007, (30): 835-858.
44.	Jacobs B, Price N. Improving access for the poorest to public sector health services: insights from Kirivong Operational Health Districtin Cambodia. Health Policy Plan, 2006, 21(1): 27-39.
45.	Jacobs B, Price N. The impact of the introduction of user fees at a district hospital in Cambodia. Health Policy Plan, 2004, 19(5):310-321.
46.	Baschieri A, Falkingham J. Formalizing informal payments: the progress of health reform in Kyrgyzstan. Central Asian Survey, 2006,25(4): 441-460.
47.	Falkingham J. Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan. Social Science & Medicine, 2004, 58:247-258.
48.	Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. HealthPolicy, 2007, (83): 304-313.
49.	Diop F, Yazbeck A, Bitrán R. The impact of alternative cost recovery schemes on access and equity in Niger. Health Policy Plan, 1995, 10(3): 223-240.
50.	Moens F. Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: a prepaidhealth plan in the Bwamanda health zone, Zaire. Soc Sci Med, 1990, 30(12): 1319-1327.
51.	Anonymous. Health Care Utilization, Expenditures, and Insurance: Household Survey Findings from Suez Governorate, Egypt. Partnersfor Health Reformplus (PHRplus), 2005.
52.	Sulzbach S, Garshong B, Owusu-Banahene G. Evaluating the Effects of the National Health Insurance Act in Ghana. Baseline Report. Partners for Health Reformplus, 2005.
53.	Huber JH. Ensuring access to health care with the introduction of user fees: a Kenyan example. Health Economics Research, 1993, 36(4):485-494.
54.	Msuya JM, Jütting JP, Asfaw A. Impacts of Community Health Insurance Schemes on Health Care Provision in Rural Tanzania. Zentrum für Entwicklungsforschung Center for DevelopmentResearch, 2004.
55.	Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, et al. Evidence is good for your health system: policy reform to remedy catastrophicand impoverishing health spending in Mexico. Lancet, 2006, 368(9549): 1828-1841.
56.	Habichi J, Xu K, Couffinhal A, et al. Detecting changes in financial protection: creating evidence for policy in Estonia. Health Policy andPlanning, 2006, 21(6): 421-431.

1. ILO. Extending social protection in health through communitybased health organizations evidence and challenges. DiscussionPaper 2002. Access from: www.ilo.org/publns.
2. Lagarde M. Evidence from systematic reviews to inform decisionmaking regarding financing mechanism that improve access tohealth services for poor people.
3. Ekman B. Community-based health insurance in low-incomecountries: a systematic review of the evidence. Health Policy Plan, 2004, 19 (5): 249-270.
4. WHO Regional Office for South-East Asia. Social Health Insurance.
5. Wagstaff A, Lindelow M. Can Insurance Increase Financial Risk? The Curious Case of Health Insurance in China. The World Bank USA, 2005.
6. Zhu L. Effects of Rural Medical Financial Assistance in China. China & World Economy, 2007, 15(2): 16-28.
7. 王桂林, 孟庆跃, 成刚, 等. 沈阳市和成都市贫困医疗救助项目实施效果评价. 中国卫生经济, 2005, 24(10): 74-75.
8. Sun XY, Jackson S, Carmichael G, et al. Catastrophic Paymentand Health Protection in Rural China-Impact of New CooperativeMedical Scheme in Shandong Province. Discussion Paper No.344, 2007.
9. Jackson S, Sleigh AC, Peng L, et al. Low Premium Insurance Compared to the Out-of-Pocket System.
10. 徐润龙, 叶真, 曾国经, 等. 浙江省三县新型农村合作医疗方案对解决“因病致贫”问题的作用评价. 中国卫生经济, 2006, 25(278).
11. 朱伟明. 宝山区新型农村合作医疗筹资、运行机制研究. 中国农村卫生事业管理, 2005, 25(9): 8-10.
12. 常文虎, 赵劲红, 邹声金, 等. 大病医疗统筹对农民灾难性卫生支出作用的案例研究. 中国初级卫生保健, 2005, 228(2): 2-6.
13. 张继伟, 杨永萌, 张红丽, 等. 黑龙江省新型农村合作医疗试点县补偿方式调查研究. 中国卫生经济, 2005, 24(4): 56-59.
14. 钟邃, 周晓媛, 曹念东, 等. 成都市新型农村合作医疗家庭账户效果分析. 现代预防医学, 2006, 33(1): 18-20.
15. 王承利, 郭泅梅. 平阴县玫瑰镇实行新型农村合作医疗情况分析.社区医学, 2006, 4(1): 3.
16. 贾晓蓉, 陈兴宝, 张文忠, 等. 上海市郊区新型农村合作医疗防止因病致贫能力研究. 卫生经济研究, 2006, (1): 34-35.
17. 胡善联. 全国新型农村合作医疗制度的筹资运行状况. 中国卫生经济, 2004, 23(9): 24-25.
18. 魏晶晶, 吕柏, 斯日尔格楞, 等. 新疆地区6个试点县合作医疗筹资水平及补偿方案分析. 中国卫生事业管理, 2006, 6: 367-368.
19. 陈迎春, 徐锡武, 王蓉, 等. 新型农村合作医疗减缓“因病致贫”效果测量. 中国卫生经济, 2005, 24(8): 26-28.
20. 颜媛媛, 张林秀, 罗斯高, 等. 新型农村合作医疗的实施效果分析——来自中国5省101个村的实证研究. 中国农村经济, 2006,(5): 64-71.
21. 崔欣, 罗力, 李春芳, 等. 新型农村合作医疗降低就医经济风险的作用. 中国卫生资源, 2005, 8(6): 253-255.
22. Devadasan N, Criel B, Van Damme W, et al. Indian communityhealth insurance schemes provide partial protection againstcatastrophic health expenditure. BMC Health Services Research, 2007.
23. Ranson MK. The SEWA Medical Insurance Fund in India. HealthFinancing for Poor People, 2004, 275-292.
24. Ranson MK. Reduction of catastrophic health care expendituresby a community-based health insurance scheme in Gujarat, India:current experiences and challenges. Bulletin of the World HealthOrganization, 2002, 80(8): 613-621.
25. Gumber A. Hedging the health of the poor: the case for communityfinancing in India. The International Bank for Reconstruction andDevelopment/ The World Bank, 2001.
26. Gumber A. The Potential Role of Community Financing in India.The world bank, 2004.
27. Ranson MK. The impact of sewa’s medical insurance fundon hospital utilization and expenditure health. Nutrition andPopulation Discussion Paper, 2001.
28. Wagstaffa A. Health Insurance for the Poor: Initial Impacts ofVietnam’s Health Care Fund for the Poor. World Bank PolicyResearch Working Paper, 2007.
29. Wagstaff A, Pradhan M. Health Insurance Impacts on Health and Nonmedical Consumption in a Developing Country. World BankPolicy Research Working Paper, 2005.
30. Sepehri A, Sarma S, Simpson W. Does non-profit health insurancereduce financial burden? Evidence from the Vietnam Living Standards Survey panel. Paper to be presented at the 38th Annual Meetings of the CEA at Ryerson University Toronto, 2004.
31. Castano RA, Arbelaez JJ, Giedion UB, et al. Equitable financing, outof-pocket payments and the role of health care reform in Colombia. Health Policy and Planning, 2002, 17(1): 5-11.
32. Ruiz F, Amaya L, Venegas S. Progressive segmented healthinsurance: Colombian health reform and access to health services. Health Econmy, 2007, 16: 3-18.
33. Castaco R, Zambrano A. Financial protection for the poor in Colombia: the effects of a subsidized health insurance scheme. Economa No 12, 2007.
34. Koren R, Steinberg DM. The impact of filipino micro health insurance units on income-related equality of access to healthcare. Health Policy, 2006, 77: 304-317.
35. Gertler P, Solon O. Who Benefits From Social Health Insurance? Evidence from the Philippines, 2002.
36. Gotsadzea G, Zoidze A, Vasadze O. Reform strategies in Georgia andtheir impact on health care provision in rural areas: evidence from ahousehold survey. Social Science & Medicine, 2005, 60: 809-821.
37. Gotsadze G, Bennett S, Ranson K, et al. Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia. HealthPolicy Plan, 2005, 20(4): 232-242.
38. Derriennic Y, Wolf K, Kiwanuka-Mukiibi P. An Assessment of Community-Based Health Financing Activities in Uganda. The Partners for Health Reformplus Project (PHRplus), 2005.
39. Xu K, Evans DB, Kadama P, et al. Understanding the impactof eliminating user fees: utilization and catastrophic healthexpenditures in Uganda. Soc Sci Med, 2006, 62(4):866-876.
40. Schneider P, Diop F. Community-Based Health Insurance inRwanda. The world bank, 2004.
41. Schneider P, Diop F. Synopsis of Results on the Impact of Community-Based Health Insurance on Financial Accessibility to Health Care in Rwanda. Discussion Paper, Health, Nutrition andPopulation (HNP), 2001.
42. Jütting JP. Financial Protection and Access to Health Care in Rural Areas of Senegal. Health Financing for Poor People--ResourceMobilization and Risk Sharing, 2004, chapter6: 232-247.
43. Asfaw A, Jütting JP. The Role of Health Insurance in Poverty Reduction: Empirical Evidence From Senegal. Intl Journal of PublicAdministration, 2007, (30): 835-858.
44. Jacobs B, Price N. Improving access for the poorest to public sector health services: insights from Kirivong Operational Health Districtin Cambodia. Health Policy Plan, 2006, 21(1): 27-39.
45. Jacobs B, Price N. The impact of the introduction of user fees at a district hospital in Cambodia. Health Policy Plan, 2004, 19(5):310-321.
46. Baschieri A, Falkingham J. Formalizing informal payments: the progress of health reform in Kyrgyzstan. Central Asian Survey, 2006,25(4): 441-460.
47. Falkingham J. Poverty, out-of-pocket payments and access to health care: evidence from Tajikistan. Social Science & Medicine, 2004, 58:247-258.
48. Ekman B. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. HealthPolicy, 2007, (83): 304-313.
49. Diop F, Yazbeck A, Bitrán R. The impact of alternative cost recovery schemes on access and equity in Niger. Health Policy Plan, 1995, 10(3): 223-240.
50. Moens F. Design, implementation, and evaluation of a community financing scheme for hospital care in developing countries: a prepaidhealth plan in the Bwamanda health zone, Zaire. Soc Sci Med, 1990, 30(12): 1319-1327.
51. Anonymous. Health Care Utilization, Expenditures, and Insurance: Household Survey Findings from Suez Governorate, Egypt. Partnersfor Health Reformplus (PHRplus), 2005.
52. Sulzbach S, Garshong B, Owusu-Banahene G. Evaluating the Effects of the National Health Insurance Act in Ghana. Baseline Report. Partners for Health Reformplus, 2005.
53. Huber JH. Ensuring access to health care with the introduction of user fees: a Kenyan example. Health Economics Research, 1993, 36(4):485-494.
54. Msuya JM, Jütting JP, Asfaw A. Impacts of Community Health Insurance Schemes on Health Care Provision in Rural Tanzania. Zentrum für Entwicklungsforschung Center for DevelopmentResearch, 2004.
55. Knaul FM, Arreola-Ornelas H, Méndez-Carniado O, et al. Evidence is good for your health system: policy reform to remedy catastrophicand impoverishing health spending in Mexico. Lancet, 2006, 368(9549): 1828-1841.
56. Habichi J, Xu K, Couffinhal A, et al. Detecting changes in financial protection: creating evidence for policy in Estonia. Health Policy andPlanning, 2006, 21(6): 421-431.

Previous Article
Establishment of CNCAM:Lessons Learned from the PedCAM Network
Next Article
Clinical Value of Serum Tumor Markers in Monitoring Patients with Recrudescent and Metastatic Breast Cancer

Chinese Journal of Evidence-Based Medicine

Study on the Role of Financial Risk Pooling of Different Health Security Mechanisms in Low and Middle Income Counties

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content