The Joint Learning Network systematically documents the reforms of its member countries and other countries that have expanded health coverage through demand-side financing. The case studies contained in these pages are brief, comparative and modular in nature, describing the key highlights and technical features of each program.
Use the reforms browser below to filter programs by design feature, and click on a program for the full case study. Use the compare reforms feature to view comparable information across multiple programs at once.
| Name | Year Launched | |
|---|---|---|
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Vietnam: Compulsory and Voluntary Health Insurance Schemes The Health Care Fund for the Poor (HCFP) was created in 2003 to provide care for the poor, ethnic minorities, and the disadvantaged. Initially implemented as a separate social program, HCFP was rolled into the national compulsory health insurance (CHI) scheme in July of 2009 as a result of a new National Health Insurance Law. The current national health insurance system consists of two parts, compulsory health insurance (CHI) and voluntary health insurance (VHI). CHI formally... |
2003 |
 |
Estonia: Estonian Health Insurance Fund The Estonian health system has come to be based on regulation and contractual relationships rather than subordinate relationships. Starting in 1991, the health system began a complete transformation. This year, the Health Insurance Act was passed and was shortly thereafter followed by the Health Services Organization Act in 1994. These two acts set out the legal framework for all subsequent reforms. First, the health financing system was transformed from a centralized, state-run system to a... |
2001 |
 |
Colombia: General System of Social Security in Health Law 100 of 1993 established the guidelines for the reform of the social security system in Colombia. The first change involved unifying the existing social security, public, and private financing institutions under the umbrella of the General System of Social Security in Health (SGSSS). The reform aimed to create quality-centered competition among service providers and insurers by (1) allowing insurers to negotiate service rates with both public and private providers, and by (2) allowing... |
1993 |
 |
Indonesia: Jamkesmas Indonesia introduced the first phase of its plan to achieve universal health coverage through a mandatory public health insurance scheme, Askeskin, in 2004. In 2008, Askeskin evolved into Jaminan Kesehatan Masyarakat, or Jamkesmas, an MoH-run “insurance” program which now covers over 76.4 million poor Indonesians. Asuransi Kesehatan Masyarakat Miskin, or Askeskin, was targeted to the poor and increased access to care and financial protection for the poorest. It initially targeted the poorest... |
2004 |
 |
Kyrgyz Republic: Mandatory Health Insurance Fund (MHIF) The Kyrgyz health care reform program was encompassed in a 10 year systematic plan called the “Manas National Program on Health Care Reforms 1996-2006.” The Manas program represented the Kyrgyzstan political will for reform and enabled the technical and aid organizations that worked in the health sector during this time. A driver of the reforms was the process by which Kyrgyz health partners worked seamlessly with WHO, World Bank, and USAID. These donors/agencies worked to their comparative... |
1996 |
 |
Mali: Mutuelles The institutional reform in 2000 created the National Social Protection and Economic Solidarity Department, providing better supervisory capacity with the creation of a unit dedicated to strengthening stakeholder capacities for developing the Mutuelle system. These include the Association Support Center, Mutuelle and Cooperative Societies (CAMASC). In 2002, the government of Mali adopted a national social protection policy, followed in 2004 by a national action plan to extend social... |
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Rwanda: Mutuelles de Sante Mutuelles are highly decentralized, relying on existing community-based health structures at the district and local level to provide a majority of management and administration of services.In 2003 the Community-Based Health Insurance system (CBHI) was expanded from a pilot project to a national system. CBHI is comprised of three parts: Mutuelles de Sante; Military Medical Insurance; and Rwanda Health Insurance Scheme. The first, known as Mutuelles de Sante, is... |
2002 |
 |
Chile: National Health Fund (FONASA) Chile’s health system is composed of mandatory health insurance that can be either public or private. Public insurance is offered through a single non-profit provider, the National Health Fund (FONASA). Private insurance can be purchased from many for-profit or not-for-profit private health insurance institutions known as ISAPREs. All formal sector workers who are not self-employed, self-employed workers with a retirement fund, and all retirees with a pension must enroll with either the... |
1979 |
 |
Taiwan: National Health Insurance The current health care system in Taiwan is the National Health Insurance (NHI) system. NHI was submitted to Parliament by President Lee Teng-Hui. Under pressure from upcoming elections, President Lee promptly established the Bureau of National Health Insurance (BNHI) and began operations of NHI in 1995. NHI was created with three specific purposes: provide equal access to health care for all citizens; ensure quality and efficiency in health care delivery; and control health expenditures... |
1995 |
 |
Korea, Rep.: National Health Insurance Program In 2000 the Unified Health Insurance Act integrated all existing health insurance societies under the National Health Insurance Program (NHIP). NHIP requires compulsory health insurance for all Korean citizens, either in the “employed” category or the “self-employed” category. Funding for the Program comes from government subsidies, a tax on cigarettes, and contributions from the insured and employers. The insured pay monthly premiums that are proportional to their income. Contributions are... |
2001 |
 |
Ghana: National Health Insurance Scheme (NHIS) In 2004, Ghana embarked on a process of developing and implementing a National Health Insurance Scheme (NHIS) to replace out-of-pocket fees at point of service. The solution was a ‘hub-satellite’ model of a national fund and authority (the hub) that regulates and subsidizes a national network of community-based health insurance schemes (CBHIs) (the satellites). As the vast majority of Ghanaians work in the informal economy, it was recognized early on that a state sponsored statutory... |
2004 |
 |
Nigeria: National Health Insurance System Nigeria is one of the first countries with demand driven health insurance for groups, where people can enroll for basic health insurance by forming a self-governed group of professionals, such as mechanics.As a part of the effort to strengthen the national health system, a National Health Policy (NHP) was adopted in 2006. NHP seeks to establish a realistic health financing system that has the capability of meeting health system goals of improved health status... |
1999 |
 |
Kenya: National Hospital Insurance Fund (NHIF) The Health Insurance Act of 1998 makes no distinction between formal and informal sector, and indicates that membership shall be mandatory for all Kenyans at least 18 years of age. The National Hospital Insurance Fund (NHIF) is the primary provider of health insurance in Kenya with a mandate to enable all Kenyans to access quality and affordable health services. NHIF was restructured by the repeal of the National Hospital Insurance Act (CAP 255) and the... |
1966 |
 |
Philippines: PhilHealth The Philippine Health Corporation, or PhilHealth, was created in 1995 with the aim of placing a renewed emphasis on achieving universal coverage. In 2000 and 2005, additional reform efforts were outlined to make decentralization and health insurance reform work more effectively, including an expanded government subsidy for the enrollment of the poor, the creation of local health service delivery/planning units to reduce fragmentation, and a stronger DoH role in regulation. Since... |
2005 |
 |
India: Rajiv Aarogyasri The Aarogyasri scheme was developed to improve social protection for the poor and reduce the financial and emotional consequences of indebtedness due to illness. Aarogyasri is state-financed and targets individuals living below the poverty line in Andhra Pradesh. Beneficiaries have access to numerous modern medical facilities and are navigated through the health care system by Aarogya Mithras, or patient advocates, hired to oversee each in-network hospital. ... |
2007 |
 |
India: Rashtriya Swasthya Bima Yojna (RSBY) RSBY was launched to provide health coverage to all those living below the poverty line in India. Under the scheme, beneficiaries are entitled to hospitalization coverage of up to Rs. 30,000/- annually (approximately USD 700) for most diseases. Beneficiaries pay Rs. 30/- as a registration fee, while the central and state governments pay the premium to the insurer. The objectives of RSBY are to:
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2008 |
 |
Mexico: Seguro Popular The Seguro Popular (SP) insurance program began as a pilot in 2001 and became law in 2003 with the passage of the System of Social Protection in Health (SPSS) legislation. The reform aimed to shift the portion of the health system that functioned as a national health service toward an insurance based system. The structural reform was designed to provide financial protection by offering publicly provided health insurance to the nearly 50 million Mexicans (50% of the population) who did not... |
2003 |
 |
Brazil: Unified Health System (SUS) The 1988 constitution crystallized the movement toward democratization. One of the primary tenets of this new constitution was the de jure establishment of free, universal healthcare. Such a goal would be pursued through the Unified Health System (SUS), a newly established administrative body responsible for the stewardship of both the public and private health systems. The primary purpose of the SUS was to decentralize health policy down to the level of the state and municipality, with... |
1988 |
 |
Thailand: Universal Coverage Scheme With a great deal of popular support, the new Thai government passed the National Health Security Act in 2002. It has since become one of the most important social tools for health systems reform in Thailand. The new Universal Coverage Scheme (UCS), or “30 Baht Scheme”, combined the already existing Medical Welfare Scheme and the Voluntary Health Card Scheme to expand coverage to an additional 18 million people. Private health insurance organizations play no role in this reform, and... |
2001 |