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 compare reforms feature below to view comparable technical information across multiple programs at once. Select a reform element to the right, and filter the selection of countries and programs using the selection list.
| Program | Target population | Coverage | Population covered |
|---|---|---|---|
| Vietnam: Compulsory and Voluntary Health Insurance Schemes |
|
36.5 million |
It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance. Read full sectionIt is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance. When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates. Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI. Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement. Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval. Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance. Compulsory and Voluntary Health Insurance SchemesPopulation coveredAll populations 36.5 million It is the responsibility of the provinces to identify beneficiaries for the HCFP. While ethnic minorities and communes are fairly easy to identify because they are well documented, developing a list of the poor is more challenging. Local governments use already existing lists produced for other government programs in addition to household surveys. About 15 million additional persons, classified as poor, are now covered by the compulsory health insurance. When the SHI program initially began, only large employers were required to enroll their workers in the scheme. However, in 2005 the government expanded the mandate to companies of all sizes. Of Vietnam’s 7.7 million formal sector workers, 4.8 million (63%) are in the contributory scheme, but 2 million formal sector workers (26%) remain without coverage. Furthermore, SHI enrollment appears to be higher among the “better-off,” while middle-income groups currently have the lowest enrollment rates. Under the VHI, until the end of 2009, full-time students were typically enrolled en masse by insurance agents operating at schools and colleges. As of January 2010, full-time students are automatically enrolled as a part of the CHI. Family members/dependents of the compulsorily insured can enroll in the VSS scheme of their own accord. Others can enroll through group organizations, including communes. Prior to 2007, dependents were required to enroll all household members together and group organizations required a 20% minimum rate of participation. However, these stipulations have since been eliminated. Nonetheless, voluntary enrollment among the non-student population has stayed low with no signs of improvement. Enrollment in HCFP is a bit more complex. Provinces are tasked with identifying beneficiaries under the target groups. Identification has not been a challenge for at least two of the target groups, as communes and ethnic minority households are well documented. In the case of poor households, who have proved to be the most difficult group to identify, local governments begin by building upon lists of officially poor households produced for other government programs. Then commune officials conduct further household surveys to produce a proposed list of HCFP beneficiaries, which is then discussed and voted upon at a public meeting presided over by the village or commune leader. Officials from the district government’s labor and social affairs offices (MOLISA) then review the list, which can be revised before it is sent to the provincial department of labor and social affairs for final approval. Until recently, provinces were free to decide whether to enroll HCFP beneficiaries in the government’s SHI program, or to manage the risk themselves and provide direct reimbursement to providers. However, this latter option, which was initially the most popular with provinces, has since been phased out through a 2005 government directive updating Decision 139. According new Health Insurance Law, effective since July, 2009, the poor are included in the compulsory health insurance program. About 15 million additional persons, classified as poor, are now covered by compulsory health insurance. |
| Indonesia: Jamkesmas |
|
76.4 million |
Though the scheme has never been formally marketed, Jamkesmas has enrolled more beneficiaries than any other Indonesian health insurance plan. Its target population is defined using an annually administered national survey known as the SUSENAS according to daily household consumption estimates. Read full sectionThough the scheme has never been formally marketed, Jamkesmas has enrolled more beneficiaries than any other Indonesian health insurance plan. Its target population is defined using an annually administered national survey known as the SUSENAS according to daily household consumption estimates. SUSENAS is a social and economic household survey used to define total household consumption for GDP estimation purposes. Based on standard definitions of the poor in terms of daily household consumption, the total number of poor has been defined. The sub-national distribution of this total has also been defined in a similar manner. P.T. Askes remains the administrator of membership in the Jamkesmas program since it has operated the program since 2005. P.T. Askes has a contract with the MoH to administer the membership part of the program separate from other programs. P.T. Askes obtains a list of the number of persons eligible each year from the Central Bureau of Statistics which is a part of Bappenas (the national planning agency). P.T. Askes then distributes the cards and registers enrollees into the program. The Ministry of Home Affairs (MoHA) is responsible for the development of a national identity card to be distributed throughout the entire population. When this card has been distributed, it will become the basis for enrollment into the national health insurance program. Jamkesmas is not being formally marketed, as it has been oversubscribed since its inception in 2008. JamkesmasPopulation coveredBelow Poverty Line 76.4 million Though the scheme has never been formally marketed, Jamkesmas has enrolled more beneficiaries than any other Indonesian health insurance plan. Its target population is defined using an annually administered national survey known as the SUSENAS according to daily household consumption estimates. SUSENAS is a social and economic household survey used to define total household consumption for GDP estimation purposes. Based on standard definitions of the poor in terms of daily household consumption, the total number of poor has been defined. The sub-national distribution of this total has also been defined in a similar manner. P.T. Askes remains the administrator of membership in the Jamkesmas program since it has operated the program since 2005. P.T. Askes has a contract with the MoH to administer the membership part of the program separate from other programs. P.T. Askes obtains a list of the number of persons eligible each year from the Central Bureau of Statistics which is a part of Bappenas (the national planning agency). P.T. Askes then distributes the cards and registers enrollees into the program. The Ministry of Home Affairs (MoHA) is responsible for the development of a national identity card to be distributed throughout the entire population. When this card has been distributed, it will become the basis for enrollment into the national health insurance program. Jamkesmas is not being formally marketed, as it has been oversubscribed since its inception in 2008. |
| Mali: Mutuelles |
|
400,000 |
The Mutuelle system is still voluntary, and thus steps must be taken to bring about large-scale enrollment of the people. Thus, the “national strategy to extend health coverage through Mutuelles” contains solutions for the slow pace at which Mutuelles grew in the past, for the poor capacities of the players involved in promoting the Mutuelle movement, the management of Mutuelle movement organizations, and the lack of information and awareness about the Mutuelle movement on the national level. It was found that the principal actors were not enlisted sufficiently at the local level in the past. Health care workers, the ASACOs, and the territorial governments were only marginally involved in promoting the Mutuelle movement. By organizing Mutuelles at the commune level, the strategy seeks to have the mayors and local elected officials play an active role in mobilizing the population. Read full sectionThe Mutuelle system is still voluntary, and thus steps must be taken to bring about large-scale enrollment of the people. Thus, the “national strategy to extend health coverage through Mutuelles” contains solutions for the slow pace at which Mutuelles grew in the past, for the poor capacities of the players involved in promoting the Mutuelle movement, the management of Mutuelle movement organizations, and the lack of information and awareness about the Mutuelle movement on the national level. It was found that the principal actors were not enlisted sufficiently at the local level in the past. Health care workers, the ASACOs, and the territorial governments were only marginally involved in promoting the Mutuelle movement. By organizing Mutuelles at the commune level, the strategy seeks to have the mayors and local elected officials play an active role in mobilizing the population. The main challenge in promoting the Mutuelle movement for large-scale enrollment thus continues to be implementing a major information and awareness campaign for Mutuelles at the national scale. This is part of the national strategy and advocacy activities that also include local and national leaders . Since the AMO is mandatory, beneficiaries are enrolled automatically by withdrawing dues from their wages. Benefit eligibility begins on May 1, 2011 for those who have paid dues for six months. With regard to identifying the indigent for RAMED, the social services in each commune routinely conduct a social survey to assess the situation after interested parties submit an application. The social services or other persons may also prepare an application on behalf of someone else who has not taken the initiative to do so for several reasons. Based on the social survey, the communal authorities issue an indigent card that serves as physical evidence to enroll the member and to obtain the card from the National Medical Assistance Agency (ANAM – the management agency for RAMED) and to obtain care (including the beneficiaries whose applications are submitted to ANAM staff). The status of indigence is always considered temporary, so that the insured member’s card is annual. MutuellesPopulation coveredInformal Sector 400,000 The Mutuelle system is still voluntary, and thus steps must be taken to bring about large-scale enrollment of the people. Thus, the “national strategy to extend health coverage through Mutuelles” contains solutions for the slow pace at which Mutuelles grew in the past, for the poor capacities of the players involved in promoting the Mutuelle movement, the management of Mutuelle movement organizations, and the lack of information and awareness about the Mutuelle movement on the national level. It was found that the principal actors were not enlisted sufficiently at the local level in the past. Health care workers, the ASACOs, and the territorial governments were only marginally involved in promoting the Mutuelle movement. By organizing Mutuelles at the commune level, the strategy seeks to have the mayors and local elected officials play an active role in mobilizing the population. The main challenge in promoting the Mutuelle movement for large-scale enrollment thus continues to be implementing a major information and awareness campaign for Mutuelles at the national scale. This is part of the national strategy and advocacy activities that also include local and national leaders . Since the AMO is mandatory, beneficiaries are enrolled automatically by withdrawing dues from their wages. Benefit eligibility begins on May 1, 2011 for those who have paid dues for six months. With regard to identifying the indigent for RAMED, the social services in each commune routinely conduct a social survey to assess the situation after interested parties submit an application. The social services or other persons may also prepare an application on behalf of someone else who has not taken the initiative to do so for several reasons. Based on the social survey, the communal authorities issue an indigent card that serves as physical evidence to enroll the member and to obtain the card from the National Medical Assistance Agency (ANAM – the management agency for RAMED) and to obtain care (including the beneficiaries whose applications are submitted to ANAM staff). The status of indigence is always considered temporary, so that the insured member’s card is annual. |
| Nigeria: National Health Insurance System |
|
5 million |
Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees. Read full sectionHealth insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees. In the Informal Sector Program, the self-employed and individuals living in rural communities enroll themselves. The self-employed must join with at least 500 other members who are occupation based (ie: taxi drivers) to qualify. Rural dwellers have a similar modus operandi, but participants need to belong to the same community rather than the same occupational group. These Social Health Insurance Schemes are self-governed, with elections held to determine who will represent the community. In order to stay enrolled, members are expected to make a monthly contribution actuarially determined based on the benefits package of their choice. Participants requiring specialist or longer treatment would need to pay for the balance from what they are entitled from the common pool. These schemes are expected to cover more than 60% of the rural and self-employed population, though due to poor data collection, the exact population enrolled is difficult to determine. The enrollment levels in private insurance is uncertain, but based on submissions from private insurers to NHIS, less than 1 million people are privately insured. The NHIS utilizes 61 Health Maintenance Organizations (HMOs) as health managers for paying healthcare providers, quality assurance, and registration of enrollees and sensitization of participants as part of improving transparency of the system. HMOs contract with the NHIS to manage the enrollment of individuals in health insurance schemes; to collect their payments; pay the healthcare providers; and to provide basic quality management of the health insurance scheme that covers formal employees. National Health Insurance SystemPopulation coveredAll populations 5 million Health insurance is obtained either through private insurers or the National Health Insurance Scheme (NHIS). About 5 million people are enrolled in the 3 NHIS Programs, which represents just about 3% of the population. In the Formal Sector Program, employees in the formal sector who pay premiums are covered, in addition to their spouse and up to 4 dependants. Companies that employ more than 10 workers are responsible for enrollment of their employees. In the Informal Sector Program, the self-employed and individuals living in rural communities enroll themselves. The self-employed must join with at least 500 other members who are occupation based (ie: taxi drivers) to qualify. Rural dwellers have a similar modus operandi, but participants need to belong to the same community rather than the same occupational group. These Social Health Insurance Schemes are self-governed, with elections held to determine who will represent the community. In order to stay enrolled, members are expected to make a monthly contribution actuarially determined based on the benefits package of their choice. Participants requiring specialist or longer treatment would need to pay for the balance from what they are entitled from the common pool. These schemes are expected to cover more than 60% of the rural and self-employed population, though due to poor data collection, the exact population enrolled is difficult to determine. The enrollment levels in private insurance is uncertain, but based on submissions from private insurers to NHIS, less than 1 million people are privately insured. The NHIS utilizes 61 Health Maintenance Organizations (HMOs) as health managers for paying healthcare providers, quality assurance, and registration of enrollees and sensitization of participants as part of improving transparency of the system. HMOs contract with the NHIS to manage the enrollment of individuals in health insurance schemes; to collect their payments; pay the healthcare providers; and to provide basic quality management of the health insurance scheme that covers formal employees. |