DESK REVIEWS | 02.02.02.01. What proportion of the population is not covered by health insurance (private or public)?
DESK REVIEW | 02.02.02.01. What proportion of the population is not covered by health insurance (private or public)?
We could not find precise estimates about that. However, based on data from the National Regulatory Agency for Private Health Insurances and Plans (ANS – Agência Nacional de Saúde Suplementar), we estimated that by the end of 2018, around 77% of the population were not covered by private health insurance (National Regulatory Agency for Private Health Insurances and Plans, 2019b).
National Regulatory Agency for Private Health Insurances and Plans, M. (2019b). Caderno de Informação da Saúde Suplementar: Beneficiários, operadoras e planos. Março 2019. https://www.gov.br/ans/pt-br/arquivos/acesso-a-informacao/perfil-do-setor/dados-e-indicadores-do-setor/informacoes-gerais/total-cad-info-jun-2019.pdf
Health insurance is not mandatory in Hong Kong. Residents can choose to buy private health insurance based on their own needs. In 2016, 3.26 million people (47% of total population) were protected by private health insurance, comprising 1.48 million people with individual-based health insurance policies, 0.86 million people with group-based policies and 0.92 million people with both types of policies (The Legislative Council Secretariat, 2018). These health insurance claims are usually used for payments of specialist services and hospitalisation in the private sector since the patients can access healthcare services without waiting.
In April 2019, the Government officially launched the Voluntary Health Insurance Scheme (VHIS) that aims at encouraging the public to purchase health insurance in order to reduce the pressure on the public health system in the long run (Food and Health Bureau, 2019d). Hospital insurance products offered by various insurance companies which meet prescribed minimum standards, are certified under the VHIS. As an incentive for purchasing VHIS, an annual tax deduction up to HK$8,000 is provided per premium paid for certified insurance plans by each insured person and his/her dependants (The Legislative Council Secretariat, 2018). As of September 2019, the number of insurance policies purchased under VHIS exceeded 300 000.
Food and Health Bureau. (2019d). Voluntary Health Insurance Scheme. About VHIS. Retrieved from https://www.vhis.gov.hk/en/about_us/scheme.html
Legislative Council Secretariat. (2018). Research Brief Issue No. 2 2017 – 2018 – The 2018-2019 Budget. Hong Kong: Legislative Council, HKSAR Retrieved from https://www.legco.gov.hk/research-publications/english/1718rb02-the-2018-2019-budget-20180412-e.pdf.
Less than 20% of the population was covered by any form of health insurance in 2014, based on the National Sample Survey (71st round) of household data (National Sample Survey Office (NSSO), 2015). An estimate of the National Health Profile (Central Bureau of Health Intelligence (CBHI), 2019), states that about 48 crore individuals were covered by any health insurance in 2017-2018, which is about 37.2% of the population. A more recent National Family Health Survey (NFHS-5) 2019-2021, found that 41% of households with any usual member was covered under a health insurance/financing scheme. In principle, all citizens are eligible to receive health services in tax-financed public facilities (Gupta, 2020). In practice, there are major supply side constraints that limit access to public facilities, resulting in high out-of-pocket expenditures at private facilities by households (Gupta, 2020).
Central Bureau of Health Intelligence (CBHI). (2019). National Health Profile. Ministry of Health & Family Welfare, Government of India. Available from http://www.cbhidghs.nic.in/showfile.php?lid=1147
Gupta, I. (2020). India | Commonwealth Fund. Commonwealthfund.org. Retrieved from: https://www.commonwealthfund.org/international-health-policy-center/countries/india.
National Sample Survey Office (NSSO). (2015). Key Indicators of Social Consumption in India Health -NSS 71st Round. Ministry of Statistics and Programme Implementation, Government of India. Available from https://www.thehinducentre.com/resources/article7378862.ece
It is estimated that 16 per cent of the Indonesian population was not covered by health insurance in 2017. The NIHS covered 70 per cent of the population and approximately 14 per cent of the population were covered through private health insurance (Agustina et al., 2019, p.90).
Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7
75% of the population in Kenya is not covered under any health (insurance) and typically relies fully on out of pocket expenses (Kenya Healthcare Federation and Task Force Health Care, 2016). Those who are not insured tend to have lower education, live in rural and remote areas, unemployed and are more likely to be women (Kazungu and Barasa, 2017).
Kazungu, J. S., & Barasa, E. W. (2017). Examining levels, distribution and correlates of health insurance coverage in Kenya. Tropical Medicine & International Health, 22(9), 1175–1185. https://doi.org/10.1111/tmi.12912
Kenya Healthcare Federation and Task Force Health Care. (2016). Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector. Nairobi, Kenya. http://khf.co.ke/wp-content/uploads/2018/03/2016-Kenyan-Healthcare-Sector-Report.pdf
According to INEGI, 17.3% of total population in 2015 was not covered by health insurance (INEGI, 2015a). People who are not affiliated to any social security institution (IMSS, ISSSTE, etc.) or public insurance mechanism (Seguro Popular) by law could access MoH services. However, it is frequent that only in the case of acute problems (heart attack) or accidents they would access these and most likely solve minor issues within the private sector, such as consultations within pharmacies in the private sector or private sector physicians, which can be found in most places, but this doesn’t necessarily equal optimal and quality care.
INEGI. (2015a). Encuesta Intercensal 2015 Estados Unidos Mexicanos. Instituto Nacional de Estadística y Geografía, 1, 85–90.
As mentioned above, about 16% of the South African population is able to afford health insurance (Mahlathi & Dlamini, 2015), for which most part is concentrated in more urban areas (Competition Commission SA, 2018; StatsSA, 2016).
Competition Commission SA. (2018). Health market injuiry. Available from: http://www.compcom.co.za/wp-content/uploads/2018/07/Executive-Summary.pdf
Mahlathi, P., & Dlamini, J. (2015). MINIMUM DATA SETS FOR HUMAN RESOURCES FOR HEALTH AND THE SURGICAL WORKFORCE IN SOUTH AFRICA’S HEALTH SYSTEM: A rapid analysis of stock and migration. Available from: http://www.prographic.com/wp-content/uploads/2016/07/0316-south-africa-case-studies-web.pdf
StatsSA. (2016). General Household Survey. Available from: https://www.statssa.gov.za/publications/P0318/P03182015.pdf