IN low-resource nations like Jamaica, there are several health-care financing models that could mitigate the various limitations of traditional health insurance and could be potentially beneficial for patients, especially the very large pool of patients in the informal economic sectors. These options aim to increase access to health-care services and reduce financial barriers. When considering health-care coverage for people employed in the informal sector in developing countries, a financial model that suits their unique needs and circumstances is crucial. Last week, we explored the concept of alternative health-care financing models for informal sector workers in Jamaica who are traditionally excluded from traditional health insurance schemes. In our column today, we will explore some of these specific models in more detail.
1. National health insurance. Implementing a national health insurance system can provide coverage for the entire population. This approach pools resources from various funding sources, such as taxes, premiums, or contributions, to finance health-care services. It ensures that essential health services are available to everyone, regardless of their current health status, age or ability to pay. This is often referred to as Universal Health Insurance and is widely available to citizens of many countries where health care is recognised as a national imperative. The social contract between the state and the citizens as well as the nexus between good health care and economic development form the bedrock of the advocacy for universal health insurance.
2. Community-based health financing. This approach involves establishing community-based health insurance schemes or micro-health insurance programmes. These programmes are designed to meet the needs of specific communities or low-income groups and can be tailored to the needs of informal sector workers, considering their irregular incomes and specific health-care needs. They often involve contributions from members of the community, which are used to cover health-care costs. Community health financing can be effective in reducing the burden of health-care expenses on individuals. For this to work, there must be a sense of community that obligates people to sign on to such schemes even when they may not be immediate beneficiaries. Many communal living societies in Asia and Africa embrace this concept because of cultural socialisation. By organising at the community level, these models can promote solidarity, local ownership, and accountability. Examples of successful community-based health insurance schemes include the Mutuelles in Rwanda and the Community Health Fund in Tanzania.
3. Social health protection programmes. These programmes target vulnerable populations, such as the poor, informal sector workers, and marginalised groups. They provide financial risk protection by offering subsidies or exemptions for health-care services. Social health protection programs can be funded through government allocations, donor support, or a combination of both. They may offer exemptions, subsidies, or reduced-cost services to ensure affordable health-care access. Ghana's National Health Insurance Scheme and Thailand's Universal Coverage Scheme are examples of successful social health protection programmes.
4. Health savings accounts. Health savings accounts allow individuals to set aside funds specifically for health-care expenses. These accounts are usually paired with high-deductible insurance plans, where individuals pay out-of-pocket costs up to a certain threshold. Health savings accounts can empower individuals to make informed decisions about their health care spending and provide a safety net for unexpected medical expenses. In some countries, tax incentives are provided to individuals to encourage health savings accounts. In such situations, funds contributed to a health savings account is exempt from taxes up to a specified limit. However, penalties and taxes would accrue if such funds are used for anything other than health care.
5. Donor funding and grants. Low-resource nations can seek support from international organisations, NGOs, and philanthropic foundations to secure funding for health-care services. Donor funding and grants can be used to improve infrastructure, strengthen health-care systems, and provide subsidies or grants to individuals who cannot afford essential health care. HIC Foundation has used grants to support individuals seeking certain services at HIC, for example. Our current HIC Save a Life programme is based on generous grant support from HIC Foundation allowing qualified patients with heart attack and unstable cardiac conditions to obtain angiogram, angioplasty with stent and hospital admissions at about 30 per cent of the usual costs with the rest paid for by HIC Foundation grant.
6. Public-private partnerships. Collaborations between the public and private sectors can help leverage resources and expertise to improve health-care financing. Public-private partnerships can involve contracting private health-care providers to deliver services, establishing insurance programmes with private sector participation, or engaging in joint initiatives to address specific health-care challenges.
7. Microinsurance. Microinsurance refers to insurance products designed for low-income individuals or households, including those in the informal sector. These products typically have low premiums and simplified administrative processes. Microinsurance plans can provide coverage for specific health-care services or a package of essential health benefits. They can be offered through partnerships between insurance providers, microfinance institutions, and community-based organisations. Examples include the Health Insurance Fund in India and the Kilimo Salama (Safe Agriculture) initiative in Kenya.
8. Government subsidies and vouchers. Governments can provide targeted subsidies or vouchers to informal sector workers to help cover health-care costs. These subsidies can be used to purchase health insurance, health-care subscriptions or access specific services at reduced costs. By directly supporting individuals in the informal sector, governments can increase their access to health care without creating an additional administrative burden for them. The Seguro Popular programme in Mexico and the Rashtriya Swasthya Bima Yojana (RSBY) in India have employed this approach. This is an approach that can be effective in Jamaica especially if targeted at informal sectors that have brought prosperity and global recognition for Jamaica like the creative industries, specifically musicians and music producers and sports, notably track and field athletes.
9. Mobile-based health financing. Leveraging mobile technology can be an effective approach to reach and engage informal sector workers. Mobile-based health financing models can include mobile payment platforms, mobile savings accounts, or mobile insurance applications. These models facilitate easy premium payments, claims processing, and access to healthcare services. Examples include M-TIBA in Kenya and Aavaz Health in India.
It's important to note that the suitability and effectiveness of these health-care financing options may vary depending on the specific context and needs of each community. Additionally, partnerships between governments, private sector entities, and community-based organisations are often crucial for the success of these initiatives. The suitability of these financial models depends on the specific context, resources, and infrastructure available in each developing country. It is important to consider the preferences, needs, and capacities of the informal sector workers themselves, involving them in the design and implementation of the financial model.
Implementing a combination of approaches tailored to the local circumstances is often necessary to achieve sustainable, inclusive and equitable health-care financing.
Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to firstname.lastname@example.org or call 876-906-2107.