The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review

46 Pages Posted: 20 Apr 2016

See all articles by Arnab K. Acharya

Arnab K. Acharya

OP Jindal Global University - Jindal Global Law School (JGLS)

Sukumar Vellakkal

Public Health foundation of India (PHFI)

Fiona Taylor

Independent

Edoardo Massett

University of Sussex - Institute of Development Studies

Ambika Satija

Independent

Margaret Burke

University of Bristol

Shah Ebrahim

Public Health Foundation of India

Multiple version iconThere are 2 versions of this paper

Date Written: January 1, 2013

Abstract

This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. The authors summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. They find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured.

Keywords: Health Monitoring & Evaluation, Health Systems Development & Reform, Health Economics & Finance, Health Law, Insurance & Risk Mitigation

Suggested Citation

Acharya, Arnab K. and Vellakkal, Sukumar and Taylor, Fiona and Massett, Edoardo and Satija, Ambika and Burke, Margaret and Ebrahim, Shah, The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review (January 1, 2013). World Bank Policy Research Working Paper No. 6324. Available at SSRN: https://ssrn.com/abstract=2202686

Arnab K. Acharya

OP Jindal Global University - Jindal Global Law School (JGLS) ( email )

Sonipat
India

Sukumar Vellakkal (Contact Author)

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

Fiona Taylor

Independent

No Address Available

Edoardo Massett

University of Sussex - Institute of Development Studies ( email )

Brighton
Falmer, Brighton, East Sussex BN1 9RE
United Kingdom

Ambika Satija

Independent

No Address Available

Margaret Burke

University of Bristol

University of Bristol,
Senate House, Tyndall Avenue
Bristol, BS8 ITH
United Kingdom

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

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