Health Insurance and Priority Health Services

Today's edition of Health Systems 20/20's [Brownbag Series]( on Applying Health Systems Strengthening to Global Health Issues--ongoing through April 7, 2011--brought a crowd of pro-poor financing champions through a mid-October rainstorm to the Global Health Council offices. Kimberly Switlick and Hong Wang discussed what health insurers cover in developing countries and what many believe are "priority services," for instance antenatal care, family planning and immunizations.

The answer to the session's subtitle is no: At the moment, insurance and priority services don't fit together well. According to the presentation by Kimberly Switlick, available for download [here](, priority services do not fit the model currently used in health insurance in developing countries, being predictable and low-cost or routine. Insurance schemes like India's [RSBY](, by contrast, are meant to cover road accidents and other unforeseen medical problems -- not routine measles shots. The Joint Learning Network for Universal Health Coverage -- on its [recently launched Web site]( -- includes [detailed information]( about the way this scheme works.

These routine services, in fact, are often offered for free in government facilities, although in some countries like Ghana are considering covering them with insurance.

Both Wang and Switlick stressed that utilization increases and out of pocket expenditures decrease when people have insurance. For instance, in [Ghana]( people spent half the average expenditure out of pocket on obstetric delivery after being covered by insurance. In Colombia, physician assisted births increased by 66% after the country's [dual-system of insurance]( was enacted.

Aside from routine services not being covered, Wang stressed that health insurance packages are not currently tailored to the poor. The poor might not be eligible for health insurance--say, if they work in the informal sector. The poor might be eligible but not enroll, or they may not benefit when they do enroll. A study Wang pointed to from China showed that due to different levels of service utilization, healthy people from the wealthiest segment received the most net benefits from health insurance.

Download the Health Insurance Handbook from HS 20/20 [here](