Community based health insurance: how can it contribute to progress towards UHC?

Overview

This policy brief outlines what community based health insurance is and why it is important to discuss it in relation to universal health coverage. It explores how community based health insurance fits into health financing policy and its key characteristics and effects of CBHI on progress towards UHC. Evidence of community based health insurance based on theory and practice is presented to show their impact on population coverage, utilisation of health services and financial protection. The policy brief then reviews how some countries transformed their CBHI model into a national scheme and what can be considered as conducive institutional design features in health financing to make progress towards UHC and to protect small pools from volatile expenditure.

A conclusion and a WHO perspective are offered at the end: Although CBHIs are one way to organize community initiatives, both theory and evidence suggest that a CBHI model, relying only on voluntary, small-scale schemes and small pools with little or no subsidization of poor and vulnerable groups, can play only a limited role in helping countries move towards UHC. More potential is seen in financial protection arrangements based on large pools and mandatory or automatic participation funded from some form of taxation to subsidize those unable to pay. Strong and good governance, including citizen participation and mechanisms for voice at the local level are needed for national pooling arrangements to overcome the potential trade-off between increased redistributive capacity of a larger pool against the loss of control and participation by lower levels and the communities themselves.