Case study

Synthesis of Case studies of Micro Insurance and Other Forms of Extending Social Protection in Health in Latin America and the Caribbean

Social protection through health insurance and the potential and limitations to extending coverage

This paper examines 11 cases from 10 Latin American Countries: Colombia, Honduras, Dominican Republic, Bolivia, Uruguay, Nicaragua, Ecuador, Argentina, Guatemala and Peru and finds that:

  • These cases do indeed achieve progress in making the out-of-pocket expenditure of poor clients more efficient this regard, largely because the poorer populations appear to increase their consumption of health services;
  • There is improvement in terms of the cost, timeliness, and quality of the benefits in the negotiations with service providers;
  • Many of the workers registered in the health insurance schemes are informal workers who, prior to these cases, did not pay premiums and received free care in the public services.

As regards financial sustainability, those six cases which did not engage in risk management and are primarily designed to increase access to health care showed that:

  • External contributions (subsidies in certain cases) are unrelated to either the number of beneficiaries or members or risk;
  • Financial sustainability is precarious and is due to the fact that almost all these systems target low-income populations;
  • There is scant capacity to collect premiums that would sustain them over the long run and these populations have higher a health risk profile;
  • Low premiums are not adjusted to any factor related to the risk of potential beneficiaries which could ultimately help to reduce the deficits;
  • Size of the beneficiary portfolio of Micro-insurances and their efforts at increasing penetration are major issues;
  • Study of this subject should be intensified in order to provide recommendations for future interventions.

Sustainable institutions contribute to conclusions and recommendations and the study shows that:

  • Two institutions or systems with financial sustainability are Colombia and Uruguay;
  • Because they have no deficit, or only a marginal deficit;
  • In spite of not managing risk explicitly, they do reveal some coherence and adaptation in terms of the revenues and expenditures associated with the risk of the target populations.

Argentina and Guatemala are cases with financial sustainability, very low deficits, and where better risk management could guarantee sustainability in the longer term. Overall the studies demonstrate:

  • Need to continue and intensify activities connected to these types of experiences;
  • Necessity of validation;
  • That the next stage should be devoted simultaneously to research, concrete field activities in the form of pilot cases, and increased exchange of the knowledge gained from experience at the regional level.