Performance Evaluation Framework for Government-Sponsored Health Insurance Programmes

Highlighting key indicators to help programs make effective and sustainable management decisions

The attainment of Universal Health Coverage (UHC) is one of the key goals of the Sustainable Development Goals (SDGs), with a special emphasis on cost-effectiveness as a key success factor. So far, a number of countries have initiated health insurance programs as a means to provide healthcare coverage, financial protection and to achieve the final goal of UHC. As more countries implement and scale up such insurance schemes, it becomes essential to be able to assess how these programs are performing. This requires a comprehensive performance measurement framework, to help policy makers and program administrators to assess the impact of the programs and identify gaps for improvement in on-going and future design.

This paper proposes a preliminary assessment and framework for the performance evaluation of government-sponsored health insurance programs. It consolidates different performance measurement criteria used by five country programs and builds on previous work conducted by the Microinsurance Network, devising key performance indicators (KPIs) for microinsurance and highlighting key indicators that can help programs make effective and sustainable management decisions. The five country programs assessed in the paper are:

  • Rhastriya Swasthya Bima Yojna (India);
  • National Health Insurance Scheme (Ghana);
  • Universal Coverage Scheme (Thailand);
  • Cellule Technique d’Appui aux Mutuelles de Sante (Rwanda);
  • Jaminan Kesehatan Nasional (Indonesia).

The Background Paper includes country profiles and overviews of each country's government-sponsored health insurance program, to provide context for the Discussion Paper.

About this Publication

By Garand, D., Sharma, S. , Achaw, M.