HEALTH INSURANCE: WHAT WORKS AND WHAT NOT? The emerging evidence-base in low income countries and policy implications for Dutch stakeholders
Research team:
ECORYS – Arthur ten Have and Judith Matthijsen
KIT – Ankie van den Broek and Merel Martens
UMC St. Radboud- Ernst Spaan
This research has been prepared as a joint research effort. Based on an internal ECORYS study proposal (2007) and the outputs of last year’s HIP write-shop (in Tilburg), UMC St Radboud, ECORYS and KIT developed a proposal for HIP to investigate the evidence-base of health insurance arrangements for the poor. The organisation of the study reflects the different priorities of the organisations involved and accommodate different funding arrangements.
The overall objective of the study is to document the existing evidence-base on the performance of different health insurance arrangements in low-income countries and linking the evidence to existing and future policies of Dutch stakeholders and their partners. This overall objective can be divided in three related sets of specific objectives, research questions, activities and deliverables.
1. Literature review
Research objective:To establish an overview of the existing evidence on impact, strengths &weaknesses of HIA for the poor in LICs using peer-reviewed literature and grey literature.
Research questions:
a. What is the existing evidence on the effect of health insurance arrangements (social, private, community) in LICs for the poor and the vulnerable?
With regard to impact it is proposed to assess the following criteria:
• Utilisation of healthcare by the community with specific attention for the poor and vulnerable;
• Performance of health services in terms quality of health care, services covered and efficiency;
• Resource mobilisation, including the extent to which HIA leads to additional funding;
• Empowerment of the community towards a respected stakeholder in health service delivery.
• Protection against catastrophic health expenditures
b. What are the relative strengths and weaknesses of the three different health insurance arrangements in LICs with respect to above mentioned criteria?
Activities and outputs
After finalising the analytical framework, including the specific (definition of) performance criteria to be used and the determination of criteria for inclusion or exclusion of different types of literature, a literature review will be carried out by the different interested research organisations and is expected to result in:
1) dedicated working papers and
2) a peer reviewed article.
2. Policy of Dutch (aid) organisation and their partners
Research objective: To strengthen the policies and programmes in the field of health insurance by Dutch (aid) organisations and their partners.
Research questions:
a. What are the existing policies and interventions in the field of health insurance by Dutch (international aid) organisations and their partners?
b. What are the policy implications of the existing evidence base on health insurance for the poor and how this can support policies of Dutch (aid) organisations and their partners
c. How can Dutch (aid) organisations and their partners use the study findings to improve their policies?
Activities and outputs
An inventory will be made of policies and interventions (projects) on health insurance for the poor by Dutch (aid) organisations and their partners. This will require active participation by the implementing organisations through provision of information and follow-up (telephone-) interviews.
Based on the results of the literature review, the inventory of policies and projects and the implications of the evidence base for the policies and projects of the Dutch (aid) organisations and their partners will be assessed and communicated in a separate working paper. This will also include a Monitoring and Evaluation (M&E) framework that will assist Dutch (aid) organizations and their partners in defining new projects and policies and monitoring and evaluating existing projects.This part of the research will be led by KIT in cooperation with ECORYS, and UMC St Radboud.
3. Country-case studies
Research objectives:
1. To deepen understanding of successful health insurance schemes; and
2. To field test the M&E framework developed.
Research questions:
a. What are the present health insurance arrangements in the country under study?
b. Do the findings from the literature review on health insurance for the poor hold in the country?
c. Under what conditions do the findings from the existing evidence-base on health insurance for the poor hold in the country? / Which preconditions need to be in place to make sure that poor and vulnerable people benefit from health insurance arrangements by improved access to quality health services?
Activities and outputs
Informed by the results of the literature review, a decision will be taken to carry out one or more country case studies to deepen our understanding of particularly interesting or successful projects or schemes. This component will result in one or several country visit reports. The country research will be organized in close cooperation with the local stakeholders ((local) governments, NGOs, owners of HIA). Stakeholder meetings will be held to introduce the case study to create ownership for the research and enhance the use of findings and recommendations. At the end stakeholder workshops will be held to review the findings and formulate implications of the research to facilitate transfer and share findings with policy makers, donors, civil society and other relevant stakeholders.
D. Dissemination of research findings to relevant stakeholders
An essential component of the research study is to disseminate the findings among stakeholders in the Netherlands and their partners active in the field of HIA. The proposed study elements will result in the following outputs:
1. Working paper(s) on literature review: These working papers will document the literature review and may result in one or two separate papers depending upon the division of work.
2. Working paper on inventory of policies and projects by Dutch stakeholders.
3. Working paper(s) on country case studies.
4. Peer-reviewed article on (parts of) literature review.
5. Poster presentation of (parts of) literature review on international Health Economics Association conference in July 2009
6. Presentation on the research outcomes to HIP platform and broader audience.
7. Briefing paper (e.g. 5 pages) with recommendations on policy implications for Dutch stakeholders.
