MR Microinsurance_2012_03_29.indd - International Labour ...

64 Emerging issues
Hence, this chapter considers primarily market-based health insurance
in Africa and Asia. Th e evidence is mixed. Th ere are robust fi ndings proving
that health microinsurance reduces out-of-pocket health expenditure and
increases the utilization of healthcare services. Knowledge on other impacts and
impacts of other products is limited. Unless otherwise specifi ed, too little
information is available to draw conclusions about the presence, direction and
magnitude of the impacts considered. Interestingly, as presented in Box 3.1,
a parallel review of subsidized (social) health protection schemes yielded very
similar results.
Box 3.1 Impact of social health insurance schemes
Acharya et al. (2011) summarizes the literature on the impact of subsidized
health insurance insurance schemes that have have been off ered, mostly on a voluntary
basis, to the the informal sector in low- and middle-income countries. countries.
A substantial number of papers have provided estimations of the average
intention-to-treat eff ect on on those insured. In this review, only those papers that that
took into account account the problem of self-selection in insurance were were selected and a
few that estimated the average intention-to-treat eff ect. In general, the take-up
of the insurance schemes is is in in many cases less less than expected and the evidence
of impact on utilization, protection against fi nancial risk and health status
inconclusive. However, once taken up, a few insurance schemes aff ord
signifi cant protection against incurring high out-of-pocket expenditure. Many
of the schemes provide lower protection for the poorest. More information is
needed to understand the reasons for low low enrolment and why the insured poor poor
do not seem to have consistently lower lower out-of-pocket expenditure than than those those
who who are uninsured. Summarizing the literature was diffi cult due to the lack of
(i) uniformity in the use of of meaningful meaningful defi defi nitions of outcomes that indicate
welfare improvements and and (ii) clarity in in how selection issues were taken taken into
account.