Every member of society has the right to social security, including access to health care (United Nations, 1948). However, 75 per cent of the world’s population is not adequately protected and approximately 40 per cent lacks even basic protection (Bachelet, 2011). The International Labour Organization (ILO) is calling for countries to define minimum social security benefits – including those for health – as soon as conditions allow (ILO, 2012). At the same time, momentum for universal health coverage (UHC), or “a system in which everyone in a society can get the health care services they need without financial hardship,” is building in countries as diverse as China, Ghana, Indonesia, Mexico and South Africa (Savedoff et al., 2012).
Many countries are pursuing government-sponsored health insurance as a primary path toward UHC. In these same countries, there are private health microinsurance (HMI) schemes sponsored by community-based organizations, commercial insurance companies or others that share many of the same goals as government-sponsored health insurance schemes.
A major barrier to provide social health protection in many low and middle-income countries is reaching informal workers and their families. Governments struggle to identify individuals, enrol them and collect premiums. These are functions that HMI providers are well positioned to manage. However, HMI schemes have difficulties in achieving scale and accessing sufficient resources. Governments are better positioned in both respects. These complementary assets open opportunities for collaboration.
This paper reviews country experiences in Cambodia, Ghana, India, Kenya, Thailand, Tanzania and the Philippines. It examines the hypothesis that government-sponsored insurance initiatives should collaborate with private actors to accelerate the expansion of health insurance to informal workers and their families.
