Table 1.
Health insurance programmes by country
| Model | Definition of variables | Benefits package | |
|---|---|---|---|
| Ethiopia | |||
| Public | Primarily government-financed health-care system; public insurance model (ie, Ethiopian Health Insurance Agency) available for civil servants and some private employees | National or community-based health insurance | Community-based health insurance benefits package, including all family health services and curative care (ie, inpatient services, outpatient services, and acute illnesses) |
| Private | Little coverage | Employer-provided health insurance or private health insurance | Private insurance plans vary widely with respect to coverage and co-pays |
| Kenya | |||
| Public | Primarily government-funded health-care system; public insurance model (ie, NHIF) for both formal sector and informal sector employees; an automatic income-rated monthly deduction for formal sector employees, whereas informal sector individuals pay premiums voluntarily | NHIF only | The national health scheme is the main scheme under the NHIF and includes inpatient, outpatient, maternity, renal dialysis, oncological, surgical, radiological, mental or behavioural, and emergency care and overseas treatment benefits packages; other schemes under NHIF include the enhanced scheme (ie, an enhanced form of national health scheme cover including a pension scheme for retired public officers, among others), Linda mama (ie, free maternity service programme administered through the NHIF), and Edu Afya (ie, a comprehensive medical scheme that covers all public secondary school students [aged approximately 15–18 years] with NHIF registration and who are recorded under the National Education Management Information System) |
| Private | A few private health facilities; private insurance model offered by commercial insurance companies, for which members pay premiums voluntarily | Private insurance only, both NHIF and private insurance, or company-provided insurance | Private insurance packages vary on the basis of agreement between the insurance provider and an individual or the company paying for the insurance and mainly cover inpatient and outpatient services to defined limits depending on premium payment |
| South Africa | |||
| Public | Dual system with care freely available in the public sector; national health insurance scheme covering everybody to be implemented | Not yet implemented | To be defined |
| Private | Dual system with private insurance providing access to additional private facilities | Hospital plan or hospital plan with day-to-day benefits | Access to all public and private facilities; co-pays vary by insurance provider |
| Laos | |||
| Public | Health care is primarily provided through government facilities; the NHI scheme initiated in 2016 provides social health protection to the population with nearly universal coverage | NHI | Access to all public facilities with small co-payments; free services for pregnant women, children, and low-income households |
| Private | Additional private insurance is available | NHI plus additional private insurance | Access to private and public facilities; co-pays vary by plan |
| India | |||
| Public | For people living below the poverty line, central and state government employees, and employees of large firms | Central Government Health Scheme, State Government Health Scheme, Employee State Health Insurance Scheme, and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana | The Central Government Health Scheme provides free comprehensive medical care to 4·2 million central government employees, pensioners, and their dependent family members through its polyclinics and hospitals and empanelled private hospitals; the State Government Health Scheme provides free comprehensive medical care to state government employees, pensioners, and dependents in state government clinics and hospitals and empanelled private hospitals; the Employee State Health Insurance Scheme is a social insurance scheme providing free comprehensive medical care to 120 million beneficiaries (ie, employees and their families of any establishment with ten or more people employed and drawing wages up to ₹21 000 per month as defined in the Employee State Health Insurance Scheme act); the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana provides coverage of ₹500 000 per family per year to more than 500 million vulnerable people and people with a low income for inpatient secondary and tertiary care |
| Private | Offered by commercial insurance companies for individuals and groups | Employer-provided health insurance or private health insurance | Employer-provided (for those employees not covered under the Employee State Health Insurance Scheme act) or privately purchased; access to empanelled private care mainly for inpatient or emergency care with cashless or co-payment according to plan |
NHI=National Health Insurance. NHIF=National Health Insurance Fund.