This essay is one in a series of essays published by HITAP from students who studied the Masters in Primary Health Care Management at the ASEAN Institute for Health Development and Faculty of Graduate Studies at Mahidol University. HITAP staff assisted in teaching on the course ADPM 613 Health Economics and the essays featured on the HITAP website were examination answers submitted by students on the course.
Government should provide health insurance for all because health is a human right and people’s health is a national resource. As stated by the World Health Organization, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity[1]”. However, there is always inequity in health related to gender, age group, living area, socio-economic class. In sustainable development goals (SDG), SDG 3 is related to good health and well-being. Universal health coverage (UHC) is specific health and social goal. It describes that people can obtain the quality health services they need (equity in service use) without fear of financial hardship (financial protection). UHC has three main dimensions: the population coverage, the services, and financial protection. This latter dimension is expressed in terms of health insurance. Health insurance is a type of insurance that covers the whole or part of the risk of a person incurring medical expenses. It is a valuable way of protecting patients from the high cost of healthcare. Countries all over the world are moving toward UHC.
Expending coverage of financial risk protection and effective health services will improve population health and productivity, so that contributes to economic and social development. It will increase the equity in accessing health services and reduce out-of-pocket and catastrophic health expenditure. Therefore, it prevents people from being driven into poverty as a result of paying for health care services.
Countries cannot make substantial progress toward covering the whole population by relying only on service using payment or voluntary insurance contributions. The government should reduce or eliminate out-of-pocket payments and expand progressive mandatory prepayment, such as taxation, compulsory social health insurance. It will ensure the sufficient resources being pooled across the population and make public resources become available to subsidise the cost of services for the poor. When the government provide health insurance for all, resources are concentrated and sustainable. The government can raise the budget through official sources. The activities will be systematically implemented and managed.
However, when people are provided health insurance from the government, they may feel less responsible for taking care of their health and family. They might be reduced compliance with preventive measures or increase exposure to risk factors. On the other hand, they may access unnecessary health services. This change in the beneficiary’s behaviour is called a “Moral hazard”[2]. It causes a negative impact because the purchasers pay out more in benefits than expected when setting premiums.
With the increase in population size and life expectancy, the insurance payment will cause a burden on the national budget, especially in low and middle-income countries. In conclusion, the government should be responsible for the management and implement health insurance for the whole country. The poor and vulnerable groups will receive full subsidies. For the counter groups, they should be co-payment participants. This mechanism will reduce the burden on budgets and increase the responsibility of people on their health.
[1] Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York: World Health Organization, 19-22 June, 1946. Available from: http://www.who.int/suggestions/faq/en/. Accessed March 21, 2017.
[2]Shavell S. On Moral Hazard and Insurance. In: Dionne G, Harrington SE, editors. Foundations of Insurance Economics: Readings in Economics and Finance. Dordrecht: Springer Netherlands; 1992. p. 280-301.
