Impact of national health insurance for the poor and the informal sector in low- and middle-income countries: a systematic review

Impact of national health insurance for the poor and the informal sector in lowand middle-income countries 5 Abstract What do we want to know? Moving away from out-of-pocket (OOP) payments for healthcare at the time of use to prepayment through health insurance (HI) is an important step towards averting financial hardships associated with paying for health services. Social health insurance (SHI) is mandated for those employed in many developed countries where employment and wage rates are high; this service is extended to those unemployed through subsidy. In lowand middle-income countries (LMICs) some version of SHI has been offered to those in the informal labour sector, who may well comprise the majority of the workforce. We carried out a systematic review of studies reporting on the impact of health insurance schemes that are intended to benefit the poor, mostly employed in the informal sector, in LMICs at a national level, or have the potential to be scaled up to be delivered to a large population. Who wants to know and why? Our findings will help policy makers to learn what lessons the implementation of such insurance suggests in terms of welfare enhancement to those who currently undertake out-of-pocket health expenditure, which often exacerbates their already meagre material living conditions. The information in this document will help reshape existing programmes, and assess the need for expanding and introducing HI programmes for the poor and those in the informal sector. We further aim to influence future effort in examining the impact of health insurance by detailing appropriate methods that have succeeded in identifying the impact of insurance, given the mechanism through which schemes were offered.