The Role of Micro Health Insurance in Realizing Universal Coverage of Health Services: A Reappraisal

Health systems worldwide face formidable task of providing affordable health care services to masses of people. Micro health insurance is a promising mechanism to achieve this goal especially in low income countries where resource-poor informal sector is predominant in the economy.

This article reappraises the existing literature to understand and assess the effectiveness of MHI mechanism in achieving the goals of health system and thereby, universal coverage of health care based on the conceptual framework that adopts system approach to health system goals.

A systematic search of published literature in the electronic database for the period of 1994 to 2010 was performed. Papers examining the impact, effectiveness of MHI were also identified via article titles, abstracts and reference lists of each or book chapter were searched. A total of 97 research papers and seven review papers, consisting of both theoretical and empirical studies were included.

The study based on quantitative techniques is limited in literature. Majority of the studies resort to simple non-statistical descriptive techniques based on scheme facility or hospital data. Literature is inconclusive owing to the diverse contexts in which these schemes operate and due to methodological inconsistencies. The evaluation made on the basis of instrumental goals such as scheme design and management, percentage coverage of target populations and levels of cost recovery found MHIs to be partially successful.

The potential of MHI mechanism is promising unless certain design features are taken into consideration while formulating and implementing it. There is scope for further research that would help the policymakers and scheme administrators to bring about desirable changes to the scheme to realize universal coverage.