ArticleInternational journal for equity in health2016
Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995-2012 and policy implications for progress towards universal health coverage.
Article in International journal for equity in health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
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Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Health financing for universal health coverage in Sub-Saharan Africa: a systematic review.Global health research and policy · 2021Pooled it
- Shaping Pharmaceutical Tenders for Effectiveness and Sustainability in Countries with Expanding Healthcare Coverage.Applied health economics and health policy · 2018Pooled it
- Laboratory test availability and user fees in routine HIV care: a global analysis in 42 countries.Health affairs scholar · 2026Article
- Factors associated with breast cancer screening among insured and uninsured women in Tanzania: an analysis of the Tanzania demographic and health survey 2022.Health economics review · 2026Article
- Service delivery factors associated with enrollment to the improved community health fund among household members: a cross-sectional study in the Manyara region, Tanzania.BMC health services research · 2025Article
- Role of digital health technologies in improving health financing and universal health coverage in Sub-Saharan Africa: a comprehensive narrative review.Frontiers in digital health · 2025Review
- The use of medicine retailers by people of Goma as an alternative healthcare provider: a risky but rational practice.BMC primary care · 2024Article
- Exploring the Challenges in Covering Dental Services through Complementary Insurance in Iran: A Qualitative Study.International journal of dentistry · 2024Article
- Landscape of kidney replacement therapy provision in low- and lower-middle income countries: A multinational study from the ISN-GKHA.PLOS global public health · 2024Article
- The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.Medical journal of the Islamic Republic of Iran · 2024Review
- Do private health providers help achieve Universal Health Coverage? A scoping review of the evidence from low-income countries.Health policy and planning · 2023Article
- Effects of healthcare financing policy tools on health system efficiency: Evidence from sub-Saharan Africa.Heliyon · 2023Article
- Assessing the efficiency of health systems in achieving the universal health coverage goal: evidence from Sub-Saharan Africa.Health economics review · 2023Article
- Teachers' Willingness to Pay for Social Health Insurance and Its Determinant Factors at Harar Region, Ethiopia, 2021.ClinicoEconomics and outcomes research : CEOR · 2023Article
- Health insurance coverage in low-income and middle-income countries: progress made to date and related changes in private and public health expenditure.BMJ global health · 2022Article
- Informal Support Networks of Tanzanians With Chronic Diseases: Predictors of Support Provision and Treatment Adherence.International journal of public health · 2022Article
- A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa.International journal of health policy and management · 2021Review
- Inequitable access to healthcare in Africa: reconceptualising the "accountability for reasonableness framework" to reflect indigenous principles.International journal for equity in health · 2021Article
- Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries.BMJ global health · 2021Article
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Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
Abstract
backgroundMost low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).
methodsHealth expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995-2012. A literature analysis offered potential reasons for trends in countries and regions.
resultsIn 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC. DISCUSSION AND
conclusionReasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.