ArticleThe International journal of health planning and management2026
Can Health Insurance Mandates and Tax Credits Reduce Coverage Gaps and Out of Pocket Cost in Small Island Developing States? Modelling the Eastern Caribbean.
Article in The International journal of health planning and management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Rising out-of-pocket (OOP) health expenditures in the Eastern Caribbean Currency Union (ECCU) underscore persistent gaps in health insurance coverage. This paper develops a Health Insurance Policy Simulation Model (HIPSM) to assess the potential impact of employer health insurance mandates and health insurance tax credits (HITCs) across five small island developing states (SIDS): Antigua and Barbuda, Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines (SVG). Using social security and insurance data, the model estimates coverage gains, fiscal costs, and labour market effects under varying thresholds and tax credit levels. Results show that employer mandates and HITCs can reduce coverage gaps and OOP expenditure in these countries but are highly sensitive to design characteristics. The findings offer important guidance for SIDS exploring scalable pathways towards universal health coverage through private insurance mechanisms, particularly in the absence of comprehensive public healthcare financing systems.
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