Publication: Health Insurance Coverage and Health Care Access in Moldova
No Thumbnail Available
Published
2011
ISSN
1460-2237 (Electronic)
0268-1080 (Linking)
Date
2012-03-30
Author(s)
Editor(s)
Abstract
BACKGROUND In 2004, the Moldovan government introduced mandatory (social) health insurance (MHI) with the goals of sustainable health financing and improved access to services for poorer sections of the population. The government pays contributions for non-employed groups but the self-employed, which in Moldova include many agricultural workers, must purchase their own cover. This paper describes the extent to which the Moldovan MHI scheme has managed to achieve coverage of its population and the characteristics of those who remain without cover. METHODS The 2008 July-October enhanced health module of the Moldovan Household Budget Survey was used. The survey uses multi-stage random sampling, identifying individuals within households within 150 primary sampling units. Numbers and characteristics of those without insurance were tabulated and the determinants of lack of cover were assessed using multivariate regression. RESULTS 3760 respondents were interviewed. Seventy-eight per cent were covered by MHI. Factors associated with being uninsured include being self-employed (particularly in agriculture), unemployed, younger age and low income. Respondents who were self-employed in agriculture were over 27 times more likely to be uninsured than those who were employed. Agricultural workers in Moldova are responsible for purchasing their own cover; most respondents cited cost as the main reason for not doing so. CONCLUSION While being uninsured has an impact on utilization, financial barriers persist for those with insurance who seek care. The strengths and weaknesses of the MHI system in Moldova provide valuable lessons for policy makers in low- and middle-income countries addressing the challenges of achieving equitable coverage in health insurance schemes and the complex nature of financial barriers to access.
Link to Data Set
Digital Object Identifier
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Improving Access to Health Care Services through the Expansion of Coverage Program : The Case of Guatemala(World Bank, Washington DC, 2013-01)Since the signing of the 1996 Peace Accords, Guatemala has made efforts to establish economic and political stability, and to improve its social indicators. The country's Constitution states that access to health care is a basic right of all Guatemalans. In practice, however, it has been challenging for the Government of Guatemala to guarantee this right using public facilities. As a result, it has been trying to improve access to health services using both Ministry of Public Health and Social Assistance (MOH) facilities and staff, and alternative health service providers, particularly nongovernmental organizations (NGOs). This case study reviews the experience implementing the Expansion of Coverage Program (Programa de Extension de Cobertura, PEC) that was established by the Government of Guatemala in 1997 to improve coverage of health and nutrition services to poor, rural, and largely indigenous areas by contracting NGOs. It describes its origins; its package of services; contracting, financing, monitoring, and supervision mechanisms; and its contributions to improving access and strengthening primary health care services in Guatemala. It also discusses opportunities and challenges that need to be addressed to continue to improve health services coverage in the country.Publication The Impact of Health Insurance on the Access to Health Care and Financial Protection in Rural Developing Countries : The Example of Senegal(World Bank, Washington, DC, 2001-09)Community-based health insurance schemes are becoming increasingly recognized as an instrument to finance health care in developing countries. Taking the example of "les mutuelles de santes" (mutual health organization) in rural Senegal this paper analyzes whether or not members in a mutual health insurance scheme have better access to health care than nonmembers. A binary probit model is estimated for the determinants of participation in a mutual and a logit/log linear model is used to measure the impact on health care utilization and financial protection. The results show that, while the health insurance schemes reach otherwise excluded people, the very poorest in the communities are not covered. Regarding the impact on the access to health care, members have a higher probability of using hospitalization services than nonmembers and pay substantially less when they need care. Given the results of this study, community financing schemes have the potential to improve the risk-management capacity of rural households. To reduce identified limitations of the schemes, an enlargement of the risk pool and a scaling up or linking of the schemes is, however, a prerequisite. Appropriate instruments to be further tested should include reinsurance policies, subsidies for the poorest and developing linkages to the private sector via the promotion of group insurance policies. All these instruments call for a stronger role of public health policy.Publication Synopsis of Results on the Impact of Community-Based Health Insurance on Financial Accessibility to Health Care in Rwanda(World Bank, Washington, DC, 2001-09)This paper evaluates the impact of prepayment schemes on access to health care for poor households, based on household survey data. Rwanda is one of the poorest countries in the world. After the genocide in 1994, public health care services were provided for free to patients, financed by donors and the government. In 1996, the Ministry of Health reintroduced prewar level user charges. By 1999, utilization of primary health care services had dropped from 0.3 in 1997 to a national average of 0.2 annual consultations per capita. This sharp drop in health service use combined with growing concerns about rising poverty, poor health outcome indicators, and a worrisome HIV prevalence among all population groups motivated the Rwandan government to develop community-based health insurance to assure access to the modern health system for the poor. The findings presented in this paper reveal that insurance enrollment is determined by household characteristics such as the health district of household residence, education level of household head, family size, distance to the health facility, and radio ownership, whereas health and economic indicators did not influence enrollment. Insurance members report up to five times higher health service use than nonmembers.Publication Navigating the Health System : Diabetes Care in Georgia(2009)Background Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. Methods The rapid appraisal study triangulated data from interviews with users, providers and key informants from various institutions in four regions of Georgia; data on clinical and social outcomes from diabetes; legislative and policy documents. Results Diabetes-related mortality in Georgia is among the worst in Europe and Central Asia, in a context of conflict, economic collapse and weak institutions. Essential inputs for diabetes care are in place (free insulin, training for primary care physicians, financed package of care), but constraints within the system hamper the delivery of accessible and affordable care. There are no evidence-based guidelines on diabetes management, formal support and quality assurance. The scope of work of primary care practitioners is limited and they rarely diagnose and manage diabetes, which instead takes place within the vertical system. Access to insulin is problematic in rural areas. Obtaining syringes, supplies and hypoglycemic drugs and self-monitoring equipment remains difficult everywhere. Prevention and effective management of complications is limited, increasing adverse outcomes. Diagnosis and treatment of diabetes complications involve hospital admission and unaffordable out-of-pocket payments. The complexity of pathways to key stages of care obstructs continuous care. There are poor linkages between primary and secondary care and ineffective patient follow-up or monitoring of outcomes. There is little effort to promote self-care, adherence to drug regimens and appropriate lifestyle, or to empower patients. Conclusions Improving diabetes outcomes will involve simplifying pathways to care and drugs, reassessing staff roles and insulin distribution systems. This would require better co-ordination of the inputs into the system and development of an integrated and patient-centred model.Publication Did the Health Card Program Ensure Access to Medical Care for the Poor during Indonesia’s Economic Crisis?(World Bank, 2007-01-30)The Indonesian Social Safety Net health card program was implemented in response to the economic crisis that hit Indonesia in 1997, to preserve access to health care services for the poor. Health cards were allocated to poor households, entitling them to subsidized care from public health care providers. The providers received budgetary support to compensate for the extra demand. This article focuses on the effect of the program on primary outpatient health care use, disentangling the direct effect of allocating health cards from the indirect effect of government transfers to health care facilities. For poor health card owners the program resulted in a net increase in use of outpatient care, while for nonpoor health card owners the program resulted mainly in a substitution from private to public health care. The largest effect of the program seems to have come from a general increase in the supply of public services resulting from the budgetary support to public providers. These benefits seem to have been captured mainly by the nonpoor. As a result, most of the benefits of the health card program went to the nonpoor, even though distribution of the health cards was propoor. The results suggest that had the program, in addition to targeting the poor, established a closer link between provision of services to the target groups and funding, the overall results would have been more propoor.
Users also downloaded
Showing related downloaded files
No results found.