Subsidized health insurance for the hard-to-reach

This study aims to contribute to the policy debate about universal health coverage (UHC) in the context of the Arab region. Specifically, it seeks to illuminate the design features of existing subsidized health insurance arrangements and to assess their importance for making progress towards the UHC goals. To this end, the study mobilizes a wide range of sources including findings from previous studies, regional and country case documentations, as well as time-series data extracted from different sources including the Global Health Expenditure Database (GHED) of the World Health Organization (WHO) and the data portal of the United Nations Economic and Social Commission for Western Asia (ESCWA). There are a number of interesting findings and key implications to be highlighted. First, analysis of key indicators reveals that most Arab countries are making moderate to fast progress through the health financing transition, which reduces the burden of health spending on vulnerable groups and is indispensable for moving towards UHC. Despite this shift in health spending, the share of domestic public resources allocated to health remains relatively low (as compared to global and other regional averages), indicating that it is not a high priority in governments' budget allocations. Second, the current subsidized arrangements appear to be inadequate to ensure full protection against vulnerability. This signals that there is a need to reconsider the institutional and organizational features of the current arrangements in order to strengthen their financial protection and service provision capacities. Results suggest that neither a policy providing free care for all nor a subsidization policy can be enough to succeed on its own. Experiences from Arab countries and elsewhere show that subsidization policies can have little success unless effective targeting and monitoring mechanisms are put in place to ensure effective identification of the population eligible for subsidies. Ensuring adequate funding from multiple sources – rather than relying solely on government budget transfers – is equally important in order to maintain the provision of adequate and good quality health services and to compensate for revenues lost by health insurance schemes and public health facilities.