This assessment of the feasibility and desirability of social health insurance (SHI) in Fiji highlights that the current healthcare financing system ensures the financial risk protection and the poor in this country do not face financial barriers in accessing available healthcare services.
The Ministry of Health (MoH) is responsible for providing most of the health services in Fiji and finances almost all hospital beds, inpatient, and preventive care, and most of the outpatient services. Out-of-pocket payments represent only 16% of total healthcare financing and in terms of financial risk protection, estimates for this country show that the overall incidences of catastrophic and impoverishing expenditures in Fiji are very low compared to other low-middle income countries. These two measures show that Fiji is doing well in financial risk protection.
Technically it is feasible to mobilize additional funding through SHI using Fiji National Provident Fund arrangements (FNFP). A healthcare levy of 1% on wages of FNPF contributors could raise the equivalent to 12% – 14% of the current MoH budget, and it would require minimal additional investments in administrative capacity. However, these two institutions do not have the skills required to manage payments to providers, and to monitor and control costs. The introduction of contributory SHI will fragment risk pooling in Fiji’s health system and in the future, it will be much harder to remerge the risk pools.