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Review of defragmentation of publicly subsidized health insurance schemes - P4H Network

Review of defragmentation of publicly subsidized health insurance schemes

This document provides a review of efforts undertaken in four Indian states and several countries on the defragmentation of their health schemes.

The document discusses health insurance reforms in various countries, with a focus on defragmentation of multiple health insurance schemes. It emphasizes the challenges of fragmentation, which lead to inequity in access and financial protection. The report provides a conceptual framework for defragmentation efforts, with a focus on publicly subsidized health insurance (PSHI) schemes. It includes a literature review of six countries and in-depth interviews and data collection from four states in India to inform the suggested framework. The framework categorizes fragmentation into three major dimensions and outlines a spectrum of defragmentation measures, including complete defragmentation, harmonization across pools, and pool merging. The report also highlights the Indian experience, indicating early-stage defragmentation reforms and identifying key predisposing factors and enablers for such reforms.

The insights from the report have informed the formulation of a guidebook for other countries and sub-national governments looking to undertake defragmentation efforts. The document concludes by emphasizing the importance of addressing fragmentation beyond PSHI schemes, such as vertical disease programs and specialty services. The report provides valuable insights into the complex nature of defragmentation processes and reforms, highlighting the need for standardized purchasing functions and unified governance and oversight mechanisms. It also underscores the significance of factors such as duplication of eligibility, inefficient healthcare purchasing mechanisms, inequity in financial contributions, and high out-of-pocket costs as key drivers for defragmentation reforms.

The comprehensive review and analysis presented in the report offer a foundational understanding of defragmentation efforts and serve as a guide for countries and governments aiming to address the challenges of fragmented health financing systems.

Grace Kabaniha, Jaidev Anand, Suneet Peepre, Hilde de Graeve, Review of defragmentation of publicly subsidized health insurance schemes, World Health Organization, Country Office for India