The project 'Health equity and financial protection in Asia' (HEFPA) evaluated the effectiveness of different interventions designed to increase utilisation of appropriate care or to provide better protection from medical expenditure risks. The project conducted research in six countries at different stages of socioeconomic development: Cambodia, China, Indonesia, the Philippines, Thailand and Vietnam. Two randomised experiments in the Philippines and Vietnam studied the impact of extending health insurance coverage through subsidised premiums and insurance information. In the Philippines, although a 25–50 % subsidy plus information increased enrolment by 5 percentage points, it was not enough to push enrolment substantially closer to full coverage. What appeared to make a bigger difference was help in filling out the application form and delivering it to the insurance office, illustrating that inconvenience is a greater barrier to enrolment than cost. In Vietnam, the findings were similar. A 25 % premium subsidy and an information pack had no significant impact on insurance uptake. The reason appeared to be the low value of the insurance and low perceived quality of the care. Studies in China, however, showed that when coverage is extended or deepened, utilisation of care tends to increase. Another strategy is to reduce out-of-pocket costs. HEFPA studies showed that waiving fees for the poor had a greater impact than providing tax-financed care. Furthermore, findings revealed that lost income imposes a greater economic burden than medical expenses. These results have significant policy implications. Large-scale health coverage is unlikely to be achieved through voluntary insurance enrolment, and increasing affordability will not necessarily increase uptake. To address these concerns, policymakers should consider streamlining the administration of voluntary health insurance and improving the design of insurance benefits and provider payments. This will raise incentives for the utilisation and delivery of care. Advancing the agenda for disability insurance would also help ensure income for the poor during times of sickness. These changes would help bring about health equity and financial protection across countries.
Health care, out-of-pocket payments, financial risks, health equity, financial protection, health insurance, subsidised premiums, tax-financed care, lost income, medical expenses, insurance enrolment, disability insurance