Insuring Without Financing: Provider Payment and the Fiscal Design of National Health Insurance
Keywords:
universal health coverage, provider payment, catastrophic health expenditure, social health insurance, strategic purchasingAbstract
Enrolling a population in health insurance and financing its care are different achievements, and the second does not follow automatically from the first. This study examines the financing side of a single-payer national scheme, with attention to the provider payment mechanism through which revenue becomes care. The method is a structured review of research published between 2017 and 2024, organised around coverage, financial protection, payment mechanism and supply-side readiness. Four findings follow. Financial protection improved substantially, with catastrophic health spending in one national panel falling from 7.9 to 4.4 per cent of households at the ten per cent threshold in a single year, and insured households recording a 39 per cent reduction in out-of-pocket payments. Coverage nonetheless outran financing: enrolment exceeded 80 per cent while out-of-pocket payments remained above 30 per cent of current health expenditure, and financing incidence moved from mildly progressive to mildly regressive between two consecutive survey years. Contribution compliance in the self-enrolled segment is the structural weakness, with 28.3 per cent not paying regularly and uncertain income cited by 52.22 per cent. And the payment mechanism, which determines what the money buys, is unevaluated domestically: no verified study within the review window estimates the effects of the national case-based payment system, so its design rests entirely on evidence from other countries.References
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