The majority of developing countries in Asia have been making reforms to their health systems for decades but have still failed to achieve their targets for universal health coverage (UHC), that is, ensuring that all people obtain the health services they need without suffering financial hardship when paying for them, and the health- and poverty-related Sustainable Development Goals (SDGs). Countries in Asia rely on a mixture of healthcare financing sources, such as government general revenue, social health insurance (SHI), external funding, private health insurance and out-of-pocket (OOP) payments. Asian countries generally spend between 1% and 10% of their national GDP on health. There are variations in government investment in health as a proportion of total health expenditure across countries, from 23.4% in Japan to Myanmar’s 4.8%. Many governments in Asia have introduced various types of publicly financed health insurance schemes (SHI). The private sector, in providing healthcare, has expanded rapidly, because many national health systems are not able to cope with rising costs, especially for co-payment, and the increasing demand for services. The introduction of private health insurance has reduced OOP payments and, in the long run, could evolve a broader SHI system. As a result of the low levels of government spending, OOP payments by health consumers constitute a large share of health expenditures, amounting to more than US$0.5 trillion or US$80 per capita annually. Rapid increases in development assistance for health (DAH) since 2000 have resulted in major health gains in the poorest countries, yet DAH levels have stagnated in recent years. DAH must evolve to help accelerate progress toward UHC.
The false private health insurance by association: a real case analysis of how actors influence the policy-making in health systems (is there any winner?)