1. From universal access to universal coverage
How does health insurance mechanisms and HIV interact: Overview of country experience
Erik Lamontagne, Ole Doetinchem, Robert Greener
Systems Integration, UNAIDS
Geneva
Bridging the Divide: Interdisciplinary Partnerships for HIV and Health Systems
Vienna, Austria, July 2010

2. Coverage of AIDS services

3. Different types of mechanisms
private health insurance social health insurance public tax-funded provision

4. The review of country experiences
Questionnaire on country situation: how is the overall health insurance and how HIV is eventually integrated
Excellent response rate (65/71) countries
Country analysed in terms of their vulnerability
Vulnerability level: incorporates proxy measures of
Poverty rate
Extend of the informal economy
(see World Social Security Report 2010)

5. Country characteristics
Government health expenditure
Classification using vulnerability index is coherent with usual characteristics
No clear trend of HIV prevalence
Among vulnerability groups of countries

6. Health insurance coverage
Blue: % country including health insurance
Green: proportion of providing ART coverage
Orange: proportion of SHI providing PMTCT

7. The case of Ghana

8. The case of South Africa

9. Lessons to draw (1)
Introducing health insurance is not an automatic recipe for increasing revenue collection for health or HIV
Integrating HIV services in SHI: more challenging for low income countries ( f(prevalence) )
Not a fatality: Ghana, South Africa and Rwanda
Countries that choose to include HIV services in SHI are mainly those already having a functioning health insurance system in place.

10. Lessons to draw (2)
The review shows that including HIV = essentially a political decision
Possibility to progressively increase coverage (pop, cost, services)
External aid, incl. HIV financing can support (and subsidise) progressive integration of HIV in SHI

11. Thank you contact: Erik Lamontagne: lamontagnee@unaids.org
Geneva, UNAIDS

12. Annexe Economic share of government

13. Health expenditures and GDP
(most of ) Sub Saharan Africa
Van der Gaag et al, Economics Reference Group, Dec 2009

14. Projection of health funding
GDP per capita is an almost perfect predictor of health expenditure per capita
The estimated income elasticity is higher than zero and close to or even higher than one.
This implies that health is regarded more as a “luxury good” than as a necessity (by the aggregate populations of most countries)
Based on projections of health funding to 2030, Van der Gaag et al (2009) concludes that:
over time (relatively fast growing) middle income countries may have sufficient funding…
…but (relatively slow growing) low income countries will need significant financial support for years to come.