Financing Health Services Through User Fees and Insurance · Case Studies From Sub-Saharan Africa

The case studies in this volume focus on user fees and self-financing health insurance as a means of contributing to improved health sector efficiency, equity, and sustainable financing. The challenge facing policy-makers is how to tap resources that African households have, ensuring that people receive good value for money. User fees are emphasized as a form of cost-sharing because private, out-of-pocket expenditures for health account for nearly one-half of total health expenditures in Africa. The country experiences presented here distill lessons learned through dos and don'ts, as well as benefits to be gained by carefully presented user-charge policies. Self-financing health insurance is emphasized because this type of insurance enables many people to pool their resources to provide coverage for catastrophic illness or injury. The evidence presented here suggests that self-financing insurance is more prevalent than had been previously thought in many countries. Nurturing such insurance offers previously unexpected opportunities to develop better health care systems in sub-Saharan Africa.