On increasing health insurance enrolment

Following the recent enactment of the Universal Health Insurance Act and its envisaged implementation, here are some few tips to go by. So, as it were a variety of interventions to either reduce costs or increase awareness of benefits can increase health insurance adoption. As we know it, the value of health insurance can be difficult to evaluate before purchasing, so giving individuals an opportunity to experience insurance coverage is important for influencing future enrolment decisions. Furthermore, individuals’ decisions are also influenced by the trustworthiness or credibility of involved institutions.

A hindsight -- out-of-pocket health spending contributes to pushing a significant number of people into extreme poverty. Now, in order to increase access to key health services and reduce the risk of poverty due to health care costs, there has been an increasing trend toward government-run health insurance schemes and universal health coverage in recent decades, our approach as well.

A key factor in these programs’ ability to increase access to medical care, protect individuals from financial hardship, and be financially sustainable insurance schemes is enrolment. It is expected that individuals will adopt health insurance if they expect the benefits of enrolling outweigh their individual costs.

A recent review focused primarily on low- and middle-income countries showed that reducing health insurance costs or increasing awareness of benefits can increase insurance adoption.

When it comes to costs, research shows that reduced premiums, reduced co-pays, and simplified procedures for enrolling, using, or paying for insurance increases the insurance take-up. Regarding benefits, interventions that build trust in the insurance scheme or inform people about their health risks are effective at increasing insurance enrolment. Providing information to help individuals compare the costs and benefits of insurance can also be impactful.

Reducing expected costs: more people would sign up for health insurance when premiums are lower – and there are evidence indicating that reducing premiums for key populations, such as informal workers, has been an effective way to reduce expected costs and increase enrolment i.e., reducing the price of health insurance premiums for public or private insurance increased coverage.

On the other hand, there are also studies pointing to the fact that a discount for informal workers (in some countries) has no impact on take-up of the government-run scheme. This lack of impact may be attributed either to the smaller discount provided or cases of coinsurance policies, in which individuals had to pay a percentage of the cost for certain expenses.

Therefore, offering individuals the opportunity to try a health insurance product at a subsidized rate enables them to learn about the product’s value and informs their future enrolment decisions after subsidies expire. Studies have found that after experiencing insurance coverage, individuals chose to keep their health insurance even after subsidies expired.

This suggests that subsidies help individuals learn more about their personal health, the quality of covered health care, or other health insurance benefits.

However, it should be noted that in some cases enrolment may likely to decline after subsidies expire particularly in cases where individuals have had a negative experience or faced minimal engagement. This may include instances when reimbursements are difficult, costs remain high, individuals remain mistrustful of institutions, or the insurance does not cover high-quality care.

Thus, one may conclude, complex enrolment or reimbursement processes could have a significant barrier to take-up. There are cases where, as an example, in some places the at-home assistance to the sick could be a key factor for the increase in significant enrolment, or the requirements to produce official documentation to prove family size and composition, how this could be a major barrier.

Still, working with other actors to simplify enrollment or coordinate health insurance plans may help to reduce cases of confusion, scepticism, or mistrust.

While policymakers and other stakeholders should explore opportunities to simplify processes and improve convenience, it is important to consider individuals’ trust in possible partner institutions and how the involvement of additional actors could have negative impacts.

The other key aspect to consider is, expected benefits: as it were, patients will not maintain enrolment if they receive unsatisfactory health care -- exposure to low-quality care under health insurance may lead to dropout in enrolment.

As human instincts would dictate, if individuals have access to other forms of health care without health insurance, such as traditional medicine, or are distrustful of health care providers, demonstrating the potential higher quality of care under insurance may be particularly important.

Therefore, in setting up these schemes, policymakers and other stakeholders should also carefully consider payment structures so that providers do not offer those with insurance lower-quality care.