BlessWorld Foundation International

Health insurance is a significant concept in global health due to its relevance in every part of the world. It is broadly described as insurance that covers all or part of an individual’s expenses resulting from disability, ill health or injury. Health insurance considers and calculates each individual’s probability of incurring medical expenses; spreads it over the same probability for a group of individuals and then estimates the overall risk of health care and health system expenses in that group. Subsequently, a routine financing structure – usually a monthly premium, is developed by the insurer for the group to raise the funds needed to pay for the specified health care benefits in the insurance contract or agreement. Hence, health insurance is not really free health care; it is a system where individuals pay for healthcare as a society- by making different degrees of contributions thus reducing the overall cost and risk of being bankrupted by medical bills. Most of the time, these benefits are administered by a central organization such as the government, business agency or not-for-profit group.

The need for an effective and efficient health insurance plan cannot be overemphasized, and is crucial to maintaining a healthy world. One major advantage and aim of health insurance is to uphold the global health goal of promoting equity in health care- given that the right to health is a fundamental human right. This ensures that individuals and families who may be living in poverty can still get the health services and care they need, even though they would otherwise not be able to afford it. Other pros of health insurance include promoting affordable healthcare while balancing out-of-pocket costs, increasing safe and great quality healthcare options, encouraging innovation and competition in the health sector, improving access to healthcare, expanding service and choices of care options, encouraging individuals to seek medical care and strengthening the healthcare workforce to meet the diverse needs of patients.

Despite the many benefits, one significant drawback of health insurance is that sometimes, it is not flexible and doesn’t cover all or part of the costs of very expensive medical services and care. This means that despite having an insurance plan, people can still go bankrupt if they suffer long-term ill-health that is quite expensive to manage and is not covered by their insurance agreement.

In Europe, nearly all the countries have universal health care (UHC), although there may be small variations across countries. Europe’s UHC is often referred to as “free health care” system due to its effectiveness and efficiency, even for foreigners. However- typical of health insurance, it is not exactly free. Europe’s health insurance system is delivered through a variety of national systems which are publicly funded through taxation.

In North America, health insurance is broad and diverse across the different countries. In the US for example, private and social insurance programs such as Medicare amasses resources and spreads the financial risk of medical expenses across the population. There are many health insurance plans in the US- including private and public plans which provide different levels of financial protection and scope of coverage. Irrespective of the various plans, over 40% of insured Americans reported that their health insurance plans did not sufficiently meet their needs. Canada’s universal health-care system is publicly provided and covers most health-care services as long as an individual possess a valid government-issued health card. This universal health-care system is funded by taxes, differs by province or territory and may vary in the medical costs and conditions covered.

In Africa, Nigeria has a National Health Insurance Scheme (NHIS) which operates under a prepayment system known as capitation. Registered members receive a monthly bill irrespective of whether or not that person used the NHIS’s services. The amount paid is dependent social factors such as income which promotes equity in the receipt of health services. The objective of NHIS in Nigeria is to reduce socioeconomic barriers to achieving universal access to health care and service. The downsides of NHIS include lack of organization, high financial cost, poor health care service and infrastructure, uneven distribution of hospitals and healthcare professionals.

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