How can policymakers meet the urgent need to extend social protection coverage? This paper discusses research findings on innovative integrated strategies to extend social health protection by linking statutory social security and informal or community-based social protection schemes. It develops a typology of links that could strengthen schemes in the areas of finance, administration, governance, service delivery and policy planning, exploring the actual and potential impact of such links. Continuing to develop parallel mechanisms for extending coverage risks competition and duplication, but linking the different systems could fruitfully address these problems.
Various financing and institutional methods are available to extend social health protection coverage – social health insurance, tax-financed universal health systems, community-based and micro-insurance schemes, as well as private insurance. However, none of these has emerged as a panacea for the sustainable extension of health care coverage in the short-term. This suggests that an ideal approach should build on the respective advantages of different systems, and exploit the complementarities between them. This means recognising the complexity of a successful coverage extension strategy and so being better equipped to establish coherence between the different methods used.
In spite of their respective advantages, disadvantages are encountered with both statutory social security schemes and community-based social protection mechanisms. Links between the two to counteract their weaknesses, however, could include:
- Financial links, such as tax subsidies, redistribution between statutory and community-based schemes, financial consolidation, and joint pooling to broaden the risk pool.
- Operational/administrative links, such as technical advice, exchanging of information/good practice, information systems links, regulation and/or control.
- Governance links, such as representation on boards or other institutional decision-making bodies.
- Links in health service provision, such as contracting links, and access to health service delivery networks/providers.
- Policy planning links, such as joint participation in the design and implementation of national social protection strategies and in core policy design principles, and policy coherence.
The example of SSS schemes and CBSP mechanisms shows that a whole variety of links between different schemes both at the policy level and the implementation level can be considered. Policy coherence combined with an effort to compensate for the respective disadvantages of schemes through links between them can avoid competition and inefficiencies. This approach can also strengthen the capacity of the existing social protection mechanisms to cover a greater share of the population in a sustainable manner.
- While some innovative measures were identified in an empirical study, links remain largely underdeveloped in practice.
- Parallel development of different mechanisms can be observed in many countries where social health insurance schemes are being implemented for some parts of the population while community-based schemes are created for population groups that cannot yet be covered by the statutory scheme.
- Unconnected parallel development of different mechanisms within the same country misses important opportunities to extend coverage, and can be detrimental to coverage through competition and duplication. Inefficiencies while resources are scarce and the demand vast should be avoided at all cost.