Selected country experiences
Lesotho
Lesotho is a small country in Southern Africa with a population of about 2 million people, over half of which are classified as poor. Its territory is completely enclosed by the Republic of South Africa. Indeed, some of the health care needs of its population are met through medical referrals to there.
Health care financing is currently primarily tax-based and out-of-pocket spending is low in comparison to other African countries. Approximately half of the health facilities accessible to the general public are government health facilities. The other half is made up mostly of faith-based health care providers, united under the Christian Health Association of Lesotho, which also receives some Government funding. All these facilities collect some user fees. However, they are set to be abolished at the lowest level of care.
There is less information available about the private for-profit health sector in Lesotho. Yet it appears that it is growing, particularly in Maseru where there are over 20 private practitioners and a private hospital. Prices charged by private providers are substantially higher than the fees at government facilities. Private health insurance is available for the few who can afford it. Group-based membership based on an employer is more frequent than individual subscription. The relatively high fee-for-service reimbursements that private health insurances tend to pay makes their customers very attractive to private service providers.
The Ministry of Health and Social Welfare of Lesotho requested the World Health Organization to undertake a financial feasibility study of social health insurance as an option of financing health care in Lesotho. There is not one optimal way to social protection for health and therefore WHO aims to assist in narrowing down the possible options that are adequate and technically feasible in order to facilitate policy decision making by the Lesotho government. The report below is one outcome of this technical support. It includes the results from stakeholder consultations and from financial projections made using the SimIns tool.