Selected country experiences
Nicaragua is a low-income country with a GDP of 1,023 USD per capita in 2007 and the second poorest in the region. Nearly half of the population live under the poverty line. The country is characterized by poor health indicators and limited financial accessibility to health care. The health financing system suffers from insufficient resource mobilization, segmentation, high out-of-pocket expenditures and inefficient use of resources. The current health financing system is a mixed one, comprising two main pillars: 1) tax-based health financing for government facilities; 2) social health insurance for a part of employees. Private health insurance and community-based mutual health insurance schemes play a rather marginal role.
As access to adequate health care is still very unequal among the population, the new government, the Frente Sandinista de Liberation Nacional, which came again into power in January 2007, is committed to moving to universal coverage in order to provide adequate quality health care to all Nicaraguans. Therefore, the Ministry of Health recognizes that reforming the health financing system constitutes an important challenge to this aim. To implement appropriate changes and reforms, there is need to properly understand the key causes of the health financing problems.