Health financing for universal coverage

Reaching universal coverage via social health insurance: key design features in the transition period

Discussion paper, Number 2/2004

World Health Organization

Publication details

Number of pages: 54
Publication date: 2004
Languages: English, French
WHO reference number: EIP/FER/DP.04.2



Social health insurance (SHI) is one of the principal methods of health financing. Twenty-seven countries have established the principle of universal coverage via this method. Several low and middle-income countries are currently interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand what characterises a well performing SHI scheme and how long the transition from incomplete to universal coverage could be expected to take.

Section two introduces the concept of universal coverage, and the main pathways to this aim, so that policymakers keep in perspective options other than SHI for financing their health system. This is followed in section three by an analysis of the transition to universal coverage, based on historical experiences of a selection of countries that have mature or developed SHI schemes.

In particular, this section discusses critical factors that can speed up the transition period. Section four then provides a simple framework for analysing the performance of a SHI scheme, based on the components of universal coverage and fundamental goals of a health system. A set of performance indicators will be presented that can be used to monitor and evaluate the progress in implementing SHI. Finally, we underline the government’s strategic role in the implementation of SHI, and give concluding remarks in section five.