Performance Evaluation Framework for Government-Sponsored Health Insurance Programs

The attainment of Universal Health Coverage (UHC) is one of the key goals of the Sustainable Development Goals (SDGs), with a special emphasis on cost-effectiveness as a key success factor. So far, a number of countries have initiated health insurance programmes as a means to provide healthcare coverage, financial protection and to achieve the final goal of UHC. These programs are based on the principles of risk pooling and purchasing of health services on behalf of the insured. They are mostly financed by government budgetary allocations and typically subsidise premiums for the poor and vulnerable. As more countries implement and scale up such insurance schemes, it becomes essential to be able to assess how these programmes are performing. This requires a comprehensive performance measurement framework, to help policymakers and programme administrators to assess the impact of the programmes and identify gaps for improvement in on-going and future design.

This paper proposes a preliminary assessment and framework for the performance evaluation of government-sponsored health insurance programmes. It consolidates different performance measurement criteria used by five country programs and builds on previous work conducted by the Microinsurance Network, devising Key Performance Indicators (KPIs) for microinsurance and highlighting key indicators that can help programs make effective and sustainable management decisions. The five-country programmes are Rhastriya Swasthya Bima Yojna (India), National Health Insurance Scheme (Ghana), Universal Coverage Scheme (Thailand), Cellule Technique d’Appui aux Mutuelles de Sante (Rwanda), and Jaminan Kesehatan Nasional (Indonesia). We also reviewed conceptual frameworks recommended by international organisations such as the World Health Organization (WHO) and the World Bank.