Social health insurance in the Universal Health Coverage era: Does it impact health?

Low- and middle-income countries are adopting social health insurance as a mechanism for achieving universal health coverage.

However, there is insufficient evidence on the causal links between social health insurance and financial protection and service utilization, and there is scant evidence that social health insurance has an impact on health outcomes.

The project aims to understand the causal relationship between social health insurance reform and primary health care utilization, financial protection, and health outcomes in low- and middle-income countries.

Using realist review methods, a model of how, why, and under what circumstances social health insurance influences health outcomes will be developed.

Using causal inference methods and household survey data from Cambodia, the impact of a social health insurance scheme on utilization, financial protection, and health outcomes will be determined.

Interviews and group discussions will be used to explore supply and demand side perceptions of how the Cambodian scheme influences financial protection and utilization.

Causal loop diagrams will be created to understand the scheme’s pathways to impact on health outcomes and refine the initial model.

The findings will generate new knowledge and a new model of the impact and causal links of social health insurance and health outcomes, financial protection, and service utilization. The project is led by Lund University and the National Social Protection Council in Cambodia.