Inequality and private health insurance in Zimbabwe: history, politics and performance
Abstract Introduction Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-023-01868-9 |
| _version_ | 1797854023557054464 |
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| author | Alison T. Mhazo Charles C. Maponga Elias Mossialos |
| author_facet | Alison T. Mhazo Charles C. Maponga Elias Mossialos |
| author_sort | Alison T. Mhazo |
| collection | DOAJ |
| description | Abstract Introduction Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system performance. Despite the considerable influence of politics (stakeholder interests) and history (past events) in shaping PHI design and implementation, these factors are frequently sidelined when analyzing PHI in Zimbabwe. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe. Methods We reviewed 50 sources of information using Arksey & O'Malley's (2005) methodological framework. To frame our analysis, we used a conceptual framework that integrates economic theory with political and historical aspects developed by Thomson et al. (2020) to analyze PHI in diverse contexts. Results We present a timeline of the history and politics of PHI in Zimbabwe from the 1930s to present. Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions. Conclusion The present design and performance of PHI in Zimbabwe is primarily a function of history and politics rather than informed choice. Currently, PHI in Zimbabwe does not meet the evaluative criteria of a well-performing health insurance system. Therefore, reform efforts to expand PHI coverage or improve PHI performance must explicitly consider the relevant historical, political and economic aspects for successful reformation. |
| first_indexed | 2024-04-09T19:59:09Z |
| format | Article |
| id | doaj.art-e8d5a0949a614203ac831cc5ce86af92 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-04-09T19:59:09Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-e8d5a0949a614203ac831cc5ce86af922023-04-03T05:20:14ZengBMCInternational Journal for Equity in Health1475-92762023-03-0122111310.1186/s12939-023-01868-9Inequality and private health insurance in Zimbabwe: history, politics and performanceAlison T. Mhazo0Charles C. Maponga1Elias Mossialos2Ministry of Health, Community Health Sciences Unit (CHSU)Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of ZimbabweThe London School of Economics and Political Science, Department of Health Policy, LSE HealthAbstract Introduction Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system performance. Despite the considerable influence of politics (stakeholder interests) and history (past events) in shaping PHI design and implementation, these factors are frequently sidelined when analyzing PHI in Zimbabwe. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe. Methods We reviewed 50 sources of information using Arksey & O'Malley's (2005) methodological framework. To frame our analysis, we used a conceptual framework that integrates economic theory with political and historical aspects developed by Thomson et al. (2020) to analyze PHI in diverse contexts. Results We present a timeline of the history and politics of PHI in Zimbabwe from the 1930s to present. Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions. Conclusion The present design and performance of PHI in Zimbabwe is primarily a function of history and politics rather than informed choice. Currently, PHI in Zimbabwe does not meet the evaluative criteria of a well-performing health insurance system. Therefore, reform efforts to expand PHI coverage or improve PHI performance must explicitly consider the relevant historical, political and economic aspects for successful reformation.https://doi.org/10.1186/s12939-023-01868-9Private health insuranceHistoryPoliticsPerformanceAgency problemUniversal health coverage |
| spellingShingle | Alison T. Mhazo Charles C. Maponga Elias Mossialos Inequality and private health insurance in Zimbabwe: history, politics and performance International Journal for Equity in Health Private health insurance History Politics Performance Agency problem Universal health coverage |
| title | Inequality and private health insurance in Zimbabwe: history, politics and performance |
| title_full | Inequality and private health insurance in Zimbabwe: history, politics and performance |
| title_fullStr | Inequality and private health insurance in Zimbabwe: history, politics and performance |
| title_full_unstemmed | Inequality and private health insurance in Zimbabwe: history, politics and performance |
| title_short | Inequality and private health insurance in Zimbabwe: history, politics and performance |
| title_sort | inequality and private health insurance in zimbabwe history politics and performance |
| topic | Private health insurance History Politics Performance Agency problem Universal health coverage |
| url | https://doi.org/10.1186/s12939-023-01868-9 |
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