PHI currently plays a humble role in covering less than 10% of individuals in the middle-income countries, with some exceptions in countries such as Brazil, Namibia, and South Africa where the PHI accounts for 20% of total health expenditure (Sekhri and Savedoff, 2005). My question is, what about the large remaining percentage of the population who cannot afford PHI? Are they going to be left behind? It is obvious that PHI benefits are only for those individuals who can afford it, which is a small proportion of the population.
This brings us to the second point, which is social injustice, inequity, and lack of efficiency, especially in countries that are divided based on ethnic, religious, or economic grounds where one group can disproportionately access private insurance (Bayoumi, 2016). Don’t you think that ‘injustice anywhere is a threat to justice everywhere’? In its report, “Blind Optimism”, Oxfam recommends that achieving universal healthcare coverage and equitable access require having the majority of healthcare provided by the public sector (Oxfam, 2009)
Let me also add the potential discrimination from the PHI provider. They could simply be very selective with the individuals to whom they provide the service (something like cream-skimming). PHI providers tend to avoid high-risk individuals who may require high-level treatment (Drechsler and Jütting, 2015).
Moreover, PHI markets are developed in most middle-income countries without the required regulatory framework. Without strong government intervention, PHI can lead to rising costs which could be up to ten times higher than the administrative costs of social insurance (Drechsler and Jütting, 2015). So the question is: Does PHI add ‘value-based care’?
When considering the quality of delivered healthcare, I do believe that the public health sector is providing better quality of care than the private sector, knowing that governments often lack direct control over some or many components of the health system in the private sector. The private sector usually does not follow government regulations, guidelines, or practices. Nine retrospective chart reviews and survey-based studies concluded that adherence, diagnosing, and accuracy in medical management is worse in private sector care providers than in public sector care providers (Udwadia et al., 2010)}}.