Inequitable Health Financing: NYU and Internationally

Paying for Primary Health Care

This past Saturday, I received an invoice from my primary health care provider. The invoice explained to me that the Comprehensive Health Care plan under Consolidated Health Plans, provided to students by New York University was in fact not comprehensive. I was charged for the routine and preventative services, in the form of updated immunizations and a long overdue check up. In order to increase my understanding of NYU’s Consolidated Health Plan and Global Health Financing Strategies, I have decided to provide an overview of different Risk Pooling Mechanisms, to explore how a lack of comprehensive health care coverage increases user fees, and how these fees create significant barriers to healthcare in low-income and high-income settings.

Risk Pooling Mechanisms: Social Insurance

As explained by The World Bank (2006), there are multiple methods of Risk Pooling, including state-funded systems or national plans, social, private or voluntary, and community-based insurance (p. 8).  By pooling risk, individuals pay a certain amount in order to protect themselves from unpredictably large health expenses (The World Bank, 2006). NYU offers a social insurance plan. Students can buy the basic plan for $1,614 or the comprehensive plan for $2,513, providing coverage for unpredictable life events, specifically injury or illness. This does not include primary health care, immunizations, or dental coverage (New York University, 2011).

While students can go to the health center for a reduced rate, immunizations and physicals, which can’t be performed at the NYU Health Center, are paid for out of pocket. NYU’s health insurance is also mandatory for both full-time students and employees or they can waive the insurance if they are covered by another plan (New York University, 2011). If students are not already covered, they purchase the “comprehensive” plan that fails to provide basic coverage, or pay for services that NYU requires students to have, like immunizations. In order to receive need primary healthcare students must pay out-of-pocket for services.

User Fees in Low-Income Countries

            As compared to the application of user fees in low-income countries, this is a small example of how forms of health care financing create differing levels of coverage and how user fees are the most “inequitable source of health financing (World Bank, 2006, p. 5).” While user fees and out-of-pocket expenses are originally intended to decrease the likelihood of patients using medical resources needlessly, user fees create significant barriers to health and negatively impact low-income more than high-income countries (James, et al., 2006). In high-income countries, out of pocket expenditure accounts for 56 percent of the private share of healthcare spending, a significantly lower amount than low-income countries, where it is 93 percent (World Bank, 2006). While user fees are only one barrier to reforming health systems, they significantly impair the use of primary and preventative health services.

– Maya Genovesi

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References:

Gottret, P., Schieber, G. (2006) Health Financing Revisited: A Practioner’s Guide. The International Bank for Reconstruction and Development/ The World Bank: Washington, D.C.

Guide to Student Health Insurance and Healthcare at New York University. (2011) New York University: New York, New York.  Retrieved at: http://www.nyu.edu/shc/pdfs/Guide_to_Student_Health_Insurance_2011_2012web.pdf

James, C. Hanson, K., McPake, B., Balabanova, D., Gwatkin, D., Hopwood, I., Kirunga, C., Knippenberg, R., Meessen, D., Morris, S., Preker, A., Souteyrand, Y., Tibouti, A., Villeneuve, P., Xu, K. (2006). To retain or remove user fees? Reflections on the current debate in low- and middle-income countries. Appl Health Econ Policy, 5(3). 137-153

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