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Voluntary health insurance (VHI) often serves a supplementary role in Europe. The ageing population and adoption of cost-sharing models in response to economic pressures raise concerns that VHI could contribute to health inequalities among older people. This study investigates the association of VHI with health outcomes among older people across 16 European countries and Israel. Prospective cohort study. Data on participants aged ≥50 years across 16 European countries and Israel were obtained from four waves (2013–2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). Gompertz proportional hazards models assessed the association of VHI with mortality and multimorbidity. Hazard ratios (HR) and 95 % confidence intervals (CI) are reported. VHI prevalence was 38.2 % in 2013 and 34.9 % in 2015, with a higher prevalence among higher-income groups. VHI was associated with a 13 % lower risk of mortality (HR: 0.87, 95% CI: 0.81–0.94) after accounting for demographic, socioeconomic, lifestyle, and health-related factors. VHI was also associated with a lower risk of multimorbidity (HR: 0.92, 95 % CI: 0.87–0.97). VHI was associated with a reduced risk of mortality and multimorbidity, after adjusting for demographic, socioeconomic, lifestyle, and health-related factors. VHI might facilitate the access to timely and high-quality healthcare services, which may exacerbate health inequalities among older individuals. [ABSTRACT FROM AUTHOR]

Do low levels of social trust increase a population's sense of insecurity and desire to get an insurance policy or alternatively make it turn to informal networks for safety nets? While generalized social trust is an important variable to explain insurance uptake, the existing literature offers conflicting accounts of its impact on a population's insurance demand. By employing a mixed-methods research design that combines multivariate regression of large-N cross-country data with a qualitative case study of Azerbaijan, the study provides a systematic analytical measurement of the impact of social trust on the voluntary purchase of health insurance in 93 emerging markets. The article finds a statistically significant positive effect of generalized trust on voluntary health insurance purchases. The findings suggest that in countries with a low level of social trust, people favor informal safety nets rather than formal contracts with insurance firms. [ABSTRACT FROM AUTHOR]

India's healthcare system is witnessing increased medical inflation, which is outpacing per capita Gross Domestic Product growth. With increased lifestyle diseases and, most recently, a pandemic caused by COVID-19, the cost of financing healthcare has become a huge issue, especially when government spending on healthcare is so low. In light of this, this article emphasises the significance of privately purchased, that is voluntary health insurance in addition to the government-sponsored health insurance programme for the vast uninsured population. Starting with the history of health insurance in India, this article examines premium growth, underwriting profit, investment income, net profit, incurred claims ratio and other metrics. Following that, the difficulties in the health insurance industry and their breadth are examined through a review of literature and recent newspaper reporting. The key issues resulting in negative underwriting experience are the inefficient risk pooling and unregulated private health care costs. A risk-sharing mechanism with an indemnification model must be implemented for better cost management to eliminate value fragmentation. Finally, ideas are given for resolving the challenges and increasing the market share of the health insurance company, with a focus on long-term business models such as managed care. [ABSTRACT FROM AUTHOR]

Lower-middle income countries (LMICs) have invested significant effort into expanding insurance coverage as a means of improving access to health care. However, it has proven challenging to fulfill these ambitions. This study investigates to what extent variables associated with the enrollment decision (stay never-insured or enroll) differ from variables associated with the dropout decision (stay insured or drop out). A cross-sectional survey that included 722 households from rural districts in Tanzania was conducted and multinomial logistic regressions were performed to determine the associations between independent variables and membership status (never-insured, dropouts, or currently insured). Both the decision to enrollment and the decision to drop out were significantly associated with the presence of chronic disease and perceptions about the quality of services provided, insurance scheme management, and traditional healers. The effect of other variables, such as age, gender and educational level of the household head, household income, and perceptions about premium affordability and benefit-premium ratios, varied across the two groups. To improve voluntary health insurance coverage, policymakers must simultaneously increase the enrollment rate among the never-insured and reduce the dropout rate among the insured. Our conclusions suggest that policies to increase insurance scheme enrollment rates should differ for the two uninsured groups.

The transmission of medical data of deceased persons is inter alia a processing of personal data and is excluded, as a general rule, from the applicability and protection of the General Data Protection Regulation. National legislation in Romania is not sufficiently satisfactory to allow such a transmission of data, in relation to the requests existing in practice and the interests of various entities, including insurance companies, to obtain such medical data. This study highlights the problems encountered in practice and details the legal regime applicable to the protection of medical data of deceased patients. Finally, it is concluded that the transmission of any kind of medical data of deceased patients can only be done on the basis of express legal provisions. [ABSTRACT FROM AUTHOR]

The problems of voluntary health insurance and assessment of current situation and the development prospects of paid medical services are raised in this article.

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The article is aimed at studying the theoretical and practical aspects of factors influencing the development of voluntary health insurance (VHI) in Ukraine. The place and indicators of development of the health insurance market in Ukraine for 2012-2019 are researched. The dynamics of health insurance market indicators based on the amount of gross insurance premiums and payments is analyzed; it is proved that voluntary health insurance (continuous health insurance) is characterized by growth during the last five years. The factors that significantly influenced the development of the market and the current state of voluntary health insurance, in particular the COVID-19 pandemic, the economic crisis, high incidence rates of insured persons, the significant cost of an insurance medical policy, the lack of tax preferences for business regarding medical social packages and the lack of specialized educational institutions on the VHI, are determined. The classification of factors of influence on the development of voluntary health insurance according to the level of their occurrence is carried out, and it is determined that the following factors have the greatest force of influence on the VHI: deterioration of solvency of potential insurers; pricing in the medical market; excessive tax burden for legal entities. It is substantiated that the indisputable way of motivating the introduction of voluntary health insurance is to amend the tax legislation of Ukraine; micro insurance is proposed as a basis for the development of voluntary health insurance. Prospects for further research lie in the study of factors influencing the development of micro insurance in the country.

We examine whether the endorsement of voluntary health insurance (VHI) in a Beveridge-oriented healthcare system may increase the probability of visiting a specialist. We use data from the 2019 European Health Interview Survey, which includes information on demographics, socioeconomic characteristics, health status, and healthcare access of over 30,000 Italian households. We also apply data from the Health for All dataset to measure the supply of physicians at regional level. In order to account for endogeneity and unobserved heterogeneity, data is modeled through a simultaneous equation model for binary variables, specifically a trivariate recursive probit. Findings show a positive impact of VHI on the probability of accessing specialist care, after controlling for physician distribution. A socioeconomic gradient is also detected in the probability of both holding VHI and visiting a specialist, with wealthier and better educated individuals showing more likelihood to do so; these results raise concern on the equity of access granted by a Beveridge-oriented system. The role of the GP in filtering the need for care and referring patients to specialists is also recognized. Both supplier inducement effects and macroregional fixed effects are detected in the access to either category of physicians. • Voluntary health insurance increases the probability of visiting a specialist. • Socioeconomic status affects the probability of holding voluntary health insurance. • Socioeconomic status affects the probability of visiting a specialist. • Supplier inducement effects and macro regional fixed effects are detected. • Trivariate recursive probit accounts for endogeneity and unobserved heterogeneity. [ABSTRACT FROM AUTHOR]

The article is aimed at studying the prospects for development of health insurance in Ukraine, taking into account foreign experience. It is defined that reform of the health care system is an important condition in the course of European direction of Ukraine’s development. The priority in this matter is assigned to insurance medicine, in particular the introduction of compulsory national health insurance. To implement the modern health care model, we urgently need management and intermediary organizational structures (insurance organizations, foundations, insurance offices) and highly qualified medical personnel, which would provide appropriate attitude to the health of the insured persons. Analysis of health insurance in the socio-economic conditions of today’s Ukraine showed that it is at the initial stage of its development. The effective experience of the world countries in the sphere of insurance medicine proves that various models, compulsory health insurance systems have already been worked out and their high results have been proven. The introduction of a new model of health care financing in Ukrainian practice involves not the increasing financing, but changing the approach to resource management in order to use recourses more effectively. The main stages of implementing compulsory and voluntary insurance as a single complex should be: optimizing of compulsory health insurance rates; substantiating the optimal amount of insurance premiums for the unemployed population, pensioners and children; introducing more progressive cost-recovery methods; setting tax breaks; excluding the possibility of duplication of payment for medical services to be provided under compulsory and voluntary health insurance schemes; organizing the uniform standards and regulations for treatment and delivery of services.

Progressive financing of health care can help advance the equity and financial protection goals of health systems. All countries' health systems are financed in part through private mechanisms, including out-of-pocket payments and voluntary health insurance. Yet little is known about how these financing schemes are structured, and the extent to which policies in place mitigate regressivity. This study identifies the potential policies to mitigate regressivity in private financing, builds two qualitative tools to comparatively assess regressivity of these two sources of revenue, and applies this tool to a selection of 29 high-income countries. It provides new evidence on the variations in policy approaches taken, and resultant regressivity, of private mechanisms of financing health care. These results inform a comprehensive assessment of progressivity of health systems financing, considering all revenue streams, that appears in this special section of the journal., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

There is no country in the world that can provide to all citizens all the benefits offered by modern medicine. In fact, the lack of financial resources with a continuous increase in health spending is a difficult challenge facing all countries of the world, including Serbia. The author deals with the analysis of the problems of unequal access to health services, insufficient health coverage, and the inability to exercise the rights of individuals on compulsory health insurance. Accordingly, the author points out how regulated health systems of developed countries, whose health funds contribute to a significant improvement in the health status of their citizens. Finally, a comparative analysis shows that there is no perfect health insurance system, but to strive for it, and some of the solutions that can contribute to improving the current state of health are proposed.

Abstract Background Struggling to correct the public-private imbalance in its health care system, the Hong Kong SAR Government seeks to introduce a government-regulated voluntary health insurance scheme, or VHIS, a distinctive financing instrument that combines the characteristics of private insurance with strong government regulation. This study examines citizens’ responses to the new scheme and their willingness to subscribe. Methods First-hand data were collected from a telephone survey that randomly sampled 1793 Hong Kong adults from September 2014 to February 2015. Univariate and multivariate methods were employed in data analysis. Results More than one third of the respondents explicitly stated intention of subscribing to the VHIS, a fairly high figure considering the scheme’s voluntary nature. Multivariate analysis revealed moderate evidence of adverse selection, defined as individuals’ opportunistic behaviors when making insurance purchasing decision based on their own assessment of risks or likelihood of making a claim. Conclusion The excellent performance of Hong Kong’s public medical system has had two parallel impacts. On the one hand, high-risk residents, particularly the uninsured, do not face a pressing need to switch out of the overloaded public system despite its inadequacies; this, in turn, may reduce the impact of adverse selection that may lead to detrimental effects to the insurance market. On the other hand, high satisfaction reinforces the interests of those who have both the need for better services and the ability to pay for supplementary insurance. Furthermore, the high-risk population demonstrates a moderate interest in the insurance despite the availability of government subsidies. This may offset the intended effect of the reform to some extent.

Copyright of Scientific Proceedings of Ostroh Academy National University Series, Economics is the property of National University of Ostroh Academy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: In the Republic of Bulgaria dental disorders concern the prevailing population. They are cumulative, progressive and are not self-healing. The present paper examines the patient's opinions about the dental care. Materials and Methods: The paper is based on a research realized in June-December 2016. The research was conducted among patients with dental care using dental services in the capital. The authors investigate their knowledge of the dental package by NHIF, how often they use it, whether their needs have been satisfied, how many of them have additional voluntary health insurance package for dental services and is there any financial benefit. Results and conclusions: The study shows that the dental healthcare system doesn’t meet the needs of the patients.

Ghana introduced a social health insurance scheme in 2003. One of its motivations was to protect consumers against adverse health shocks. Financing for the programme comes from a 2.5% goods and service tax, contributions by formal sector workers directly transferred from their social security savings and individual premiums from informal members. This arrangement makes formal workers compulsory members of the scheme while informal members voluntarily enroll. We view this as a natural experiment in which one section of the population automatically acquires insurance (with formal sector employment), and the remainder choose to obtain the same coverage (or not). Using data from the 2009/2010 Ghana Socioeconomic Panel Survey, we explore the determinants of the uptake of health insurance by informal members and test whether this voluntary health insurance uptake impacts the frequency of use of health care resources. We find robust evidence that older, wealthier and more educated individuals are more likely to buy (voluntary) health insurance. Moreover, using the method of propensity score matching, we find that voluntary health insurance uptake is strongly associated with higher health care utilization-implying that, with respect to the frequency of use, the mode of insurance acquisition matters. [ABSTRACT FROM AUTHOR]

Interventions aiming to simultaneously improve financial protection and quality of care may provide an important avenue towards universal health coverage. We estimate the effects of the introduction of the Kwara State Health Insurance program in Nigeria on not only the insured but also the uninsured. A subsidized voluntary low cost health insurance was offered by a private insurer as well as a quality upgrade in selected health care facilities. Using propensity score matching and panel data collected in 2009 and 2011 (n = 3509), we find that, for the insured, the program increased health care utilization (36 percent, p < 0.000) and reduced out of pocket expenditure (63 percent, p < 0.000). However, the uninsured in the area with upgraded facilities did not increase their care utilization and even spent less on health care, which is problematic given that 67 percent of the population in the treatment area did not take up the insurance. Our findings suggest that while voluntary health insurance combined with investments in health care supply can increase health care use and financial protection among those that take up the insurance, attention should be paid to potential unintended effects on the – typically sizeable– group of people who do not enroll in the insurance. [ABSTRACT FROM AUTHOR]

Within the existing health financing literature, males are typically categorized as the household's decision-makers. While this view accurately reflects many local sociocultural realities, approximately a quarter of sub-Saharan African households are now headed by females. In light of various efforts to expand health insurance coverage in the region, it is necessary to examine whether the factors influencing voluntary health insurance enrolment are analogous across male- and female-headed households. This study sought to identify the gendered determinants of voluntary enrolment into a church-run micro health insurance scheme. A cross-sectional survey of 550 households was carried out in Bui and Donga-Mantung Divisions of North-West Cameroon in May 2016. A structured questionnaire was administered on health insurance membership, household attributes, headship characteristics and health-seeking behaviour. We assessed the influence of gender on the associations between health insurance enrolment and the explanatory variables using logistic regression. This study found that voluntary health insurance demand was influenced by involvement in social networks regardless of gender. However, in line with entrenched household roles, men's understanding of potential household health risks ultimately facilitated their enrolment decisions, while economically empowered women prioritised their direct knowledge of household health risks. Men's demand for health insurance was correlated primarily with their education level (OR = 2.238 [CI 1.228-2.552]), as well as with their socioeconomic status (OR = 2.207 [CI 1.173-4.153]), age (OR = 2.238 [CI 1.151-4.352]) and trust of the insurance provider (OR = 4.770 [CI 2.407-9.453]). Conversely, women's enrolment decision was primarily associated with their income levels (OR = 5.842 [CI 1.589-21.484]), as well as by the presence of children (OR = 3.734 [CI 1.228-11.348]). The influence of wealth on health insurance enrolment highlights the need for policymakers to subsidize health insurance schemes for vulnerable population groups. Further, it is imperative to develop sensitization campaigns that are simple and digestible to facilitate understanding of health insurance across all target groups. [ABSTRACT FROM AUTHOR]

The author of the article researched the teoretical and methodological approaches to the formation and development of the health insurance market conditions, also investigated the condition and features of the functioning of the health system in Ukraine and abroad, reasonable prospects of introducing mandatory and dissemination of voluntary health insurance, as well as ways of improving financial provide health insurance system in Ukraine.

Recent European Court of Justice (ECJ) case law has highlighted apparent inconsistencies in ECJ rulings on the regulation of voluntary additional health insurance. In 2013, the ECJ upheld Belgian regulations limiting the operation of the free market by restricting increases in premium rates of additional health insurance contracts. By contrast, in 2012, an ECJ ruling required Slovenia to repeal such restrictive legislation and not to hinder the operation of the free market. The objective of this article is to feed the discussion on the question whether and under what conditions free-market-driven additional health insurance in the European Union might be acceptable. We conclude that, provided that basic health insurance effectively covers all essential healthcare (essential healthcare services being broadly defined), additional health insurance could be regulated in the same way as all other non-life insurance. [ABSTRACT FROM AUTHOR]

Urgency of the research. Health care system as a unique scope of services for the full functioning of the human body is of great importance in the conditions of formation of market infrastructure. Health insurance is an important part of the social infrastructure of every developed country and is regarded as an alternative model of health care. Target setting. Ukrainian health care system is currently under reform. It is necessary to move to health insurance in order to provide effective reforms in health care system of Ukraine. Actual scientific researches and issues analysis. The issue of health insurance is developed in the works of O. V. Baeva, O. H. Hupalo, O. M. Holyachenko, O. N. Litvinova, V. M. Mnikh, N. A. Molozina, Y. V. Pasichnik, A. L. Svechkina, O. H. Spodareva, V. M. Fedosov, S. I. Yuriy. Uninvestigated parts of general matters defining. The questions on reasoning capabilities of formation and implementation of complex mechanisms of health insurance in Ukraine are not fully developed by the scholars. The research objective. The aim of the article is to structure the directions of improvement of health insurance mechanism in modern market conditions. The statement of basic materials. The current state of functioning of health insurance market in Ukraine is analyzed in the article. The share of voluntary health insurance in the insurance market Ukraine is defined. The main problems that hinder the effective development of health insurance in the country are listed. Promising directions of improvement of the mechanism of health insurance through an integrated approach to the use of forms of health insurance are suggested. The economic effect of the proposed directions is grounded. Conclusions. The introduction of a comprehensive mechanism of health insurance in Ukraine, which will combine voluntary and mandatory health insurance results into possible health care reform that will lead to growth of strong and healthy nation and as a result - a strong and efficient economy of Ukraine. [ABSTRACT FROM AUTHOR]

Voluntary private health insurance (VPHI) has gained popularity in universal public healthcare systems. We studied how the local provision of healthcare services correlated with VPHI take-up in Finland. Nationwide register data from a Finnish insurance company was aggregated to the local level and augmented with high-quality data on public and private primary care providers' geographical closeness and fees. We found that the sociodemographic characteristics explained the VPHI take-up more than public or private healthcare provision. The VPHI take-up was negatively associated with distance to the nearest private clinic, while the associations with distance to public health stations were statistically weak. Fees and co-payments for healthcare services were not associated with insurance take-up, meaning that the geographical closeness of providers explained the take-up more than the price of services. On the other hand, we found that VPHI take-up was higher when local employment, income and education levels were higher., Competing Interests: Declaration of Competing Interest The study company provided data, a laptop and research facilities, but no financial assistance., (Copyright © 2023 The Author. Published by Elsevier B.V. All rights reserved.)

Lower-middle income countries (LMICs) have invested significant effort into expanding insurance coverage as a means of improving access to health care. However, it has proven challenging to fulfill these ambitions. This study investigates to what extent variables associated with the enrollment decision (stay never-insured or enroll) differ from variables associated with the dropout decision (stay insured or drop out). A cross-sectional survey that included 722 households from rural districts in Tanzania was conducted and multinomial logistic regressions were performed to determine the associations between independent variables and membership status (never-insured, dropouts, or currently insured). Both the decision to enrollment and the decision to drop out were significantly associated with the presence of chronic disease and perceptions about the quality of services provided, insurance scheme management, and traditional healers. The effect of other variables, such as age, gender and educational level of the household head, household income, and perceptions about premium affordability and benefit-premium ratios, varied across the two groups. To improve voluntary health insurance coverage, policymakers must simultaneously increase the enrollment rate among the never-insured and reduce the dropout rate among the insured. Our conclusions suggest that policies to increase insurance scheme enrollment rates should differ for the two uninsured groups., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

This working paper explores the position of the voluntary health insurance within the scope of the mandatory health insurance as a main tier of health insurance in the Republic of Macedonia. The main subject of research is the legislation regulating this issue (Law on voluntary health insurance), the application and functionality of its provisions; and also the accomplished results considering the fact that this law has been in force almost 4 years. For this purpose an analysis will be made of the statistical data on the number of insured persons under the voluntary health insurance. A brief comparison with several Balkan countries will be made in terms of the legal solutions for voluntary health insurance and also in the development of the voluntary health insurance through the statistical data of the insured persons under the voluntary health insurance scheme. This paper will also address some of the positive experiences in the countries in which the voluntary health insurance functions appropriately and simultaneously with the mandatory health insurance. The goal of this working paper is to point out the shortcomings of the voluntary health insurance system in Macedonia and to provide some ideas for improvement, to develop better, cheaper and more accessible health services for the Macedonian citizens. This goal can be accomplished with deregulation and liberalization of the health insurance sector, through amendments to the Law on health insurance aimed at balancing the basic and additional package of health care services and amendments to the Law on voluntary health insurance aimed at providing a greater freedom for all market participants in the health insurance system. Also, the idea of this paper is to examine the possibility to allow some citizens that would fulfill the necessary conditions, to abandon the mandatory health insurance system and join the voluntary health insurance system. [ABSTRACT FROM AUTHOR]

Objective: Health insurance provides financial support for health care expenditures. There are two types of health insurance: compulsory and voluntary. Voluntary health insurance can be divided into two categories: self-employed and supplementary. In this study, the main factors that affect the demand for self-employed health insurance in Iran were determined. Materials and Methods: In this cross-sectional study, data were derived from the 2013 Household Income and Expenditure Survey from the Statistical Center of Iran. Then, a logistic regression model was designed to determine the factors influencing health insurance demand. Results: The age, income, and education level of the head of the household directly correlated with the demand for self-employed health insurance. There was no significant relationship between the demand for health insurance and the gender or marital status of the head of the household. In addition, there were no significant relationships between occupation or house ownership and the demand for health insurance in rural households. Conclusion: To promote voluntary health insurance, it is helpful to identify effective factors that stimulate the health insurance demand. [ABSTRACT FROM AUTHOR]

Copyright of Economic Annals-XXI / Ekonomìčnij Časopis-XXI is the property of Institute of Society Transformation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12 months prior to the baseline survey the subsidy-only intervention raised enrollment by 3.5 ppts (p = 0.08) while the combined intervention raised enrollment by 4.5 ppts (p = 0.02); however, the differences in the effect sizes between the sick and non-sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC). Methods: Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995-2012. A literature analysis offered potential reasons for trends in countries and regions. Results: In 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC. Discussion and Conclusion: Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC. [ABSTRACT FROM AUTHOR]