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Expanding Health Coverage for Vulnerable Groups in IndiaIndia's health sector continues to be challenged by overall low levels of public financing, entrenched accountability issues in the public delivery system, and the persistent dominance of out-of-pocket spending. In this context, this case study describes three recent initiatives introduced by the central and state governments in India, aimed at addressing some of these challenges and improving the availability of and access to health services, particularly for the poor and vulnerable groups in the country. This includes two federal schemes introduced by the Government of India-the National Rural Health Mission (NRHM) of the Ministry of Health and Family Welfare and the Rashtriya Swasthya Bima Yojana (RSBY) of the Ministry of Labor and Employment-and the Rajiv Aarogyasri scheme launched by the state government of Andhra Pradesh. The three schemes discussed in this case study were designed and implemented by different agencies almost in parallel, over the same time period, and used different financing and delivery approaches. A discussion of the mechanics and operational features of these programs has been undertaken to unravel the underlying complexities, interactions, and interdependencies of these programs within the country's health system. The remainder of this case study on India's march toward universal health coverage focuses on three recent, prominent programs, and includes a discussion on the institutional structure of these programs and their interactions within the country's health system, their mechanisms for beneficiary targeting and enrolment, the benefits packages covered by them, accompanying innovations in public financial management, and their information environment. Annex one presents an overview of the health system and health financing in India, and annex two discusses the evolutionary context of India's Government sponsored health insurance schemes. The discussion of the mechanics and operational features of these programs has been undertaken to unravel the underlying complexities, interactions, and interdependencies within these programs. The case study also aims to contribute to the ongoing debate within the Indian health sector, with opinions divided between investments in traditional input-based health spending for publicly managed health facilities versus demand-side financing, purchasing of care, and involving private providers and intermediaries in delivering services financed by public money. The case study also aims to share how the lessons learned by one program can be applicable more widely within the Indian health system and beyond
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Integrating the Poor into Universal Health Coverage in VietnamThis case study is aimed at providing a descriptive assessment of the key features of Vietnam's Social Health Insurance (SHI), focusing on the impediments to integrating the poor into universal coverage. The trajectory of SHI in Vietnam is similar to that of many other countries in the East Asia and Pacific region. The poor were covered under a separate Health Care Fund for the Poor to begin with. The 2009 Law on Health Insurance merged all of the different programs into one. Health insurance premiums for the poor were fully subsidized by the government and enrolment became mandatory, resulting in almost complete enrollment of the poor by 2011. Vietnam has combined elements of contributory social health insurance with substantial levels of tax financing to provide coverage for the poor and informal sector. The case study is structured as follows. Section 2 describes the institutional structure and system characteristics of Vietnam's SHI. Section 3 addresses the main topic of the case study - the impediments to integrating the poor. Section 4 concludes by addressing the pending agenda.
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Egypt : Health Sector Reform and Financing ReviewIn 1997, the Ministry of Health and
 Population (MOHP) of the Government of Egypt (GOE) launched
 a comprehensive Health Sector Reform Program (HSRP) aiming
 to develop a national health system, based on social
 insurance that would address existing problems in equity,
 access, efficiency, quality and financial sustainability.
 The purpose of the Health Sector Reform and Financing Review
 is to provide the GOE and its development partners with a
 critical assessment of experience to date with the reform.
 At a critical juncture of the program's life, such an
 assessment is imperative to inform future phases of the
 reform and to revalidate, modify, or if necessary revisit
 the model envisioned at the outset. This study is comprised
 of five sections: the first sets the background for the
 study by reassessing the health sector problems that
 triggered the reform efforts; in the second section, the
 status of implementation of the HSR Pilot Project will be
 reviewed in relation to the model envisioned at the outset;
 section four tries to interpret why implementation of the
 HSR Pilot Project met, exceeded, or fell short of
 expectations; in section four, short-term and medium-term
 reform strategies are proposed aimed at expanding and
 sustaining the HSR Pilot Project; finally section five
 concludes the study with a summary of main findings and
 presents a road map for the future of health sector reform
 in Egypt.