Objective. The Government of Swaziland decided to explore the
feasibility of social health insurance (SHI) in order to enhance
universal access to health services. We assess the financial feasibility
of a possible SHI scheme in Swaziland. The SHI scenario presented
is one that mobilises resources additional to the maintained
Ministry of Health and Social Welfare (MOHSW) budget. It is
designed to increase prepayment, enhance overall health financing
equity, finance quality improvements in health care, and eventually
cover the entire population.
Methods. The financial feasibility assessment consists of
calculating and projecting revenues and expenditures of the SHI
scheme from 2008 to 2018. SimIns, a health insurance simulation
software, was used. Quantitative data from government and other
sources and qualitative data from discussions with health financing
stakeholders were gathered. Policy assumptions were jointly
developed with and agreed upon by a MOHSW team.
Results and conclusion. SHI would take up an increasing
proportion of total health expenditure over the simulation period
and become the dominant health financing mechanism. In principle,
and on the basis of the assumed policy variables, universal coverage
could be reached within 6 years through the implementation of
an SHI scheme based on a mix of contributory and tax financing.
Contribution rates for formal sector employees would amount to
7% of salaries and the Ministry of Health and Social Welfare budget
would need to be maintained. Government health expenditure
including social health insurance would increase from 6% in 2008
to 11% in 2018.