Health care financing under structural Adjustment: Some reflections on the Health insurance experience of Khartoum State, Sudan

The study aims at investigating the different aspects associated with the adoption of health insurance as financing mechanism for curative health services in the Sudan. Specifically, it aims at examining the general features of the insurance plan and its likely impact on utilization, access, efficiency, and quality of the services provided under the insurance scheme. The study also attempt to examine the potentials and limitations of the scheme. The research was conducted in Khartoum State, which is a pioneering State in adopting the insurance plan. Both primary and secondary data have been used in the study. Primary data were collected through a household survey conducted in three residential areas. The total sample size, randomly selected, is 341 households of which 210 are insured and 131 are uninsured. One of the main findings of the study is that the insurance scheme has contributed to overcoming many shortcomings associated with the application of user charges financing such as scarcity of financial resources for the health sector and lack of access to health services. The study has also revealed that the health service . The study has also revealed that the health insurance programme has positive implications for the utilization of public health services and provision of equal access to health services. The study recommends expansion of the insurance coverage to include all segments of the population, injection of extra financial resources into the health sector, reduction of the negative effects of the insurance scheme such as adverse selection and moral hazards, and rationalization of resource use. The quality of the services should be enhanced and incentives should be provided to the staff.