Social protection schemes play a critical role in protecting vulnerable groups from various forms of economic and social risks. This report focuses on the financial sustainability of a specific social protection scheme in a developing country. The selected scheme is a healthcare insurance scheme, and the analysis is based on a minimum of five previous years of financial data. The report begins with a review of theoretical and empirical literature on how the fiscal, governance, demographic, and economic environments affect the financial sustainability of social protection schemes. The report then discusses the methodology, data sources, and model adopted for the empirical analysis. The empirical financial data analysis is presented in Section 4, followed by a discussion of the major issues that could impact the financial sustainability, funding system, and proposed designs of the selected healthcare insurance scheme. The report concludes with key recommendations to address the challenges identified.
Fiscal Environment and Its Impacts
The fiscal environment refers to the government’s ability to mobilize and allocate resources to finance social protection schemes. Several studies have shown that inadequate government funding is a significant challenge to the financial sustainability of social protection schemes (Holzmann, Koettl, & Chernetsky, 2018; Palacios, & Sluchynsky, 2006). Insufficient funding results in inadequate coverage, inadequate benefit levels, and a lack of financial resources to respond to unexpected shocks, such as epidemics. Furthermore, fiscal challenges arise when the scheme relies heavily on external funding, which can be unpredictable and unsustainable.
Governance Environment and Its Impacts
The governance environment refers to the institutional arrangements and processes that ensure effective and efficient management of social protection schemes. Poor governance has been identified as a significant challenge to the financial sustainability of social protection schemes (Holzmann et al., 2018; Palacios & Sluchynsky, 2006). Inadequate governance can lead to poor financial management, weak monitoring and evaluation systems, corruption, and political interference. These challenges can undermine the scheme’s financial sustainability by reducing public trust, decreasing contributions, and increasing administrative costs.
Demographic Environment and Its Impacts
The demographic environment refers to the population characteristics that affect the design, coverage, and cost of social protection schemes. An ageing population and an increase in chronic illnesses have significant financial implications for healthcare insurance schemes. Older populations tend to have higher healthcare costs, and chronic illnesses require long-term care and expensive treatments (Holzmann et al., 2018). Furthermore, the demographic environment affects the scheme’s contribution base, as younger and healthier populations tend to contribute less than older and sicker populations.
Economic Environment and Its Impacts
The economic environment refers to the macroeconomic conditions that affect the affordability and sustainability of social protection schemes. Economic downturns can reduce government revenues, increase unemployment, and decrease the contribution base, making it challenging to sustain social protection schemes. Furthermore, inflation and currency devaluations can erode the scheme’s purchasing power, leading to inadequate benefits and low public confidence (Holzmann et al., 2018).
The review of the literature identified several policy gaps that need to be addressed to improve the financial sustainability of social protection schemes. First, there is a need for more reliable and sustainable funding sources, such as domestic resource mobilization, to reduce reliance on external funding. Second, there is a need for stronger governance systems that promote transparency, accountability, and public participation. Third, there is a need to design schemes that respond to the demographic and economic realities of the country, such as ageing populations and economic shocks. Finally, there is a need for more robust monitoring and evaluation systems to track the scheme’s financial performance and impact on the beneficiaries.