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Table 3 Eligibility Rules

From: State budget transfers to Health Insurance to expand coverage to people outside formal sector work in Latin America


Groups eligible for subsidization

Targeting method

Organization responsible for identification

Enrolment process

Type of affiliation of the subsidized


Pregnant women; children (<5 years);

Older persons (>60 years) that are not affiliated to a social security scheme; people with disabilities [52]

Indirect targeting [52]

Post-identification also possible (at the health facility level when seeking care) [53]

Municipal governments, together with Ministry of Health [53]

Enrolment by the municipality [54]



FONASA group A: The poor; older persons above 80 years; victims of human rights violations and their family members; and those receiving family allowance (children < 18 years, pregnant women, mentally disabled) [55]

Direct targeting: (Proxy) means testing

Indirect targeting for beneficiaries of the family allowance and pension [56]

The local administration offices of the health ministry [57]

Active enrolment by the beneficiary [57]



The three lowest income groups (out of 6 income groups) [58]

Defined vulnerable groups (abandoned children, abandoned older persons, homeless, indigenous people, rural migrants) [59]

Shifting towards a universalist approach [21]

Direct targeting: Means testing [27]

Indirect targeting of vulnerable groups [24]

The local health authorities at the municipality level [60]

Prioritization: Number of the enrolled depends on the resources available in each municipality [24]

Active enrolment by the beneficiary who needs to fill out the beneficiary identification questionnaire (direct targeting) or otherwise provide proof of his/her vulnerability status (e.g. being listed on a specific census list) [60]

Mandatory [21]

Costa Rica

Poor people; indigenous people; people with disabilities

Partially subsidized: low-income independent workers [46]

Direct targeting: (Proxy) means testing when attending services and not yet insured [46]

Primary health care units [46]

Once the collected data is validated (household visits) beneficiaries become automatically enrolled [46]

Mandatory [46]

Dominican Republic

Poor; informal sector workers with income below the minimum wage;

Disabled; single mothers; unemployed

Older persons who receive a “Solidarity Pension” [61]

Direct targeting: (Proxy) means testing

Indirect targeting [61]

Regional offices of the beneficiary identification system. Priority is given to areas with high poverty incidence [62]

Active enrolment by the beneficiary [61]

Mandatory [63]


Until 2010:

Fully subsidized: Poorest four income deciles; families until the 7th decile with a pregnant woman or child, unless otherwise enrolled.

Conditional cash transfer program beneficiaries (Oportunidades)

Partially subsidized: Households from the 5th lowest income decile to those in the 10th decile, unless otherwise insured; [36]

Meanwhile, in practice, nearly everybody without formal sector insurance is fully subsidized [20]

Direct targeting: Means and proxy means testing

Indirect targeting for those in Oportunidades [20]

State Government Authorities for Social Protection in Health

The number of families being eligible was set and limited, prior to reaching near to universal population coverage rates [64]

Active enrolment on a per-family basis, combined with condition of health check-up in the enrolment units at hospital and clinic level [36]

Voluntary [20]


Fully subsidized: the poor and extreme poor [65]

Partially subsidized: low-income self-employed and families and workers of micro-enterprises [34]

Direct targeting: Proxy means testing [30]

Local Targeting Units of the Household Targeting System [66]

Active enrolment by beneficiaries [66]

Mandatory [34]


People with disabilities; older persons; unemployed; victims of state terrorism [67]

Informal sector workers [68]

Indirect targeting for beneficiaries of economic assistance

Direct targeting: Applicants required to present information on their income [69]

The local offices of the Public Health Services Administration

Active enrolment by beneficiaries (verification of receiving economic assistance at the local Public Health Services Administration office) [69]

Voluntary [68]