Table 3 Eligibility Rules
Country | Groups eligible for subsidization | Targeting method | Organization responsible for identification | Enrolment process | Type of affiliation of the subsidized |
|---|---|---|---|---|---|
Bolivia | 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] | Mandatory |
Chile | 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] | Mandatory |
Colombia | 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] |
Mexico | 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] |
Peru | 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] |
Uruguay | 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] |