**8. Health insurance providers**

Evidence produced by Sommers et al. [20] on the effects of health insurance on health care and health outcomes in US for the period between 2007 and 2017 revealed that coverage expansions significantly increase patients' access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery and these increases appear to produce significant, multifaceted, and nuanced benefits to health. They further concluded that some benefits may manifest in earlier detection of disease, some in better medication adherence and management of chronic conditions, and some in the psychological well-being born of knowing one can afford care when one gets sick [20]. This signifies the role and importance of health insurance providers as stakeholders in pharmaceutical policy development.

However, assessing the impact of insurance coverage on health is complex since health effects may take a long time to appear, can vary according to insurance benefit design, and are often clouded by confounding factors, since insurance changes usually correlate with other circumstances that also affect health care use and outcomes [20]. A central aspiration of Universal Health Coverage (UHC) is to protect households from catastrophic health expenditures [21]. UHC aims to provide financial risk protection by increasing prepaid coverage, whether from the fiscal or from health insurance funds, thus decreasing reliance on out-of-pocket expenditure [22]. Governments and national health systems must provide adequate financing to ensure the inclusion of essential medicines in benefit packages provided by the public sector and all health insurance schemes [23].

The path to universal coverage involves important policy choices and inevitable trade-offs. The way pooled funds – which can come from a variety of sources, such as general government budgets, compulsory insurance contributions (payroll taxes), and household and/or employer prepayments for voluntary health insurance - are organized, used and allocated, influences greatly the direction and progress of reforms towards universal coverage [22]. Pooled funds can be used to extend coverage to those individuals who previously were not covered, to services that previously were not covered or to reduce the direct payments needed for each service. These dimensions of coverage reflect a set of policy choices about benefits and their rationing that are among the critical decisions facing countries in their reform of health financing systems towards universal coverage. Choices need to be made about proceeding along each of the three dimensions, in many combinations, in a way that best fits their objectives as

*Stakeholders in Pharmaceutical Policy Development DOI: http://dx.doi.org/10.5772/intechopen.105606*

well as the financial, organizational and political contexts [22]. It is here that the health insurance providers as stakeholders can help in making choices during the process of pharmaceutical policy development regarding the best trade-offs that can be made in a given country situation identifying the most needed insurance services, vulnerable populations and cost-sharing packages that are most suitable in the local context.
