Health financing policies implemented by nations around the world vary based on who receives coverage and what health system resources are covered. Although, many health systems are attempting to move towards Universal Health Coverage, part of their populations continue to incur out-of-pocket payments for using all or some health services. Some health systems restrict health insurance for certain migrant populations, providing coverage for emergency care only, or none at all. Other health systems fail to provide coverage for prescription drugs, leaving those without the ability to pay out-of-pocket for medications behind. The lack of financial protections against catastrophic or impoverishing healthcare expenditures for these patients may deter them from seeking the care they need or increase the risk of severe financial hardships. This dissertation addresses these migrant and drug coverage gaps by examining the impacts of health financing policies and how these can be changed to move health systems towards Universal Health Coverage. First, this dissertation examines restrictions to refugee health policy in Canada by conducting an interpretive policy analysis to reveal how political actors strategically use causal stories to enact policy change. Second, quantitative studies assessing the effects of health insurance on migrants’ health-related outcomes are systematically reviewed. Third, this dissertation explores a provincial health system without universal prescription drug coverage to establish associations between health services use, prescription drug coverage and immigrant category. Finally, given migrants experience health outcome and health services utilization disparities, an exploratory analysis of factors that impede or assist migrants’ access to prescription drugs is conducted to uncover how these factors influence their health. While each study is distinct, together, these chapters build on each other using mixed methodological approaches to identify ways that address health financing policy gaps to reduce health inequities, build inclusive and cost-effective health systems and strengthen global health security. / Dissertation / Doctor of Philosophy (PhD)

Given the general poor state of health care and the devastating effect of user fee, the National Health Insurance Scheme (NHIS) was instituted as a health financing policy with the main purpose to ensure universal access for all Nigerians. However, since NHIS became operational in 2005, only members of scheme are able to access health care both in the public and in private sectors, representing about 3% of Nigerian population. The thesis therefore examines the design and implementation policy of NHIS in Oyo state, Nigeria. Key design issues conceptual framework guides the analysis of data. The framework identifies three health interrelated financing functions namely revenue collection, risk pooling and purchasing. Data was collected from the NHIS officials, employees of the Health Maintenance Organisations (HMOs) and the Health Care Providers (HCPs) using key informant interview. In addition, in-depth interview and semi structure questionnaire were used to gather data from the enrolees and the nonenrolees. Empirical findings show that NHIS is fragmented given the existence of several programmes. In addition, there is no risk pooling neither redistribution of funds in the scheme. Revenue generated through contributions from the enrolees was not sufficient to fund health care services received by the beneficiaries because of the small percentage of the Nigerian population that the scheme covers. Further findings indicate that enrolled federal civil servants have not commenced monthly contribution to the NHIS. They pay 10% as co-pay in every consultation while federal government as an employer subsidised by 90%. Majority (76.8%) of the respondents agreed that they were financially protected from catastrophic spending. However, the overall benefit package was rated moderate because of exclusion of some priority and essential health care needs. Although above half (57%) of the respondents concurred that HMOs are accessible, in the overall, (47.6%) of the respondents were not satisfied with their services. In the case of the HCPs, majority (61.9%) of the respondents claimed that there is no excessive waiting time for consultation. Furthermore, (64.3%) rated their interpersonal relationship with the HCPs to be good. However, more than half of the respondents (54%) disagreed on availability of prescribed drugs in NHIS accredited health facilities. For the nonenrolees, findings show that most of the respondents (72.9%) were willing to enrol, but significant proportion (47.5%) indicated financial constraint as impediment to enrolment. / Sociology / D. Phil. (Sociology)