Review of the quality, effectiveness, efficiency and sustainability of health insurance schemes in the United Nations system organizations – JIU/REP/2023/9

The Joint Inspection Unit is pleased to announce the release of its report on health insurance schemes for active and retired staff in the United Nations system organizations, prepared by Inspector Jesús S. Miranda-Hita. This topic was last covered by the JIU in 2007.

Health insurance is an essential part of the compensation package provided to the international organizations. While it is part of the obligation of the organizations to establish a social security scheme for their staff, retirees and families, the review found that in all cases except one, governing bodies and legislative organs have played a very limited role in health insurance policymaking, which has resulted in the existence of 26 different health insurance schemes in the 28 JIU participating organizations with different coverage and benefits.

While having one health insurance scheme for the United Nations system is not feasible at the present time and could not be effective or adequate to meet the differing needs or preferences of the staff, the absence of a minimum set of principles, requirements or standards for health insurance schemes poses a challenge to promote coherence among the schemes and determine their adequacy.  Although most plans have a mechanism in place to engage staff and retirees in health insurance policymaking, the review found that locally recruited staff and retiree outside headquarters locations are not sufficiently engaged in the process.

The 26 health insurance schemes apply varying eligibility criteria for staff, retirees and their family members and associated protected persons. The unharmonized eligibility criteria, especially for those who receive subsidized premium rates from their organizations, create unequal access to health insurance coverage for active and retired staff and their family members, and demonstrate an inequitable use of public funding. The solidarity models underpinning the health insurance schemes to ensure equitable distribution of premiums and risks are also not well aligned. Therefore, there is room for a system-wide approach to create a set of contribution-setting principles that could foster harmonization and comparability and promote equity and solidarity.

Even though after-service health insurance liabilities have been on the agenda of governing bodies, the United Nations System Chief Executives Board for Coordination and external auditors as a system-wide issue since the 1990s, funding those liabilities remains an unachieved goal, with only 31 per cent already funded. The choice of the pay-as-you-accrue method is not only a matter of sound financial management or long-term financial sustainability, but also of transparency and efficiency in legislative budget discussions.

Access the full report here

Access the review highlights here

Access the appendices: the comparative study of 26 health insurance schemes in JIU’s participating organizations and the results from the global staff survey on staff health insurance here