Madagascar’s health insurance system is a mix of limited public coverage and a growing presence of private international insurers. While both public and private health insurance aim to improve access to medical services, they differ significantly in scope, quality, affordability, and target populations.
Key Differences
One of the most fundamental differences lies in the scope of coverage. Public health insurance schemes like the National Social Insurance Fund (CNaPS) and community-based plans such as AMBC and IRAY offer only basic health services. These include outpatient care, maternity services, vaccinations, and hospitalization. In contrast, private health insurance—offered by companies like MSH International, AXA, and Cigna—typically covers a wider range of services, including advanced diagnostics, elective treatments, and even international medical evacuation.
Target population is another area of divergence. Public schemes mainly serve salaried employees in the formal sector, along with small efforts to include informal and rural workers. For example, CNaPS covers only about 5% of the population, with goals to reach 25% in the coming years. Community-based initiatives also strive to reach marginalized and rural groups. Private insurance, however, is largely used by expatriates, high-income earners, and those seeking higher standards of care.
Quality and accessibility also vary greatly. Public healthcare, though theoretically universal, is often underfunded and limited in infrastructure, particularly in rural areas. Facilities may lack modern equipment and suffer from staff shortages. On the other hand, private insurance holders usually access faster services, modern medical equipment, and international-level care—though mainly in urban centers or abroad via evacuation benefits.
Moreover, the claims process differs significantly. Public systems tend to be more bureaucratic and paper-based, while private insurers prioritize digital efficiency. For example, April International and MSH International offer user-friendly apps, paperless claims, and 24/7 customer support.
Key Similarities
Despite these differences, there are notable similarities. Both public and private systems are working to improve inclusivity. Public mutual insurance schemes like IRAY and AMBC aim to reach informal workers, while some private insurers offer tiered or customizable plans to accommodate different budgets and needs.
Another similarity is the growing recognition of medical evacuation needs. While not commonly included in public plans, this is a critical feature in most private insurance packages due to Madagascar’s limited high-level healthcare facilities. Both sectors acknowledge the importance of emergency care access and are taking steps to address gaps in rural areas.
Top Public Health Insurances in Madagascar
Madagascar’s healthcare system has faced consistent challenges in infrastructure, funding, and service accessibility. Public health insurance coverage remains limited, with the majority of the population relying on out-of-pocket payments or free services offered through donor-supported public health programs. Madagascar does not have a robust, nationwide public health insurance scheme akin to those in wealthier nations, but the following represents the key public and semi-public health coverage frameworks that exist in the country today.
1. Caisse Nationale de Prévoyance Sociale (CNAPS)(Official website: https://www.cnaps.mg/)
- Cost: Contributions are made jointly by employers and employees. Typically, employees contribute around 1%–2% of their salary, while employers contribute approximately 13%.
- Available Services/Coverage Features: CNAPS covers a range of social security benefits, including maternity leave, workplace injuries, pensions, and some healthcare reimbursements. The healthcare aspect, however, is not comprehensive and often covers only specific medical situations or workplace-related incidents.
- Open for All or Limited: CNAPS is primarily open to formal sector employees. Informal sector workers, who make up the majority of the population, are generally excluded.
- Core Financial Features: CNAPS acts more as a social security safety net than a full health insurance provider. The financial support is primarily post-treatment reimbursement or direct compensation for work-related injuries.
- Consumer Satisfaction Score: CNAPS receives a moderate satisfaction score—around 6.0/10—due to limited healthcare benefits, long reimbursement timelines, and low public awareness.
2. Ministry of Public Health Free Service Programs(Official website: https://www.sante.gov.mg/)
- Cost: Free of charge, funded by the government and international donors such as WHO, UNICEF, and USAID.
- Available Services/Coverage Features: Includes immunization programs, maternal and child health services, basic consultations at public clinics, and treatment of communicable diseases like malaria and tuberculosis.
- Open for All or Limited: Open to all citizens, particularly targeting vulnerable populations including children under five, pregnant women, and rural communities.
- Core Financial Features: As a donor-supported initiative, there are no premiums or fees. However, the sustainability of services is contingent on external funding and can be inconsistent.
- Consumer Satisfaction Score: These programs score approximately 7.5/10 due to accessibility and cost-free services, although availability of medicines and medical staff varies widely.
3. Mutuelle de Santé (Community-Based Health Insurance Programs)(Official website: https://iray-mutuelle.org/)
- Cost: Premiums are very low (often under $10/year) to accommodate rural and low-income populations.
- Available Services/Coverage Features: These mutual health schemes offer partial reimbursement for outpatient visits, prescription drugs, and basic hospital services. Coverage is basic and depends on the financial pool available in the community.
- Open for All or Limited: Available in select regions and limited to those who enroll in community cooperatives or development programs.
- Core Financial Features: Based on a pooling system where members contribute to a communal fund. Services are delivered through public health centers with partial cost-sharing.
- Consumer Satisfaction Score: Scores around 6.5/10, with users appreciating affordability but often frustrated by limited service scope and weak administrative capacity.
Top Private Health Insurances in Madagascar
Private health insurance in Madagascar is relatively underdeveloped compared to other regions due to the country’s economic structure and limited purchasing power among the general population. The private insurance sector is primarily geared toward wealthier individuals, expatriates, and employees of international organizations or large companies. As of now, Madagascar has a small number of private health insurance providers. Below are the key ones offering private health insurance services.
1. Assurances ARO (Aro Assurance)(Official website: https://www.aro.mg/)
- Cost: Premiums range from MGA 500,000 to MGA 2,000,000 annually (approximately $100–$400), depending on age, health status, and coverage tier.
- Available Services/Coverage Features: Offers medical consultations, hospital stays, surgery, emergency services, maternity care, and some specialist treatments. Dental and optical care are available as add-ons.
- Open for All or Limited: Open to individuals, families, and corporate clients, but mostly marketed to upper-middle class and expatriates.
- Core Financial Features: Operates on reimbursement or direct billing at partner clinics/hospitals. Policies usually have annual limits and co-pays depending on the plan level.
- Consumer Satisfaction Score: Approximately 7.0/10. Customers value ARO’s reliability and range of services, but some report administrative delays and limited access outside major cities.
2. Ny Havana Insurance(Official website: https://www.nyhavana.mg/)
- Cost: Premiums range from MGA 400,000 to MGA 1,800,000 annually (~$80–$360), based on plan type and risk profile.
- Available Services/Coverage Features: Coverage includes outpatient and inpatient care, emergency treatments, surgeries, and access to private clinics. Maternity and diagnostic imaging services are available on mid to high-tier plans.
- Open for All or Limited: Generally open to all, with a focus on professionals, civil servants, and company packages.
- Core Financial Features: Uses a mixed model of reimbursement and direct settlement. Premiums are typically paid annually or semi-annually.
- Consumer Satisfaction Score: Roughly 6.8/10. Appreciated for decent network coverage and mid-tier pricing, though claims processing time is a noted concern.
3. Saham Assurance Madagascar(Official website: https://mg.sanlam.com/)
- Cost: Premiums start around MGA 600,000/year (~$120), rising based on coverage and age.
- Available Services/Coverage Features: Offers a comprehensive medical package including consultations, hospitalization, specialist visits, surgical procedures, maternity, and optional coverage for chronic conditions and overseas emergencies.
- Open for All or Limited: Available to both individuals and corporate clients, although premiums may be out of reach for average income earners.
- Core Financial Features: Claims are usually handled via reimbursement; however, preferred provider networks allow for some direct billing.
- Consumer Satisfaction Score: Scores about 7.2/10, particularly favored by business clients for its international affiliations and relatively smooth reimbursement system.
4. Allianz Madagascar(Official website: https://allianz.mg/)
- Cost: Premiums start at approximately MGA 800,000 (~$160) annually, depending on age, health history, and desired coverage.
- Available Services/Coverage Features: Known for international-grade policies, Allianz covers general and specialist care, emergency evacuations, surgical procedures, dental, vision, and maternity (with waiting periods).
- Open for All or Limited: Primarily targeted at expatriates and multinational corporate clients, with limited marketing to the general public.
- Core Financial Features: Offers tiered plans with both reimbursement and direct payment options at designated facilities. International portability is a key feature.
Consumer Satisfaction Score: High, with around 8.0/10 due to international service standards, though pricing is a barrier for most locals.
READ MORE: Private and public health insurance of Ukraine (Make informed choices)
