Innovations for improving access to quality health care The prospects for municipal health insurance in Guatemala

By Gary Bland, Lucrecia Peinado, Christin Ashley Stewart

Municipal insurance–a collective compact in which municipal government is the lead actor in designing, delivering, and supervising a health care financing arrangement—is considered by some Guatemalans as a potential new avenue for improving financial protection against rising costs and improved access to quality health care. This brief presents a political economy analysis of the prospects for the adoption of municipal insurance in Guatemala. Municipal insurance has so far been tried only once, in 2015, by the large suburban municipality of Villa Nueva. Drawing from the Villa Nueva experience, based on interviews with nearly 30 key informants, this brief examines the potential obstacles to municipal insurance reform as well as leading factors favoring its introduction. Consistent health ministry support and equity concerns are potential limitations, for example, while decentralization and the recent emergence of creative insurance products are likely to be supportive. This brief then concludes with consideration of the policy implications of such a reform. We also offer a series of policy recommendations for policymakers and practitioners who may be looking to implement municipal insurance reform.


Bland, G., Peinado, L., & Stewart, C. A. (2017). Innovations for improving access to quality health care: The prospects for municipal health insurance in Guatemala. (RTI Press Publication No. PB-0016-1712). Research Triangle Park, NC: RTI Press.

© 2019 RTI International. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


Gary BlandGary Bland, PhD, is a Fellow in Governance at RTI International.

Lucrecia PeinadoLucrecia Peinado, MD, is a public health consultant.

Christin Ashley StewartChristin Stewart, MPH, is a health systems specialist at RTI International.

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