By Jule Harnack, Intern at RSC
Reviewed by Khald Jomaa and Adv. Rami Qweider
On April 7, 2026, the global community celebrated World Health Day, under the theme “Together for Health: Stand with Science”. This campaign emphasizes that health is not an isolated metric but a product of interconnected systems, evidence-based policy, and collective action. In Jordan, while significant strides have been made in health system reforms, the journey toward health equity remains debated.
Jordan is classified with a relatively high investment in health sector. The Kingdom spends about 7.7% to 8.1% of its GDP on health, which is higher than the international average (around 6%) for countries with similar income levels. Approximately 68% of Jordanians are covered by some form of health insurance. However, this figure masks significant structural variation: a WHO-EMRO analysis shows that coverage is concentrated in the MoH civil scheme (41.7%) and the military/RMS system (38.0%), while private insurance covers only around 12.4% and typically functions as supplementary coverage rather than a full alternative. The launch of the Health Financing Reform and Universal Health Coverage Plan (2024–2030) includes establishing a new insurance fund for uninsured members of the Social Security Corporation to gradually expand coverage to the entire population. Although this plan emerges as an ambitious goal, there is widespread recognition that current coverage structures leave too many behind.
The Core Challenges: Fragmentation and Structural Barriers
Despite these achievements, Jordan’s health financing system is characterized by fragmentation – meaning the parallel coexistence of multiple financing pools across public and private schemes, each operating with different eligibility requirements, benefit packages, and payment mechanisms. The WHO Health Financing Progress Matrix (2024) identifies this as a key obstacle, noting overlapping roles between payers and providers and limited private sector oversight. Since the money is kept in separate “pools,” the system cannot balance itself out. The “cross-subsidy” – whereby contributions from healthier and wealthier members help cover the costs of those who are sicker or poorer – does not happen effectively, leading instead to duplicated structures, higher costs, and poor coordination On top of that, given that most health insurance schemes are linked to formal employment whether in the public or private sector or to affiliation with professional unions, and considering that private-sector 34.5% to 36% of total health expenditure comes directly out of patients’ pockets, making healthcare a significant financial burden for households.
A key clarification is needed here: while health insurance is formally provided for within Jordan’s Social Security Law, its implementation requires a separate Council of Ministers decision and is currently suspended due to high costs – a 2022 proposal to activate it was unsuccessful. The SSC, therefore, covers work-related injuries only. Furthermore, even formal SSC enrollment does not guarantee access to health insurance, since private-sector employers are not legally mandated to provide coverage, leaving it to employer discretion.
This means a large share of the workforce – estimated at 54% in the informal economy according to a recent ministerial statement, and up to 59% by World Bank labour market analysis – is exposed to high out-of-pocket costs and limited safety nets.
Healthcare access is then largely dictated by job status, rather than by medical need, with high healthcare costs and unequal access to insurance meaning that economic vulnerability directly translates into health vulnerability. It is important to note, however, that Jordan maintains additional coverage pathways beyond formal employment: the Health Insurance Administration (HIA) offers a voluntary annual-subscription scheme (with age-based premiums) and targeted cards for NAF beneficiaries and uninsured cancer patients; pregnant women, children under six, and the elderly receive government-subsidized coverage; and the Royal Hashemite Court can issue medical expense coverage for uninsured citizens who cannot afford treatment. These mechanisms are insufficient to close the equity gap, but any analysis of coverage must account for them.
National data from the Jordan Population and Family Health Survey 2023 show clear disparities in insurance coverage across socioeconomic groups. Understanding these inequalities therefore requires a closer look at Jordan’s social security system, which plays a central role in shaping access to employment and social protection.
According to the ILO’s 11th Actuarial Review (2023), the social security system is heading toward a critical turning point. A World Bank analysis estimates that around 60% of contributors retire early; by 2030, pension payouts are expected to exceed contributions collected, and by 2038 to also surpass investment returns. If nothing changes, reserves could run out entirely by 2050. A proposed reform – recently approved for parliamentary consideration – focuses on early retirement rules and contribution years. Contrary to earlier reporting, it does not introduce new mandatory health insurance deductions: activating an SSC health branch would require a separate legal act. In fact, a 2024 SSC regulation moved in the opposite direction, reducing contribution rates for private-sector workers to ease the burden on SMEs and encourage formal employment. As noted by prominent social security researchers, these amendments are likely to be a temporary fix rather than a structural solution, hitting the most vulnerable hardest – workers in small firms, women, and those with interrupted employment histories who are unlikely to accumulate the required 30 years of contributions.
Inequalities Within the Social Security System
Women face systemic barriers in accessing and benefiting from social security, particularly due to their prevalent participation in informal and unpaid work. The gender gap in outcomes is significant: according to a 2024 HelpAge International report, only around 18% of contributory SSC pension recipients are women. A Tamkeen analysis (2023) attributes this to early labour market exit and interrupted contribution histories. At the insurance level, the Jordan Population and Family Health Survey 2023 shows that while approximately 69% of ever-married women aged 15–49 hold some form of insurance, coverage type shifts sharply by wealth quintile – private insurance is concentrated among the highest earners, while lower-income women rely disproportionately on limited public schemes or remain uninsured. This reflects both labour market inequalities and structural features of the system itself. Moreover, pension formulas based on final salaries disproportionately benefit higher-income earners, while lower-income workers receive insufficient benefits. This undermines the redistributive function of social security and limits its effectiveness as a tool for social justice.
Furthermore, Jordan hosts one of the highest numbers of refugees per capita in the world. Most are not formally integrated into Jordan’s national health insurance schemes. It is important to note, however, that refugees in Jordan’s government health facilities are generally treated on the same basis as uninsured Jordanian citizens – meaning the state bears a substantial share of their healthcare costs. A Global Affairs Canada project profile (2025) confirms that government policy is to “provide health services for refugees at the same rate as uninsured Jordanians,” with the Jordan Health Fund for Refugees (JHFR) – a multi-donor mechanism within the Ministry of Health – bridging the remaining cost gap. The WHO’s Health Financing Progress Matrix assessment (2024) notes that smaller schemes serving refugees were explicitly excluded from its core analysis, reflecting how structurally separate these populations remain from national health financing arrangements. Any honest account of health equity in Jordan must include its large refugee population – and acknowledge both the government’s existing commitment and the fragility of a model still dependent on donor continuity.
Looking Ahead: A Moment of Opportunity
Despite the structural challenges outlined above, there are genuine reasons for cautious optimism. Jordan is consistently engaging with reforms and discussions around expanding insurance coverage to uninsured populations, acknowledging that the current system is under pressure and that structural adjustments are necessary to protect future generations. Difficult reforms rarely emerge without social debate, and the fact that these discussions are happening openly – in parliament, in the media, and in civil society – is itself a sign of a functioning reform process.
Conclusive Recommendations
To bridge these gaps and implement a more equitable access to healthcare, while also building a more integrated health insurance coverage, the following actions are recommended:
- Integrate Health and Social Protection: Health financing policies must be synchronized with social security reforms to ensure that losing a job or working informally does not mean losing the right to healthcare. The legal pathway to activate SSC health insurance should be revisited with a realistic fiscal roadmap.
- Formalize and Subsidize: Create specific insurance mechanisms for informal workers and vulnerable groups outside the current SSC framework, reducing reliance on out-of-pocket payments. Existing instruments – HIA voluntary insurance, NAF cards, the Shifa cancer card – should be better publicized and expanded.
- Unified Purchasing and Pooling: Move toward a more consolidated health financing model to reduce waste and ensure fairer distribution of medical resources, as recommended by the WHO-HFPM.
- Include Refugee Populations in National Planning: Transition from a primarily donor-dependent supplementary model to one that systematically incorporates refugee populations into national health planning frameworks through a shared-responsibility approach that engages government, donors, and international actors. This model should recognize that financing and delivering healthcare for refugees is not borne solely by the Government of Jordan, but requires sustained, coordinated international commitment aligned with national systems.
By connecting the missing links, a more integrated and widespread social protection could act as the foundation for health rights, equity, and access. In concrete terms, this means three things:
- first, decoupling health coverage eligibility from employment status by activating and financing the SSC health insurance branch through a dedicated legal and fiscal framework;
- second, consolidating fragmented pools into a unified purchasing mechanism that enables genuine cross-subsidization;
- third, extending and publicizing the existing targeted programmes – HIA voluntary insurance, NAF cards, medical exemptions – so that those currently outside the formal grid can reliably navigate them.
When social safety nets can cover all categories of society, the system moves away from a fragmented approach toward a unified system where the most vulnerable are ensured equitable healthcare access – not as a function of employment status, but as a right.
