These issues are particularly salient since enrolees are not able to choose their insurer, maintain their insurer given a change in employment, or receive care free-at-the-point-of-service from providers who are outside of their scheme (w'ho may be perceived as offering higher quality services, be more conveniently located, or have more flexible working hours). This leads many to pay out-of-pocket to receive services in the private sector. While creation of a single pooled fund that distributes resources across schemes according to needs may be a long-term goal for some stakeholders, in practice there are a number of important barriers to attaining this in the short term, including the presence of a large informal labour force that impedes revenue generation, the long-standing position of social security schemes as distinct societal institutions. Nevertheless, a structurally-defined single pooled fund is not an absolute necessity, in practice, the policy objective of improved equity of access can be achieved through alternative incremental financing reforms that functionally bring the schemes closer together from the user’s point of view.