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Strengthening Micro Health insurance Units for the Poor in India:

Strengthening Micro Health insurance Units for the Poor in India

OBJECTIVES:

OBJECTIVES To study various factors responsible for Growth of micro insurance . To examine need of health insurance in India To study the various development of micro units To know the various sources of funding of micro units To examine the outcome of micro units

HEALTH COVERAGE PROBLEM :

HEALTH COVERAGE PROBLEM Only 5% of poor population is insured Lack of awareness in rural sector of insurance schemes High cost and charges

THE MAIN ISSUES OF HEALTH INSURANCE IN INDIA :

THE MAIN ISSUES OF HEALTH INSURANCE IN INDIA Barriers to entry into the market of insurance Insufficient pooling of healthcare expenditure Limited possibilities to buy health insurance Low-cost (and low quality) services for the poor

HEALTH INSURANCE FOR THE POOR:

HEALTH INSURANCE FOR THE POOR A large majority of poor people are exposed to severe financial risk due to healthcare Health insurance is usually unavailable at affordable cost An emerging fall-back solution includes “ Micro health insurance units ” (MIUs)

A STRATEGIC VIEW OF THE PROBLEM:

A STRATEGIC VIEW OF THE PROBLEM Who should be responsible for solutions? What solutions cost least? What solution entails the lowest risk of failure? What solution can build on local and sustainable structures? What solution is actionable quickly?

STRENGTHENING OF MHI DEPENDS :

STRENGTHENING OF MHI DEPENDS Realizing the need for the Micro Health insurance product Awareness about the MHI product Availability of the suitable MHI product Affordable price Reliable assured service by the intermediary Trust on the insurance company Period of collection of premium Availability of credit for payment of the premium. Removal of social, cultural and environmental barriers

MICRO HEALTH INSURANCE UNITS:

MICRO HEALTH INSURANCE UNITS .“Community-based health financing (CBHF)” “Mutual Health Insurance (MHI)” Micro health insurance broadly covers financing schemes that have three key features: Community control Voluntary membership Prepayment for health care by community members

MIUS WORKING:

MIUS WORKING Community Scheme Pay contributions Provide health services Pays providers Healthcare providers Insureds

COMPARATIVE ADVANTAGE FOR POOR/ RURAL POPULATIONS (BASED ON ARGUMENTS DEVELOPED BY IRDA) :

COMPARATIVE ADVANTAGE FOR POOR/ RURAL POPULATIONS (BASED ON ARGUMENTS DEVELOPED BY IRDA) Characteristic Commercial insurer Major insurer + MIUs as agents MIUs stand alone MIUs +SR Knowledge of /Responsiveness to local priorities none + ++ +++ Knowledge of/ Adapting to local ability to pay none + ++ +++ Concern with equity/equality among all insured + + +++ +++ Ability to gain trust of clients + ++ ++ +++ Keep administrative costs down -- --- -- - Mobilizing & training local talent none + ++ +++ Mobilizing social capital to get buy-in none ++ +++ +++ Interaction with local providers + ++ ++ +++ Reserve capital needed for underwriting - - --- - Pooling of risks and resources +++ +++ ++ +++

Slide 11:

Legend: MIUs = Micro health insurance units SR = Social Re Values: + = good – = bad ++ = better – – = worse +++ = best – – – = worst

ESTIMATES OF COVERAGE BY MICRO HEALTH INSURANCE UNITS IN INDIA :

ESTIMATES OF COVERAGE BY MICRO HEALTH INSURANCE UNITS IN INDIA 20 schemes Tamil nadu (accord) ashwini Gujarat (sewa) sewa bank Maharashtra etc

GENRAL MODEL OF INSURANCE SCHEMES:

GENRAL MODEL OF INSURANCE SCHEMES

CORPORATE STRUCTURE OF MICRO HEALTH INSURANCE UNITS :

CORPORATE STRUCTURE OF MICRO HEALTH INSURANCE UNITS Partner –Agent Model Mutual model Friendly Society model Provider-driven Schemes

MIUS NEED REINSURANCE:

MIUS NEED REINSURANCE Community Scheme Pay contributions Provide health services Pays providers Pay reinsurance premiums Covers outlier risk, provides surplus relief And technical assistance SOCIAL RE Healthcare providers Insureds

EFFECT OF SOCIAL -RE:

EFFECT OF SOCIAL -RE Pooling of resources  lower unit price = better purchasing Diversification of risks  lower variance = lower average costs per case More health spending  more supply of healthcare Lower variance & unit cost  cheaper health insurance premiums = affordable health care

RECOMMENDATIONS:

RECOMMENDATIONS Supporting flexible benefit package according to local priorities and ability Building capacity to provide knowledge transfer. Setting up a reinsurance facility. Small ticket size

SOCIAL -RE:

SOCIAL -RE Grassroots role : agent (recruit members, collect premiums, front-office, health information, contracting) National intermediary role : regulator, underwriter (back office, claims, actuarial, accounting, audit) Financial sector : financier (raise capital, engage governments ) to subsidize reinsurance

SUMMARY:

SUMMARY There is growing evidence that Micro health insurance units (MIUs) make a real difference MIUs need capital to manage risk. . Reinsurance is cheaper & better alternative to holding contingency reserves. The facility that will accept to reinsure MIUs needs to be developed.

CONCLUSION:

CONCLUSION Community building NGO staff must be trained Mobilizing large geographically problem Transferability of schemes “Health Care Backbone” Create awareness SHG

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