Partnering with Microfinance Institutions in Financing Health Care Services for the Informal Sector
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1 Partnering with Microfinance Institutions in Financing Health Care Services for the Informal Sector Wealth and Health: Leveraging Microfinance for Better Health Outcomes Ayodeji Ajiboye, MD June 13,2011
2 Healthcare International (HCI) One of Nigeria s foremost health maintenance organizations Private company incorporated in 1997 Licensed by the National Health Insurance Scheme (NHIS) to provide managed health care services to all sectors of the Nigerian society Operational presence nationwide with over 300,000 lives covered HEALTHCARE INTERNATIONAL HMO004 2
3 The Growth of Enrollee Base HCI initially focused on the organized private sector in trying to provide health insurance to Nigerians The launch of the NHIS for federal civil servants in 2005 became the next big thing Then NHIS for state civil servants, but only few states could fund it Tertiary institutions are currently enjoying attention Very little effort focused on the informal sector before 2008 Pseudo saturation - with < 5% of Nigerians covered!!! HEALTHCARE INTERNATIONAL HMO004 3
4 Motivation for Reaching the Informal Sector 80% of Nigerians work in the informal sector Majority of Nigerians are poor Burden of disease in Nigeria Strong desire to make health care services affordable to all Nigerians Universal health coverage HEALTHCARE INTERNATIONAL HMO004 4
5 The Hurdles Financial incapacity of potential enrollees Low awareness and apathy to health insurance Logistical hurdle of guaranteed and regular premium collection Administrative and logistic burden of reaching the rural areas Failure of MFIs to appreciate importance of clients health on repayment of loans why health insurance? HEALTHCARE INTERNATIONAL HMO004 5
6 Partnering with an MFI - SEAP Started talks in 2005 Aim was to provide affordable health insurance to all members Concluded negotiations in 2010 HCI Dropped premium Customized a new plan (Urban Basic) Renegotiated of fees for hospital services Streamlined coverage and limit Expanded network SEAP Health insurance as condition for loans Marketing of plan Premium collection Administrative responsibilities HEALTHCARE INTERNATIONAL HMO004 6
7 The SEAP Plan Urban Basic Plan Benefits Package General consultation Basic lab test Hospitalization in a general ward Maternity care (ANC, normal delivery, and Caesarian Section) A & E cover nationwide Local evacuation where necessary Minor surgeries Premium N3,500 Benefit limit N100,000 Mechanisms to curb moral hazard? No ceilings on services No copayment No coinsurance No deductibles Only overall benefit limits HEALTHCARE INTERNATIONAL HMO004 7
8 Enrollment Trend Started with 16 enrollees in 2005 Stagnated at about between Rose to over 2,800 in 2010 About 5,000 today HEALTHCARE INTERNATIONAL HMO004 8
9 Advantages of Collaborating with MFIs Guaranteed collection of premium vs. alternative channels: Ere Ijesha community scheme, political schemes Obio scheme with SPDC, Obalende Children scheme Expansion of enrollee base Greater and easier reach to rural areas HEALTHCARE INTERNATIONAL HMO004 9
10 Advantages of Collaborating with MFIs Reduction in administrative overheads Improving and helping to sustain private health facilities especially in rural areas (over 90% of facilities are privately owned) Provides variable alternative to under-funded public facilities (end to no money, no drugs ) HEALTHCARE INTERNATIONAL HMO004 10
11 Areas for Improvement Scope of coverage Individual vs. family plans Extension of reproductive health services beyond antenatal, postnatal, and delivery Family planning Diagnosis and drug treatment of infertility Expansion of scope of coverage Inclusion of common surgical procedures Inclusion of annual medical checks Inclusion of basic optical and dental services Increasing the benefit limit HEALTHCARE INTERNATIONAL HMO004 11
12 Possibilities for Partnership Sponsorship of family members of enrollees Collaborations to expand scope of coverage Funding the inclusion of additional services Voucher schemes Provision of health education materials (translated in local languages) HEALTHCARE INTERNATIONAL HMO004 12
13 Did the Efforts Make Any Impact? HEALTHCARE INTERNATIONAL HMO004 13
14 Thank you HEALTHCARE INTERNATIONAL HMO004
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