Threading the needle: How to make health microinsurance work

Transcription

1 Threading the needle: How to make health microinsurance work 10 th International Microinsurance Conference Jeanna Holtz Mexico City, November 2014

2 ILO s Impact Insurance Facility Based on research and practice based learning and innovation > 60 innovation partners 20 focused on health How to address challenges to pay for and access health care for low income households? Abt Associates pg 2

3 Health and poverty go hand in hand In India: % 5 above poverty line fall below because of health expenses ( 35 million people) 1 in every 10 rural households becomes poor or poorer due to health Abt Associates pg 3

4 What has to go right Scale Manage costs Subsidy Margin Admin Benefits Traditional allocation of premium is possible at scale Admin The upside down triangle (when things are wrong) Benefits Margin Abt Associates pg 4 Sources: 1) Koven et al., 2013 MILK brief #26; 2) Koven and McCord, Best s Review, Oct 2014; 3) Weilant, M. Study on drivers of viability for HMI schemes (forthcoming )

5 Getting it right Focus on 3 Ps Client value Viability Products Partnerships Processes Abt Associates pg 5

6 3Ps: Products Product design Value-added services Products Partners Processes Link to savings Client Value Understandable Start simple Mandatory Complement insurance Tangible Lower OOP expenditure Ease liquidity constraints Finance OOP costs, premiums Viability More efficient, accurate claims Easier to sell Reduce claims Enhance sales, persistency Enhance persistency Cross-selling Abt Associates pg 6

7 Uplift Mutuals Community based health insurance ,000 clients in 7 mutuals Premium average $2.50 per person, $6.70 per family Hospitalization benefits: $250 per family per year Value-added services Mostly mandatory Nearly viable (historical subsidy for operating costs) Abt Associates pg 7

8 Uplift Mutuals - product Product design Value-added svcs Link to savings Streamlined benefits and contributions Mandatory (mostly) Health camps part of product launch Savings product linked to HMI Fund premiums Abt Associates pg 8

9 3Ps: Processes Partners Products Processes User-friendly Technology Monitoring Client Value Fast turnaround Easy, flexible Facilitate premium collection Cashless Quality assurance Feedback mechanism Viability Promote enrolment Lower acquisition costs Cost-effective Reduce fraud Reduce fraud Product, process improvements Abt Associates pg 9

10 Uplift Mutuals - Processes User friendly Technology Monitoring 24/7 helpline Simpler claims process Client reminders Web-based MIS Note: not cashless SoPs Analyze claims Abt Associates pg 10

11 3Ps: Partnerships Partners Products Processes PPPs, subsidy Distribution Health Providers Client Value Expand coverage Lower OOP (subsidy) Affordable High-touch support Convenient, trusted points of access Better access & quality Reduce OOP costs Viability Revenue, scale Risk pooling Improve infrastructure New markets Efficient processes (claims) Reduce fraud Lower claim costs Abt Associates pg 11

12 Uplift Mutuals- Partnerships PPPs, subsidy Distribution Health Providers Fills gaps in public programs Donor support has been critical MFI, Community groups Partners to enable savings-linked product Network with > 300 providers Facilitate referrals and monitor Abt Associates pg 12

13 The Ecosystem Insurers Health-care Providers Government Donors Distribution Channels Simple processes Train partners, clients Quality services Efficiency Collaborate with insurers Enabling environment PPPs Subsidies Public health Smart subsidies Mid to long term view Measure impact Ethical Educate clients Promote health Abt Associates pg 13

14 Final thoughts Health insurance can work for the poor but only when carefully orchestrated. Abt Associates pg 14

15 Final thoughts Products - Simple - VAS - Bundle with savings What s next? Better implementation Technology breakthroughs PPPs in support of UHC Partnerships - PPPs, subsidies - Distribution - Health providers Processes - User-friendly - Technology - Monitoring Understanding impact Abt Associates pg 15

16 Thank you! Jeanna Holtz