[Subgroup-health] Rép. : Re: 2nd discussion - Workshop during CGAP Conferenceon Microinsurance

[Denis Garand]

Dear all

 

Valerie you bring up some interesting points especially on the supply side.
The delivery of health care can change by looking at new ways of providing
health such as is done by several providers in Bangladesh, BRAC, Grameen
Kaylan, Gonoshasthaya Kendra (Dr Zafrullah Chowdhury) and Dhaka Community
Hospital.  These providers have all made progress in making the provision of
service more efficient and controlling quality. Adding this component to the
discuss would be helpful.

 

Regards,

 

Denis Garand

denis at garandnet.net

(306) 591-0783, Toll free\sans frais (866) 591-0783 , Canada

-----Original Message-----
From: subgroup-health-bounces at microfinance.lu
[mailto:subgroup-health-bounces at microfinance.lu] On Behalf Of Valérie
Schmitt-Diabate
Sent: May 8, 2008 6:44 AM
To: subgroup-health at microfinance.lu
Subject: [Subgroup-health] Rép. : Re: 2nd discussion - Workshop during CGAP
Conferenceon Microinsurance

 

Dear all,

Many thanks for this very interesting discussion!

 

If I understand well the topic of our roundtable at the 2008 MI Conference
could be on the design and provision of the best possible benefit package,
which should at the same time

1) respond to the priority protection needs of the insured (otherwise the
product is not very attractive) >> idea of inclusive benefit packages

2) cover HC services that are available (it is therefore important to
negociate with HC providers and the Ministry of health to make sure that the
supply matches the demand)

3) be affordable (it is therefore important to contain costs through various
means : negotiations with pharmaceutical industry, negotiations with HC
providers on the treatment protocols to rationalize the utilization of the
HC services, etc.)

 

In Western Africa where the STEP programme has a long experience of
supporting microinsurance schemes, most benefit packages which are
affordable are far from being "inclusive". Among Senegalese rural workers
for instance the affordable amount of premium is assessed to be of 3 500 CFA
Francs per person per year whereas a basic health insurance package
including both primary and secondary health care in public health structures
would cost 13 000 CFA Francs (20 Euros or 30 US dollars).

 

The question is then the following : If we want to provide inclusive benefit
packages how are we going to finance them ? 

Is it the State's responsibility to finance a share of the benefit package
for the poorest members of the society? For instance in the case of the
Yeshasvini scheme the State of Karnataka covers a share of the scheme's
expenditure.

Is it the responsibility of other players / stakeholders such as the
corporate sector to subsidize health insurance for the poorest? For instance
in Jharkand the corporate sector (TATA, MITAL) committed themselves to
contribute with huge amounts of money to cover the social protection needs
of the poor.

Is it the responsibility of the international community through allocation
of global funds to the financing of at least a share of the premiums of the
poorest? For instance in Rwanda the global fund for malaria, HIV/AIDS and
tuberculosis is partly used to finance the health insurance premiums of
certain categories of insured people.

 

The second element (availability of health care services) is also very
important and meets one of the key questions mentionned in the mission
statement "How to develop and manage relashionship with health care sector
(contracting)". It is nonsense to provide a benefit package including
services that are not available in existing health centers / hospitals at an
acceptable level of quality. To grant availability of services it is
important to develop networks of accredited hospitals (like in India) or to
negociate at all levels of the health pyramid (like in western Africa). 

This matching between health supply and demand is all the more important
when nation wide health insurance schemes including a community based
component are developped; it is the case today in India, in Rwanda, in
Senegal, in Colombia. In such situations the allocation of resources in the
health sector (decided at the level of the ministry of health) needs to be
coherent with the benefit package.

 

So I guess that if our subject focuses on the design and provision of the
best possible benefit package we should also make sure that these questions
(on the affordability of the package and therefore on the mobilization of
additional resources, and on the availability of health care services and
relationship with the health sector) are addressed.

 

Thanks in advance for your reactions and comments,

Valérie

 

 

>>> David Dror <davidmdror at yahoo.com> 04/22/08 3:14 pm >>>

Deal all,

John Pott has raised an important issue, that of the link between cost
structure and what health insurance actually covers (or could cover). When
aggregate average costs are considered, medicines are without doubt more
costly than hospitalisations. Yet, as we know, most low-cost micro health
insurance schemes put the emphasis on covering hospitalisations, but
excluding outpatient medicines and many other outpatient services/goods.
This raises two essential issues: one: better ways to include in the benefit
package the kind of services/goods that the clients need and would be
willing to pay for; and secondly: what optimal way to match income &
expenditure: should we emphasize mainly cost containment and restrictions of
benefits (which really means exclusions, limitations, caps), or should we
give attention mainly to contracting with providers (but then, is this the
role of insurers and are they really best trained to do so?), or should we
rather stress more inclusive rather than exclusive methods, for instance
getting better financial results through effective guidance of members where
they can get quality services that are also cost-effective (following the
model of the 24/7 hotline put into place by Uplift Health) and better
pooling across many micro insuraqnce schemes?

The exclusion-based model has been less effective simply because it gives
more attention to the concerns of the insurer and less to those of the
clients/members. We have some evidence that trusting the members to make
judicious choice pays off in many ways. If they will seek to include
medicines, and would be willing to pay a higher premium for that, we may
come across as more credibly catering to their needs.

In my view, this thinking should inspire what we plan to do within all the
sub-groups.

 

One final note on medicines: based on a study by Kotwani et al on cost and
availability of medicines in India (published in the Indian Journal of
Medical research 2007), generics are not cheaper in all cases than branded,
as the cost to the end user reflects not only production and R&D costs but
also the cost of distribution, which are high in medicines. The other
serious concern is counterfiet drugs, which -no matter how cheap - are the
most expensive, and end customers or micro insurers may be ineffective in
circumventing... so quality of care is also important to the clients, not
just cost.

 

Hope this helps focus the discussion toward customer-orintation of our
deliberations.

 

Regards,

david Dror   

mukti bosco <mukti.bosco at healing-fields.org> wrote:

Dear All,
i agree with john.  Cost of medicines is a very important and critical
element in lowering relapses as well as loss of working days for the poor.
We need to look into different ways that have been used to tackle this.
The other important aspect is how do we bring in Out Patient care into
Insurance? Many of the illnesses requiring hospitalisation now can be
avoided and this reduces work days lost for the poor as they cannot afford
to fall ill.
Rgds
mukti bosco
Secretary General
Healing Fields Foundation
Hyderabad
india

----- Original Message ----
From: John Pott <john.pott.ext at akdn.org>
To: Valérie Schmitt-Diabate <schmitt-diabate at ilo.org>;
subgroup-health at microfinance.lu
Sent: Monday, April 21, 2008 2:28:06 AM
Subject: Re: [Subgroup-health] 2nd discussion - Workshop during CGAP
Conferenceon Microinsurance

Dear Fellow Work Group Members,

 

The cost of medicines is a very major concern of the micromarket because in
many instances for them more than 50% of their out of pocket expenditures
for health constitute payment for medicines.

 

Perhaps I am jumping the gun, but I would like to suggest within the
innovative products section - strategies to design an effective low cost
benefit package - there should be an activity component that comprises
taking an inventory of the approaches that have been adopted so far by
insurers to lowering the costs of medicines component of a health package.

 

 The stronger purchasing power of an insurer with a large number of insured
( eg. medicine discounts for members at hospitals and pharmacies); the
ability of the insurer to wield some control over the prescribing practices
(e.g. strong pressure for generics which are usually so much cheaper than
branded); as well as the ability through education of its insured membership
to influence patient behaviour and expectations ( e.g. not to expect that
risky, expensive and unnecessary vitamin injection at every visit) should I
believe yield promising cost savings and therefore lower premiums for our
market.

 

With best regards

 

John Pott

Project Manager 

AKAM Microinsurance Initiative,

1-3 Avenue de la Paix,

1211 Geneva 2,

Switzerland

Geneva Office Phone 00 41 22 909 7355

Swiss based Mobile phone 00 41 79 2011 468 

email: john.pott.ext at akdn.org

 


  _____  


From: subgroup-health-bounces at microfinance.lu on behalf of Valérie
Schmitt-Diabate
Sent: Fri 4/18/2008 15:53
To: subgroup-health at microfinance.lu
Subject: [Subgroup-health] 2nd discussion - Workshop during CGAP
Conferenceon Microinsurance

Dear workgroup members, 

We have done already some progress in the joint definition of a mission
statement and key questions that we want to adress in our Subgroup on Health
Microinsurance (the second round of comments is arriving ; a final version
will be ready beginning of May).

This mission statement is the starting point for the planning of concrete
activities of our workgroup. In november the CGAP Conference on
Microinsurance will be held in Colombia and we think it is a good
opportunity for our workgroup to :

- meet on this occasion (organize an "internal" working session of the
health microinsurance subgroup)

- organize a workshop / round table on one of the key questions mentioned in
our mission statement. 

We would like the workshop to be a joint activity of the workgroup and ask
for your input in its design and realisation. 

The topic of our workshop should fit in one of the 4 themes of the
conference: 1) technology, 2) capacity building, 3) regulation, supervision
and policy issues, 4) innovative products and distribution channels

Combining these themes with the key questions of our mission statement we
come up with the following suggestions for the topic of the workshop:

Regulation, supervision and policy issues 

*   The role of HMI in national health systems: Initiatives of national
governments to extend coverage of health services through HMI (With cases of
for example India, Colombia, Ghana, Peru). 

Innovative products and distribution channels 

*   Strategies to design of an essential cost effective benefit package
adapted to the specific needs and priorities (economically and socially) of
the targeted groups 

*   Models of providing health microinsurance: the role of social security
institutions, CBHI, MFIs, insurance companies and cooperatives. 

*   Microinsurance and provision of health: improving health care quality
through innovative models of purchasing services 

Off course, other suggestions are welcome !!! 

Questions we would like you to answer: 

*   What should be the central topic of the workshop (choose one of options
above, or suggest another topic) ? 

*   Suggestions on speakers and cases 

*   Input your organization is able to give to the workshop (case studies,
documents, exponents, methodology..) 

We would like you to give your input before the 1st of May. We then will
present the results of this election and propose a workplan to prepare the
workshop. 

Harrie Oostingh, Oxfam Novib and Valerie Schmitt, ILO / STEP





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Hon. Professor of health insurance, Erasmus University Rotterdam

Chairman, the Micro Insurance Academy, New Delhi
(www.microinsuranceacademy.org <http://www.microinsuranceacademy.org/> )

Access my publications freely at: http://ssrn.com/author=183410 (Social
Science Research Network) 

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