[Subgroup-health] new member comment

[Denis Garand]

Dear Bill

 

Many of the elements you propose are valuable for Micro health insurance.
The one area that it would have a challenge is that the vast majority of
people in developing economies have no employer. This makes implementation
much more difficult. It is a mystery to me why mutual health organizations
have not been very present in a country such as India. Hopefully your
intervention will inspire a development of mutual health models.

 

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 bill mcpate
Sent: May 14, 2008 4:31 AM
To: subgroup-health at microfinance.lu
Subject: [Subgroup-health] new member comment

 

Dear All,

I am new to the group but have a strong belief that the experience of the
health mutual I managed in the UK could be of value to the group's efforts
to find solutions to delivering healthcare in developing countries. This may
not be the best time to introduce detail to the discussions of the subgroup
but if you will allow me to "get it off my chest" it will also serve as an
introduction to my background.

The Benenden Healthcare Society is a mutual healthcare organisation
providing affordable health services to almost 1 million members in the UK
who can be broadly identified as public servants and their families. 

The Society was first formed in 1905 to provide sanatorium care for
tuberculosis or TB.  The type and method of care was not specified and
discretion was applied by the elected members to determine the most
appropriate service for members with TB. As vaccines and treatments were
developed to deal with TB, the services changed to encompass other medical
conditions and a wider benefit range. Since the formation of the National
Health Service in 1948, these services have supplemented the care available
through the state system. The benefits are discretionary and supported by an
ethos of trust rather than contractual and supported by insurance
principles. 

Amongst the issues you have discussed to date is the dilemma between
concentrating on principles and detail. Perhaps we need to concentrate on
both. 

The principles/values of the mutual health model will be familiar to you
all- Solidarity, Autonomous management, Not for Profit orientation,
Inclusivity and non-selection.

However, there are a variety of ways that a health system can be designed to
utilise these principles.  The design features in the Benenden model appear
in other systems but the way that they combine seem to offer a unique
solution:

The community of members is based upon groups of workers. 

The affinity between member of staff provides the necessary solidarity to
support universal discretionary benefits and collective action.  Our group,
in 1905, comprised postal workers. As their confidence grew in managing the
fund, this was widened to other groups of workers and family members. Cotton
workers might be a typical start up community today, developing to include
family members later.

The Employer recovers contributions on the Employee's behalf.

Providing the workers receive payment through some form of payroll system,
deductions from pay is the mechanism used for collecting contributions to
the mutual fund. This overcomes the problem experienced by some other forms
of micro insurance of high costs for premium collection. Employers will be
motivated to cooperate in this way by the attraction of a healthier
workforce. (It is accepted that the dependence upon a payment system for
cost control will limit the scope of application for this model). 

The Community decide themselves what services they wish to provide.    

The postal community in the UK in 1905 chose cover for TB care because
purchasing care in a sanatorium was only affordable by the rich so their
prospects of surviving TB were poor. There are numerous candidate conditions
in the developing world, for example TB, malaria or AIDS.  The range of
services for those conditions would also be a matter of member choice. It
may be education, diagnostic services or clinic facilities that they deem
most important. Their health service choices will be based not only on need
but also affordability. Affordability and therefore inclusivity can be
prioritised in this model because the benefits are discretionary. 

Suitability for Developing Countries

There are a number of reasons why I remain convinced of the suitability of
this model for developing countries:

a)      In contrast to dependence upon the external efforts of others, such
as the state or donor countries, the members take responsibility for
organising this form of health system themselves.  As widely recognised,
when people are engaged in looking after their own health the outcomes are
improved. 

b)      Compared to the enormity of the health challenge facing many
countries, this model can be introduced with a narrow benefit focus, such as
a single disease. It has the natural potential to grow and take on a wider
range of health services over time. 

c)       The trust and accountability inherent in the model will enable
funds to be safely targeted on the changing needs of members. Governments
can also trust this model to fit in with the development of state health
services.

You have more experience than me in the problems of the developing world so
please let me know why you think that this model may not be appropriate.
Returning to Valerie's e-mail of 8th May could this be one solution to the
search for a model that "responds to the priority protection needs of the
insured" that is also "inclusive"," available" and "affordable"?   

Bill McPate

The Benenden Healthcare Society

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