[Subgroup-health] 2nd discussion - Workshop during CGAP Conference on Microinsurance

Mon May 19 10:47:57 CEST 2008

Hi Tara,
Does the Rs.750/ cover the actual health expenditure or even after the state
is subsidising it are costs met elsewhere?
rgds
mukti

On 5/19/08, Tara Sinha <taragsinha at yahoo.co.in> wrote:
>
>   The outer limit for the total premium is around Rs. 750, though the
> exact amount depends on the bid by the insurance company.  If we assume that
> the insurance company is paid Rs. 750, then the Rs. 30 comes to 4% of the
> total amount.
>
>
> Tara Sinha
> Ahmedabad
> Ph: 91 79 6632 5402
>
>
>
> --- On *Mon, 19/5/08, Ellis Wohlner <elliswohlner at yahoo.com>* wrote:
>
> From: Ellis Wohlner <elliswohlner at yahoo.com>
> Subject: Re: [Subgroup-health] 2nd discussion - Workshop during CGAP
> Conference on Microinsurance
> To: "Tara Sinha" <taragsinha at yahoo.co.in>, subgroup-health at microfinance.lu,
> "Valérie Schmitt-Diabate" <schmitt-diabate at ilo.org>
> Cc: "Craig Churchill" <churchill at ilo.org>,
> dreinhard at munichre-foundation.org
> Date: Monday, 19 May, 2008, 2:09 PM
>
> Dear Tara,
>
> Very good!
>
> One immediate question that comes to my mind is how much of the overall
> cost of the program is met by the state? Or, turned around, what percentage
> of the total cost is met by the households' fees of Rs. 30?
>
> Kind regards,
>
> Ellis
>
> *Tara Sinha <taragsinha at yahoo.co.in>* wrote:
>
>   Dear All:
>
> Really sorry - forgot the attachment!  Here it is.
>
>
>
> Tara Sinha
> Ahmedabad
> Ph: 91 79 6632 5402
>
>
>
> --- On *Fri, 16/5/08, Valérie Schmitt-Diabate <schmitt-diabate at ilo.org>*wrote:
>
> From: Valérie Schmitt-Diabate <schmitt-diabate at ilo.org>
> Subject: [Subgroup-health] 2nd discussion - Workshop during CGAP Conference
> on Microinsurance
> To: subgroup-health at microfinance.lu
> Cc: "Craig Churchill" <churchill at ilo.org>,
> dreinhard at munichre-foundation.org
> Date: Friday, 16 May, 2008, 9:45 PM
>
>  dear all
> it seems we have to urge concerning the proposals of speakers and
> presentations if we want to organize a session on behalf of the Health
> microinsurance subgroup (see mail below from Dirk Reinhard)
> so could you please react by monday on my previous e mail (below)?
> the form to be filled in by each speaker is also attached
> many thanks, Valerie
>
> >>> Reinhard Dirk - Munich-MR <dreinhard at munichre-foundation.org> 05/16/08
> 4:55 pm >>>
> Dear Valerie,
> Since the deadline for the call for proposals has already expiered, we have
> already forwarded the submissions to the SC.
> However I have already indicated that there mights be a few late runners.
> If I receive the proposal by monday it should be ok. In any case since we
> already initiated translations, it has to be in English.
> I will forward you the form again.
> Best regards
> Dirk Reinhard
>
> >>> "Valérie Schmitt-Diabate" <schmitt-diabate at ilo.org> 05/15/08 12:13 pm
> >>>
> Dear All
> Today is the last day to submit our proposal of session for the
> microinsurance conference. This is why I am copying this e mail to the
> organizers of the Conference.
> Based on past discussions within the subgroup, I suggest following title :
> *"Design and provision of the best possible benefit package: technical and
> policy perspectives"*
> Since the topic is at the border of technical and policy aspects, our
> session could fit under:
> Topic 4: Innovative products and distribution channels
> Topic 3: Regulation, supervision and policy
> It is now time to find good examples of schemes or initiatives and the
> speakers that will present them.
> I guess some of you have already some ideas !!
> I suggest that the speakers present concrete experiences of health
> microinsurance schemes and stress in their presentations the different
> aspects that we mentionned in our previous discussions (the question of the
> priority needs to be covered, the questions of availability and
> affordability of the benefit package) and the solutions that were found
> internally (participative design and adjustment of the package, increase of
> efficiency through the use of MIS system, etc.) or externally (through
> negotiations with health care providers or pharmaceutical industry,
> connexion to national health programmes or regional initiatives, links with
> networks of cooperatives, links with the corporate sector on behalf of the
> CSR, links to international funds, etc..)
> This session will give us a better idea of the area of work of our
> subgroup for the following year and we may use the conclusions to formulate
> our 2009 Key question that will then be developped through research, taken
> into consideration in existing field projects and discussed in conferences.
> Thanks in advance for your inputs !!
> Valerie
>
>
> >>> Iddo Dror <iddo at mia.org.in> 05/15/08 9:58 am >>>
> Dear All,
>
> With regards to Harrie Oostingh's comment on the policy debate, I would
> like to add the following thought:
>
> The link to policy is certainly an interesting issue to look at, and for me
> this remain very much linked to the previous discussions on designing
> relevant packages, with a special focus on giving members the ability to
> design their own packages, to achieve coverage that makes sense to them, and
> which can be modeled around what they can get elsewhere (for the government
> etc.) for better value than by buying insurance from the private sector or
> by mutually pooling their resources.
>
> Let me give an example: The government of India recently launched and
> started rolling out the Rashtriya Swasthya Bima Yojna (RSBY<http://rsby.in/index.aspx>)
> scheme, which is targeted at the poor, and offers BPL families coverage of
> up to Rs 30'000 (approximately $ 750) and includes coverage for pre-existing
> conditions, and offers cashless facility (through the use of smartcards) at
> both public and private facilities. Leaving aside the questions of whether
> targeting BPL is the way to go, and the logistical hurdles that identifying
> BPL families represents, this product, which will be offered for a premium
> of Rs. 30 per household (up to five lives) per year – a cost of less than 2
> cents per person per month. While the scheme excludes maternity, OPD etc.
> (and thus its impact on OOPS is an open issue), it does represent better
> value for money than most commercial products on the Indian market today,
> while covering a very similar benefit package.
> This is where innovative, client-led benefit design can link very well to
> the policy debate, and the CHAT methodology (version 2.0 launched in 2008, a
> video of version 1.0 available online at www.youtube.com/microinsurance)
> can make a difference.  If mutuals can find ways to let their members
> design packages that will complement what they can get from the state for
> free (or almost), this is more likely to contribute to social protection
> than if we see a tougher competition between the state and the private
> sector on delivering similar packages.
>
> Best,
>
> Iddo
>
> P.S
>
> By the way, Harrie Oostingh quotes the 2005 ILO inventory - I was under the
> impression that a revised ILO inventory on health micro insurance units was
> prepared by the ILO Delhi office in 2007, but have not seen the
> publication.  If someone on this group has a copy and can share it, it may
> help us analyze how things have progressed since 2005.
>
>
>
> Harrie Oostingh wrote:
>
> Dear All,
>
> It is good to see that our workgroup is gaining dynamism and that
> more members get involved in the debate.
>
> The development of health insurance with a significant coverage has a
> technical and a policy dimension.
>
> On a technical level there is a big challenge on designing a benefit
> package according to the priority needs of the poor, and institutional and
> contracting arrangements that can deliver on a cost-efficient basis. I think
> this issue was stressed in the interventions of Jonh Pott, Mukti Bosco and
> David Dror.
>
> Even improving methods for design and delivery of micro health insurance
> there will probably be a significant gap between what people can afford and
> the cost of a significative insurance coverage. David Dror mentioned in
> Mumbai that health microinsurance schemes he invested in India only cover an
> average of 11% of households expenditure on health. This means that the role
> of microinsurance in social protection in health depends on additional
> sources of funding and availability of health care services (issues
> stressed by Valerie).
>
> The above is also illustrated by the history of mutuals in Europe, as
> may'be the Benenden Healthcare Society in the UK or health mutuals in The
> Netherlands. These schemes were able to develop gradually because of strong
> growth of income of people (and their capacity to pay premiums) and strong
> growth of tax income of governments (to be able to support membership of
> certain low income groups). Still these mutuals cover only part of total
> health care needs of the population.
>
> Therefore I think that the policy debate on the role of microinsurance and
> its contribution to social health protection is crucial. The evaluation of
> health insurance schemes only on the the impact for the people able to
> join my'be misleading as often these schemes are detrimental for health
> systems objetives as a whole. ILO revised in 2005 14 health micro insurance
> schemes in India, of which 12 schemes excluded childbirth and pregnancy
> related illnesses, most excluded people living with HIV. This way insurance
> schemes might be affordable, but place an important part of the financial
> burden of diseases on people with high health risks or on other
> institutions.
>
> Again, for me the discussion on designing benefit packages should not be
> disconnected with the policy debate, taking also into account the
> specifities of health microinsurance we agreed upon..
>
> Harrie Oostingh
> Microinsurance
> Research & Development
> Oxfam Novib
> Mauritskade 9
> Postbus 30919
> 2500 GX DEN HAAG
> harrie.oostingh at oxfamnovib.nl
> (+31) (0)70 3421720
>
>
>
>
>
>
>  ------------------------------
> *From:* subgroup-health-bounces at microfinance.lu [
> mailto:subgroup-health-bounces at microfinance.lu<subgroup-health-bounces at microfinance.lu>]
> *On Behalf Of *bill mcpate
> *Sent:* Wednesday, May 14, 2008 12:31 PM
> *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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>
> --
> Iddo Dror
> Director of Operations
> Micro Insurance
>  Academy
> D-127, Panchsheel
>  Enclave
> New Delhi 110017
> India
>
> Tel:  +91 11 4174 9101
> Fax:  +91 11 4174 9102
> www.microinsuranceacademy.org
>
>
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-- 
Mukti K Bosco
Founder & Secretary General
Healing Fields Foundation
Hyderabad
Tel: +91 40 23232841/42
Fax: +91 40 23232843
Mob: +91 98480 41234
www.healing-fields.org
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