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

[Iddo Dror]

Dear Valérie and all,

Our discussions touched upon designing relevant packages many times in 
the past weeks.  It may be of interest if a proposal from the subgroup 
reflected this in a proposed session. 

Prior to your email last Thursday, I had submitted a proposal for a 
presentation on this issue (attached for your info - original proposal 
already with the organizers).  From our discussion, it seems like some 
others might have interesting experience and data to share from other 
models and part of the world (MIA's data is from community-based schemes 
and India). 

If this is the case, and other agree, than it would be a pleasure to 
merge this presentation into a session by the subgroup. 

Best,

Iddo



Valérie Schmitt-Diabate wrote:
> 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 
> <http://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] *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 8^th 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
>>
>> ------------------------------------------------------------------------
>>
>> _______________________________________________
>> subgroup-health mailing list
>> subgroup-health at microfinance.lu
>> http://lists.microfinance.lu/mailman/listinfo/subgroup-health
>>   
>
> -- 
> 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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>
> the sender and delete the message; do not disclose, distribute, or copy
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> the information.
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>
> viruses; the ILO is not liable in any such event.
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> Ce message électronique peut contenir des informations confidentielles,
>
> ou spécialement protégées, à la
>
> seule intention du destinataire. Dans le cas où vous ne seriez pas
>
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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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