[Subgroup-health] Faire suivre : RE: 2nd discussion - Workshop during CGAP Conferenceon Microinsurance
Valérie Schmitt-Diabate
schmitt-diabate at ilo.org
Mon May 19 15:31:47 CEST 2008
dear all
please find attached Denis' proposal
valerie
>>> "Denis Garand" <denis at garandnet.net> 05/18/08 9:40 pm >>>
Valerie
Here are two submissions one for Mukti Bosco, She may want to modify it
and one from me on Yeshasvini.
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 16, 2008 10:15 AM
To: subgroup-health at microfinance.lu
Cc: Craig Churchill; dreinhard at munichre-foundation.org
Subject: [Subgroup-health] 2nd discussion - Workshop during CGAP
Conferenceon Microinsurance
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] 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
_______________________________________________subgroup-health mailing
listsubgroup-health at microfinance.luhttp://lists.microfinance.lu/mailman/listinfo/subgroup-health
-- Iddo DrorDirector of OperationsMicro Insurance AcademyD-127,
Panchsheel EnclaveNew Delhi 110017India Tel: +91 11 4174 9101Fax: +91
11 4174 9102www.microinsuranceacademy.org
--------------------------------------------
This electronic message may contain confidential, proprietary or
privileged information.
It is intended for the use only of the named recipient. If you are not
the intended recipient, please notify
the sender and delete the message; do not disclose, distribute, or copy
the information.
Electronic messages are not secure or error-free, and may contain
viruses; the ILO is not liable in any such event.
--------------------------------------------
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
destinataire de ce message, merci d'avertir
l'expéditeur et de supprimer le message sans révéler, copier ou
distribuer les informations qu'il contient.
Les messages électroniques ne sont pas sécurisés ou à l'abri d'une
erreur et peuvent contenir des virus;
le BIT ne peut être tenu responsable de tels évènements.
--------------------------------------------
Este mensaje electrónico puede contener información confidencial o
especialmente protegida.
Está dirigido para el uso exclusivo del destinatario indicado. Si Usted
no es el destinatario previsto,
notifique por favor al remitente y suprima el mensaje; no divulgue, no
distribuya, ni copie la información.
Los mensajes electrónicos no son seguros o libres de error, y pueden
contener virus; la OIT no se responsabiliza en
cualquiera de estos casos.
--------------------------------------------
--------------------------------------------
This electronic message may contain confidential, proprietary or
privileged information.
It is intended for the use only of the named recipient. If you are not
the intended recipient, please notify
the sender and delete the message; do not disclose, distribute, or copy
the information.
Electronic messages are not secure or error-free, and may contain
viruses; the ILO is not liable in any such event.
--------------------------------------------
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
destinataire de ce message, merci d'avertir
l'expéditeur et de supprimer le message sans révéler, copier ou
distribuer les informations qu'il contient.
Les messages électroniques ne sont pas sécurisés ou à l'abri d'une
erreur et peuvent contenir des virus;
le BIT ne peut être tenu responsable de tels évènements.
--------------------------------------------
Este mensaje electrónico puede contener información confidencial o
especialmente protegida.
Está dirigido para el uso exclusivo del destinatario indicado. Si Usted
no es el destinatario previsto,
notifique por favor al remitente y suprima el mensaje; no divulgue, no
distribuya, ni copie la información.
Los mensajes electrónicos no son seguros o libres de error, y pueden
contener virus; la OIT no se responsabiliza en
cualquiera de estos casos.
--------------------------------------------
--------------------------------------------
This electronic message may contain confidential, proprietary or
privileged information.
It is intended for the use only of the named recipient. If you are not
the intended recipient, please notify
the sender and delete the message; do not disclose, distribute, or copy
the information.
Electronic messages are not secure or error-free, and may contain
viruses; the ILO is not liable in any such event.
--------------------------------------------
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
destinataire de ce message, merci d'avertir
l'expéditeur et de supprimer le message sans révéler, copier ou
distribuer les informations qu'il contient.
Les messages électroniques ne sont pas sécurisés ou à l'abri d'une
erreur et peuvent contenir des virus;
le BIT ne peut être tenu responsable de tels évènements.
--------------------------------------------
Este mensaje electrónico puede contener información confidencial o
especialmente protegida.
Está dirigido para el uso exclusivo del destinatario indicado. Si Usted
no es el destinatario previsto,
notifique por favor al remitente y suprima el mensaje; no divulgue, no
distribuya, ni copie la información.
Los mensajes electrónicos no son seguros o libres de error, y pueden
contener virus; la OIT no se responsabiliza en
cualquiera de estos casos.
--------------------------------------------
-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://lists.microfinance.lu/pipermail/subgroup-health/attachments/20080519/d2891f93/attachment-0001.html
-------------- next part --------------
A non-text attachment was scrubbed...
Name: MIC2008Proposal_form_es_engYes DG.doc
Type: application/msword
Size: 361984 bytes
Desc: not available
Url : http://lists.microfinance.lu/pipermail/subgroup-health/attachments/20080519/d2891f93/attachment-0001.doc
More information about the subgroup-health
mailing list