[Subgroup-health] Rép. : AW: 2nd discussion - Workshop during CGAP Conference on Microinsurance

Wed May 28 11:21:24 CEST 2008

Dear All, 

I just want to add to what Valerie and Vijay proposed, especially on the third point. We just had a workshop organised here at GTZ headquarters with the CGAP working group on performance indicators and capacity development and some international experts and practitioners, where we discussed the tools and approaches that GTZ has been developing over the years in community based health insurance and tried to explore their potential for a more systemic, broader use in MI.

One option discussed was to take one of our learning approaches, the competency health centre  (CHIC) that has been developed for the regional and national level, higher up to an international level as a learning plattform and centre for MI competencies/good practices along different product lines and competencies (management, finances, administration, insurance literacy, etc.), a similar idea to what Vijay and Valerie discussed. 

We are still exploring how we can go about, but as soon as we have developed a concept note on that I will circulate it and would be grateful for your comments and possible collaboration. 

Regarding Vjay's idea of a conference, I think that this would be an excellent idea. 

Kind Regards, 

Barbara 

Barbara Rohregger, PhD
Projectmanager

Sector Initiative Systems of Social Protection
Deutsche Gesellschaft für
Technische Zusammenarbeit (GTZ) GmbH
Postfach 5180
65726 Eschborn

Tel.: ++49-6196/79-1280
Fax: ++49-6196/79-801280
E-Mail: barbara.rohregger at gtz.de
Internet: http://www.gtz.de <blocked::http://www.gtz.de/> 

________________________________

From: subgroup-health-bounces at microfinance.lu [mailto:subgroup-health-bounces at microfinance.lu] On Behalf Of Valérie Schmitt-Diabate
Sent: Friday, May 23, 2008 11:48 AM
To: subgroup-health at microfinance.lu
Subject: Re: [Subgroup-health] Rép. : AW: 2nd discussion - Workshop during CGAP Conference on Microinsurance

Dear Vijay, dear All,
Thanks for your e mail and for your proposal of doing a thorough assesment of existing proposals, of documenting and disseminating the experiences mentionned in the proposals.

As you may know we had a very interesting discussion at the end of April / beginning of May (before you joined the group) in order to chose together a topic of our intervention for the MicroInsurance conference. As a result of this active discussion we decided on the following topic: "Design and provision of the best possible benefit package: technical and policy perspectives"

You may have a look at the threads of discussions by consulting the archives of the list. The following thread includes a large part of the discussion http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000021.html
Here is also a contribution of Harrie Oostingh that raises interesting ideas http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000024.html
Here is the final subject that we proposed to the organizers in May 15 http://lists.microfinance.lu/pipermail/subgroup-health/2008-May/000028.html

You proposed the following key criteria for the evaluation of the ideas that were shared within the subgroup with following criteria: scalability, replicability, PPC partnerships; these ideas are really interesting and give additional inputs to our previous discussions

The most important criteria for assessing health insurance schemes is their capacity to improve the health coverage in terms of numbers of people covered (in that sense I fully agree with you when you propose the idea of scalability) and in terms of the level of financial protection (this is the idea of the "best possible benefit package")

1) a best possible benefit package is firstly (as Iddo Dror explained) a package that attracts prospective "clients" i.e. that responds to what they consider to be priority in terms of their protection needs ... from a public health perspective however it is a cost / efficient package that therefore not only covers major risk but includes also preventive measures, primary health care, maternity, immunization ... which have a major impact on health indicators. The Colombian experience is very interesting in that sense since the package provided by the subsidized health insurance scheme was designed by the State with public health considerations in mind.

2) a best possible benefit package should guarantee real protection. Therefore the services covered under the package need to be available in the health facilities. Covering drugs in a context of regular drug shortage is non sense. This is why it is so important to develop a strong relationship with the health care providers (through negociations, treatment protocols, etc.) ... This issue was stressed by Denis Garand (Healing fields experience). It is also important to facilitate the access to health structures for the insured (often poor people) through for instance the implementation of a meeting point or a special desk in the hospital as it is the case in the network of hospitals accredited under the Yeshasvini scheme.

3) a best possible benefit package may not be affordable for the insured although it is "affordable" at the national level. A package of 13 000 Francs CFA in Senegal (30 dollars) is not affordable to the Senegalese rural population (they can afford 3 500 CFA Francs per person and per year) although it may be feasible if the State participates in the funding of the contribution.
Today there are many examples of linked schemes where the State or the regional governments provide direct subsidies of the premium: the recent initiative in India mentioned by Tara (I know that Marc Socquet from ILO New Delhi was really involved in this project and he will for sure give us additionnal inputs on the initiative; the Colombian experience of course (cross subsidies from the formal statutory scheme + direct subsidies fron the State and the regional entities), the Yeshasvini scheme (which receives a regular subsidy from the government of Karnataka), etc. 
It is also interesting to note that other financing mechanisms have emerged such as subsidizes from the corporate sector on behalf of the CSR, the "utilization" of the Global fund to finance a share of the premiuns in Rwanda and thereby strengthen the health sector, etc.

The next question is how to organize the provision of this package in the optimal / most efficient way ? Here again I fully agree with your 3rd inidcator (Leveraging public- private- community partnerships) .. At the ILO STEP programme we call this "linkages" between various stakeholders .. Experience shows that linkages between complementary organizations (e.g., a cooperative and a satutory health insurance scheme like in the Philippines KaSAPI programme; e.g., a national health programme working with private commercial and non commercial insurers like in the Colombian subsidized regime; a micro insurance scheme working in partnership with the Department of cooperatives and cooperative societies as in the case of Yeshasvini, etc.) can create synergies and improve the organization of the scheme and its performance.

Cocerning your 2nd point (scalability) of course I fully agree. The idea of sharing experience, documenting schemes is certainly a source of inspiration, but developing and sharing standardized methods and tools to facilitate the implementation of these schemes is also of great value !!

We could continue to share ideas and experiences on these elements:
- identifying interesting / innovative schemes for "our" issue (how to design a best possible benefit package?) which includes at least 3 sub topics: the question of the design of the package, the question of the ability of supply of health care to meet demand, the question of the financing of the package 
- identifying succesful ways to distribute this package in an efficient way ("public- private- community partnerships" or "linkages")

We could identify and share a list of relevant publications and working papers on each experience, and if some schemes are not suffficiently documented, as Vijay proposed, we could organize the production of case studies ...

Transforming these experieces into replicable knowledge (tools that can be used anywhere) is a big challenge .. and Vijay's proposal to start sharing what we already have developed internally is a good starting point.

I also note Vijay's proposal to organize a one or two-day conference or workshop on Health
Insurance/Financing for the Poor. This sounds of course very interesting !

Best regards
Valérie

>>> <vkalavak at worldbank.org> 05/21/08 7:07 pm >>>

Dear Valerie,

I have been following the email traffic of the last few days. An excellent job
in culling the number of proposals. Let's hope that a good number of them make
it to the finals.

I was wondering as a sub-group if  we should not be doing a more thorough
assessment of each one of these proposals, independent of what is being
submitted to the MRF. There may be some very interesting ideas and concepts
which should not be lost with the short-term objective i.e., proposals for
Colombia Conference. We could then explore how these interesting ideas could be
documented and disseminated to a larger audience interested in health
insurance/financing for the poor. Towards this end I would suggest that we come
up with some KEY INDICATORS which could be used as a tool to evaluate some
interesting ideas that has been floating around. From my perspective I have the
following to offer:

a) Idea should be SCALABILITY - I have seen plenty of schemes which are run
perfectly well when they are relatively small (i.e., less than 15,000 - 20,000),
BUT when scaling-up they fail for various reasons. It would have been
interesting to hear the Yeshasvini experience (but I am sure there were good
reasons to drop it from the current round of submissions) which insures more
than 2.5 million in the informal sector, the sort of target population we see in
a lot of developing countries.

b) REPLICABILITY - replicable WITHIN a country and probably across countries. I
generally hear arguments  saying that "country contexts" are different, and
hence replication might not necessarily be possible. BUT, nevertheless given the
great minds we have in the sub-group I am sure we could still come up with some
interesting ideas for replication i.e., the CHAT model for designing and
"probably" pricing the benefit package.

c) Leveraging Public - Private - Community (or Peoples) Partnership - I am sorry
for the lengthy name, BUT the bottomline is are there interesting ideas which
brings together all these three elements together. Let us not forget that
Government's are still a major funder (i.e., NOT INSIGNIFICANT) and people (or
community) are the LARGEST FUNDER but the irony is both these sources of funds
are spent in a DIS-OPTIMAL or LESS PRODUCTIVE manner. Are there interesting
examples which could help influence some thinking on this issue.

I hope this provokes some discussion. We would not be averse to organizing a
stand alone (one or two-day) conference or workshop on Health
Insurance/Financing for the Poor.

Once again Valerie an excellent job and great set of ideas.

Regards
Vijay

(Embedded image moved to file: pic21119.gif)
Vijayasekar Kalavakonda
Financial Markets for the Social Safety Net
The World Bank Group | International Finance
Corporation
2121 Pennsylvania Avenue, NW Washington, DC
20433, USA
tel: +1 202-458-4624    fax: +1 202-522-7105
email: vkalavak at worldbank.org
rru.worldbank.org | www.ifc.org

             "Valérie                                                
             Schmitt-Diabate"                                          
             <schmitt-diabate at il                                             To
             o.org>                      "Craig Churchill"             
             Sent by:                    <churchill.GENP3.GEND1 at ilo.org>,
             subgroup-health-bou         <subgroup-health at microfinance.lu>,
             nces at microfinance.l         "Reinhard Dirk - Munich-MR"   
             u                           <dreinhard at munichre-foundation.org>
                                                                             cc

             05/21/2008 12:17 PM                                        Subject
                                         [Subgroup-health] Rép. : AW:  2nd
                                         discussion - Workshop during CGAP
                                         Conference on Microinsurance  

Dear Dirk,
I understand your point : we need to limit to 3 speakers per session

I sent you 7 proposals under the CGAP Health microinsurance subgroup
   1. Christine Bockstal - Developing innovative health micro insurance schemes
      to reach social protection for all in Africa
   2. Annie Asanza - KaSAPI: Working Hand in Hand to Extend Health Insurance
      Coverage to Informal Economy Workers
   3. Iddo Dror - Involving customers in benefit package design - Choosing
      Healthplans All Together (CHAT): a new and improved way to reflect client
      preferences in insurance packages
   4. Mukti Bosco - Making health insurance affordable, The Healing Fields
      Foundation model
   5. Denis Garand - Yeshasvini, 4 years of experience, the demographic
      information
   6. Tara Sinha - State-led Initiative to Provide Health Insurance to the Poor
      in India
   7. Fabio Duran - Extension of social protection through health micro
      insurance
I also sent you 5 proposals under the Colombian experience and other linked
schemes
   1. Teresa Tono - Colombia's Social Security System. Results and challenges.
   2. Elisa Torrenegra - The subsidized health insurance regime operated by
      mutuals and cooperatives.
   3. Ursula Giedion - The Colombian Health Insurance Scheme for the Poor:
      Results in Access, Utilization and Financial Protection.
   4. Valérie Schmitt - The extension of coverage through linked schemes: a
      typology and several examples from elsewhere in the world
   5. Brenda Rial - The design and implementation of an integrated National
      Health System in Uruguay
All these proposals are very interesting; so I suggest to reorganize STEP's and
the CGAP's Health microinsurance subgroup participation in the following way:

1) Session on "The Colombian experience"
Under "Innovative products and distribution channels"
   1. Teresa Tono - Colombia's Social Security System. Results and challenges.
   2. Elisa Torrenegra - The subsidized health insurance regime operated by
      mutuals and cooperatives.
   3. Ursula Giedion - The Colombian Health Insurance Scheme for the Poor:
      Results in Access, Utilization and Financial Protection.
Facilitator : Christian Jacquier

2) Session on "Design and provision of the best possible benefit package"
Under "Innovative products and distribution channels"
This session will deal with the design of a package that answers to the priority
needs of the target group as well as the national objectives in terms of public
health and takes also into account the question of availability of health and
affordability
   1. Iddo Dror - Involving customers in benefit package design - Choosing
      Healthplans All Together (CHAT): a new and improved way to reflect client
      preferences in insurance packages
   2. Mukti Bosco - Making health insurance affordable, The Healing Fields
      Foundation model (+ Denis Garand as dicutant since he participated also in
      the study)
   3. Valerie Schmitt-Diabaté - Designing a relevant benefit package:
      perspectives and challenges (=> I will modify my proposal so that it fits
      under this session)
Facilitator : ?? To be discussed within the subgroup since the subject was
designed within the subgroup

3) Session on "Extending health insurance coverage to informal economy workers
through linkages between microinsurance schemes and other institutions"
   1. Tara Sinha - State-led Initiative to Provide Health Insurance to the Poor
      in India
   2. Christine Bockstal - Developing innovative health micro insurance schemes
      to reach social protection for all in Africa
   3. Brenda Rial - The design and implementation of an integrated National
      Health System in Uruguay
Additional speaker (if it is too much she will only participate as discutant)
   1. Annie Asanza - KaSAPI: Working Hand in Hand to Extend Health Insurance
      Coverage to Informal Economy Workers in the Philippines
Facilitator : ?? To be discussed within the subgroup since the subject was also
designed within the subgroup

- -

Through this re organization we unfortunately deleted 2 proposals:

1) Denis Garand - Yeshasvini, 4 years of experience, the demographic information
=> I propose that Denis's proposal is included in another session (on capacity
building).
Denis will for sure be a very active discutant in the 2nd session since he made
a study on the subject for the healing fields foundation.
2) Fabio Duran - Extension of social protection through health micro insurance
Fabio Duran will be for sure a very active discutant within the 3rd session.

- - - - - -

In addition to these 3 sessions we would like to propose a side event on IT
tools (with demonstrations):
- SimIns and other tools from the GTZ (Barbara Rohregger, GTZ)
- GIMI (ILO) www.microinsurance.org  (Valerie Schmitt Diabaté, ILO)
- ACYM (network of cooperatives and mutuals supported by the ILO in Latin
America) www.acym.net (Brenda Rial, ACYM)
- others ??? we could think of a MIS software developped by the ILO / STEP in
Africa as well as other platforms / interactive websites ...
Do you think it would be possibe to organize that in Cartagena ?
Do we need to send you also proposals for the organization of this side event ?

Many thanks for your support and patience !
Best regards, Valerie

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