designing private health insurance products to serve marginalized populations
TRANSCRIPT
Designing private health insuranceproducts to serve marginalizedpopulations
Jeanna Holtz, Abt Associates
January 29, 2017
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Pathways to UHC
3
Marginalized populations and insurance
Health insurance…what’s that?
I should onlypay for insurance
if I use it
I don’t visita doctor unlessI’m really sick
My village does nothave a doctor
I can’t afford to payuser fees
Health providersdon’t want to treat
people like meOur well is
contaminated
I lose wages when Iqueue up at the clinic I haven’t told anybody
I have HIV
I don’t have myown money
4
What has to go right
Sources: 1) Koven et al., 2013 MILK brief #26; 2) Koven and McCord, Best’s Review, Oct 2014; 3) Weilant, M. Study on drivers of viability for HMI schemes (forthcoming )
Scale
Efficiency
Revenue
Admin
Benefits
Losses
The “upside-down cost triangle”(when things are wrong)
Surplus
Admin
Benefits
Desirableallocation possibleat scale
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Health insurance can work for the poor
• Focus on 3 Ps
Client value
Viability
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3Ps: Products
Core product Value-added services Link to savings
Cli
en
tvalu
e
Understandable,simple
Complementpublic programs
Tangible, save money
Complement insurance
Finance premiums,other costs
Via
bil
ity Easier to sell
More efficient,accurate claims
Reduce claims
Enhance sales
Fewer lapses
Cross-selling
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3Ps: Processes
User-friendly Technology Monitoring
Cli
en
tvalu
e
Fast turnaround
Easy, flexible
Facilitate premiumcollection
Cashless, paperless
Feedback mechanism
Via
bil
ity
Promote enrolment Cost-effective
Reduce leakage
Reduce fraud
Product, processimprovements
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3Ps: Partnerships
Govt, donors Distributors Health providers
Cli
en
tvalu
e
Expand coverage
Affordable
Direct client contact
Convenient, trustedpoints of access
Better access andquality
Reduce out-of-pocket costs
Via
bil
ity Scale
Subsidies
Improve infrastructure
New markets
Efficient processes
Lower claim costs
Reduce fraud
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Applying the 3Ps: Community-based schemes
Uplift Mutuals, India 250,000 clients
Core product Processes Partnerships
Cli
en
tvalu
e Affordable
Hospitalization, value-added services(health camps,consultations)
Client reminders viatext message
24/7 helpline
Community-led
Provider network
Via
bil
ity Lower admin cost
Retention
Group enrollment
Standard procedures
Web-based MIS
Microfinanceinstitutions, NGOs
Donor support
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Applying the 3Ps: Mobile phone-enabled health insurance
Airtel/MicroEnsure, Africa: 3.74m clients in 7 countries
Core product Processes Partnerships
Cli
en
tvalu
e Simple: Lump sum for3+ days in hospital
Free to clients using$2 air time per month
SMS enrollment,updates
Claims filed, paid viamobile
3 partners: Airtel MicroEnsure
(intermediary) Insurer
Via
bil
ity
Encourage clientretention
Build a culture ofinsurance; potentialfor upselling
Efficient-use existingIT platforms
Limited pay out perpolicy
Leverage trustedtelecom brand
Mass market model
source: USAID mHealth Compendium Special Edition 2016: Reaching Scale
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Summary: The 3 Ps
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Health insurance can work for the poor...
... but only when carefully orchestrated.