the fight for social inclusion
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THE FIGHT FOR SOCIAL INCLUSION. GREATER INCLUSION: POSSIBILITIES AND PROSPECTS Sa-Dhan Annual Conference 17-18 January 2007. ILO SUBREGIONAL OFFICE, NEW DELHI STEP (Strategies and Tools against social Exclusion and Poverty) Asia Coordination. SOCIAL PROTECTION: A RIGHTS-BASED APPROACH…. - PowerPoint PPT PresentationTRANSCRIPT
THE FIGHT FOR SOCIAL INCLUSIONTHE FIGHT FOR SOCIAL INCLUSION
GREATER INCLUSION: POSSIBILITIES AND PROSPECTS
Sa-Dhan Annual Conference 17-18 January 2007
GREATER INCLUSION: POSSIBILITIES AND PROSPECTS
Sa-Dhan Annual Conference 17-18 January 2007
ILO SUBREGIONAL OFFICE, NEW DELHI
STEP (Strategies and Tools against social Exclusion and Poverty) Asia Coordination
SOCIAL PROTECTION:A RIGHTS-BASED APPROACH…
SOCIAL PROTECTION:A RIGHTS-BASED APPROACH…
SOCIAL PROTECTION IS A FUNDAMENTAL HUMAN RIGHT (1948)
EACH GOVERNMENT SHOULD PROVIDE SOCIAL PROTECTION TO EACH AND EVERY CITIZEN
UNDER ILO’S DEFINITION NINE MAJOR BENEFITS SHOULD BE COVERED BY SOCIAL PROTECTION SYSTEMS (MEDICAL CARE, SICKNESS BENEFITS, UNEMPLOYMENT BENEFITS, OLD AGE BENEFITS, EMPLOYMENT INJURY BENEFITS, FAMILY BENEFITS, MATERNITY BENEFITS, INVALIDITY BENEFITS, SURVIVOR’S BENEFITS)
UNDER A BROADER DEFINITION AND IN THE INDIAN CONTEXT MORE BENEFITS COULD STILL BE ADDED...
MEASURING THE MAGNITUDE OF THE CHALLENGE…
MEASURING THE MAGNITUDE OF THE CHALLENGE…
POPULATION: 1.1 BILLION
370 MILLION WORKERS OPERATING IN THE INFORMAL
ECONOMY
92% OF THE LABOUR FORCE LEFT WITHOUT ANY
SOCIAL PROTECTION BENEFIT
HEALTH PROTECTION: STILL
A DREAM FOR CLOSE TO ONE
BILLION PEOPLE…
… THE BIGGEST EXTENSION
CHALLENGE IN THE WORLD…
SOCIAL PROTECTION PRIORITY NEEDS OF THE POOR
SOCIAL PROTECTION PRIORITY NEEDS OF THE POOR
☺HEALTH CARE:
A STRONG DEMAND FOR COMPREHENSIVE COVERAGE (WHOLE CARE VS RARE CARE)
QUALITY IS A MAJOR CONCERN
☺ MATERNITY PROTECTION NEED FOR A BROADER RCH PERSPECTIVE
☺ OLD AGE PENSION A NEW BUT FAST INCREASING DEMAND
☺ LIFE A STRONG DEMAND FOR MATURITY BENEFITS (CASH
BACK SERVICES)
☺ ACCIDENTS
1
2
3
4
5
HEALTH PROTECTION EXTENSION:HOW TO ANSWER THE CHALLENGE?HEALTH PROTECTION EXTENSION:
HOW TO ANSWER THE CHALLENGE?
A UNIQUE CHALLENGE: NO ROADMAP AVAILABLE… HENCE THE NEED FOR A DIVERSITY OF INNOVATIVE MECHANISMS…
GIVEN THE MAGNITUDE OF THE EXCLUSION PHENOMENON, MANY MORE ACTORS HAVE A ROLE TO PLAY… HENCE, THE NEED FOR MORE ADVOCACY AND FOR A MULTI-PARTNERSHIP APPROACH…
THERE IS NO ADVOCACY WITHOUT EVIDENCE… HENCE, THE NEED TO DEVELOP MORE KNOWLEDGE AMONGST ALL ACTORS…
ACCESSING, WITHOUT FINANCIAL BARRIERS, QUALITY HEALTH CARE SERVICES IS THE PRESSING NEED OF THE DAY… HENCE, THE NEED TO FOCUS ON HEALTH PROTECTION INCLUDING MATERNITY PROTECTION…
THE BEST WAY FORWARD: LET A THOUSAND FLOWERS BLOOM… AND LEARN FROM BEST PRACTICES BEFORE SCALING UP…
HEALTH PROTECTION:ESTIMATED PRESENT COVERAGE
HEALTH PROTECTION:ESTIMATED PRESENT COVERAGE
FORMAL AND INFORMAL SYSTEMS No. BENEFEMPLOYEES’ STATE INSURANCE SYSTEM (ESIS) 32,500,000
CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) 4,300,000
DEFENCE/POLICE EMPLOYEES 6,600,000
RAILWAYS EMPLOYEES HEALTH SCHEME 5,500,000
CESS-BASED CENTRAL WELFARE FUNDS 4,000,000
STATE-LEVEL WELFARE FUNDS 3,000,000
EMPLOYER-SPONSORED INSURANCE SCHEMES 20,000,000
INDIVIDUAL COMMERCIAL INSURANCE 6,000,000
MEDICLAIM 18,000,000
UNIVERSAL HEALTH INSURANCE SCHEME 1,100,000
HEALTH MICRO-INSURANCE SCHEMES 7,000,000
TOTAL 106,100,000
% OF POPULATION 9.7%
MAIN HEALTH PROTECTION EXTENSION MECHANISMS
MAIN HEALTH PROTECTION EXTENSION MECHANISMS
ESIS COVERAGE: GRADUAL EXTENSION TO INFORMAL ECONOMY WORKERS
WELFARE FUNDS: FUNDS CREATED THROUGH CESS / CONTRIBUTION CATERING FOR A SPECIAL CATEGORY OF WORKERS – TRIPARTITE MANAGEMENT – BROAD RANGE OF BENEFITS: EDUCATION GRANTS, OLD-AGE PENSION, MEDICAL CARE, LIFE… (EXAMPLE: KERALA - 24 WELFARE FUNDS)
MICRO-INSURANCE PRODUCTS: PROVIDED BY INSURANCE COMPANIES (BOTH PUBLIC AND PRIVATE) AND TARGETING THE DISADVANTAGED GROUPS (RURAL & SOCIAL SECTORS)
IN-HOUSE MICRO-INSURANCE SCHEMES: DEVELOPED BY A WIDE DIVERSITY OF ACTORS
SPECIAL FUNDS: ALLOCATED BY STATE GOVERNMENTS TO PAY FOR SURGICAL PROCEDURES NEEDED BY BPL POPULATION (EXAMPLE: JHARKHAND – US$ 2.2 MILLION/YEAR)
CENTRAL GOVERNMENT: HEALTHPROTECTION EXTENSION STRATEGIES
CENTRAL GOVERNMENT: HEALTHPROTECTION EXTENSION STRATEGIES
PUBLIC INS. Co. (4) PRIVATE INS. Co. (11)
WITH / WITHOUT SUBSIDY THROUGH REGULATIONS
MICRO-INSURANCE
HEALTH PROVID.
NON-GOV. ORG.
MICRO-FINANCE
CO-OP. MOVEM.
TRADE UNIONS
LOCAL GOVERNM.
LOCAL GOVERNM.
IN-HOUSE (30%)
PARTNER-AGENT (70%)
TRADE UNIONS
CO-OP. MOVEM.
MICRO-FINANCE
NON-GOV. ORG.
HEALTH PROVID.
UHIS (SUBSIDY)
INSURANCE SCHEMES
HEALTH MICRO-INSURANCE: TOWARDS SELF-RELIANCE? HEALTH MICRO-INSURANCE: TOWARDS SELF-RELIANCE?
SCHEMES N0 OF BENEFIC.
TYPE OF SCHEME
TYPE OF COVERAGE
TYPE OF BENEFIT
TYPE OF SUBSIDY
YESHASVINI 1,850,000 IN-HOUSE TER. CASHL. DIRECT
DHARAMST. 400,000 P.AGENT SEC. CASHL. -
SEWA 174,000 P.AGENT SEC. REIMB. INDIRECT
VHS 124,000 P.AGENT PR/SEC CASHL. INDIRECT
PREM 108,000 IN-HOUSE SEC. CASHL/REIM INDIRECT
RAHA 74,000 IN-HOUSE PR/SEC. CASHL. IND/DIRECT
NAANDI 60,000 IN-HOUSE PR+SEC+TER CASHLESS IND/DIRECT
AROGYA 55,000 P.AGENT SEC. CASHL. INDIRECT
INDORE 49,000 P.AGENT SEC. CASHL. DIRECT
H.FIELDS 30,000 P.AGENT SEC. CASHL/REIM INDIRECT
UPLIFT 16,000 IN HOUSE SEC. REIMB. INDIRECT
KARUNA 12,000 P.AGENT PR/SEC. REIMB IND/DIRECT
ASHWINI 12,000 P.AGENT PR/SEC CASHL. IND/DIRECT
HEALTH MICRO-INSURANCE:THE FINANCING CHALLENGE… HEALTH MICRO-INSURANCE:
THE FINANCING CHALLENGE…
0
10
20
30
40
50
60
70
80
%
Rs. 13Rs. 44Rs. 88
PLANNING COMMISSION DEFINITION: VALUE OF A SPECIFIED NUTRITION REQUIREMENT
o 26%o 278 MILLION
UNDP DEFINITION: LESS THAN 1 US/DAY/PERSON
o 35%o 374 MILLION
UNDP ANALYSIS: LESSTHAN 2 US/DAY/PERSON
o 80%o 855 MILLION
…AT THE END OF THE DAY… NOT MUCH LEFT TO PAY FOR INSURANCE…
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER
INCOME: Rs. 2,000/MONTH
ESIS CONTRIBUTIONS: RS 1.700
INCOME: Rs. 2,000/MONTH
MI CONTRIBUTIONS: Rs. 365?
LIMITED CONTRIBUTION RESOURCES
LARGE CONTRIBUTION RESOURCES
CONTRIBUTIONS FROM WORKERS, EMPLOYERS AND GOVERNEMENT
WORKERS LEFT ALONE TO PAY FOR THEIR OWN PROTECTION?
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER
INCOME: Rs. 2,000/MONTH
ESIS CONTRIBUTIONS: RS 1.700
INCOME: Rs. 2,000/MONTH
MI CONTRIBUTIONS: Rs. 365?
REDUCTION OF RESOURCES ALLOCATED TO BENEFIT PAYMENTS
FULL ALLOCATION OF RESOURCES TO BENEFIT PAYMENTS
NO ADMINISTRATIVE COSTS ADMINISTRATIVE COSTSTO BE BORNE BY THE SCHEME
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…
FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER
INCOME: Rs. 2,000/MONTH
ESIS CONTRIBUTIONS: RS 1.700
INCOME: Rs. 2,000/MONTH
MI CONTRIBUTIONS: Rs. 365?
VERY LIMITED SCOPE AND LOW LEVEL OF BENEFITS
BROAD SCOPE AND HIGH LEVEL OF BENEFITS
COMPULSORY SYSTEM AND OWNERSHIP/CONTROL OF
HEALTH FACILITIES
LESS COSTS OF ADVERSE SELECTION AND OVER PRESCRIPTION
HEALTH PROTECTION: LOOKING AT SOME CO-CONTRIBUTION EXPERIENCES…
HEALTH PROTECTION: LOOKING AT SOME CO-CONTRIBUTION EXPERIENCES…
UNIVERSAL HEATH INSURANCE SCHEME (THROUGH
PUBLIC INSURANCE COMPANIES) – CENTRAL GOVERNMENT
CONTRIBUTION
YESHASVINI (NO INSURANCE COMPANY) – STATE
GOVERNMENT CONTRIBUTION
INDORE MUNICIPAL CORPORATION (THROUGH PUBLIC
INSURANCE COMPANY) – LOCAL GOVERNMENT CONTRIBUTION
NAANDI FOUNDATION (NO INSURANCE COMPANY) –
CORPORATE SECTOR/CIVIL SOCIETY CONTRIBUTION
JHARKHAND (NO INSURANCE COMPANY) – CORPORATE
SECTOR/STATE GOVERNMENT CONTRIBUTION
YESHASVINI CO-OPERATIVE FARMERS HEALTH SCHEME (KARNATAKA)
YESHASVINI CO-OPERATIVE FARMERS HEALTH SCHEME (KARNATAKA)
PRIVATE TRUST (HEALTH PROVIDERS / GOVERNMENT)
MARKETED THROUGH THE COOPERATIVE MOVEMENT
COVERS ONLY SURGICAL PROCEDURES (1.600 PROCEDURES) UP TO Rs. 100,000 PER YEAR
PREMIUM: Rs. 120 /PERS /YEAR (Rs. 60 FOR CHILDREN UNDER 18)
IN-HOUSE MODEL (NO INS. CO)
TPA (FAMILY HEALTH PLAN)
HOSPITAL NETWORK (295)
CASHLESS SERVICES
GOVERNMENT DIRECT CONTRIB.
COVERAGE (2006): 1,854,731
SECOND LARGEST IN THE WORLD
YESHASVINI:EVOLUTION OF PERFORMANCE INDICATORS
YESHASVINI:EVOLUTION OF PERFORMANCE INDICATORS
0
20
40
60
80
100
120
Year 1 Year 2 Year 3 Year 4
Premium Subsidy
00.5
1
1.52
2.53
3.5
44.5
5
Year 1 Year 2 Year 3
Cost/Ins Net Cost
0
500000
1000000
1500000
2000000
2500000
Year 1 Year 2 Year 3 Year 4
N0.Insured
PREMIUM VERSUS SUBSIDY PER INSURED ADMINISTRATIVE COST PER INSURED
EVOLUTION OF NUMBER OF INSURED
THE MICROFINANCE AVENUE: THE WAY FORWARD…
THE MICROFINANCE AVENUE: THE WAY FORWARD…
EMPHASIZE THE INSURANCE SOLIDARITY CORE PRINCIPLE
RELY ON STRONGER INSURANCE AWARENESS AND EDUCATION
ACHIEVE THE FINANCIAL TRINITY: SAVINGS, CREDIT, INSURANCE
ORGANIZE LONG-TERM CO-CONTRIBUTION AGREEMENTS
WORK TOWARDS AUTOMATIC/COMPULSORY ENROLMENT MECHANISMS
DEVELOP EFFICIENT PARTNERSHIPS WITH HEALTH PROVIDERS’ NETWORKS