Dear Friends,

First of all let me wish all of you a Merry Christmas and a Meaningful 2005. Let us continue to work towards reaching out to the poor in our regions and make their life a little easier than it was in 2004.

It has been more than three months since the last newsletter and there have been some who speculated whether CHIN was a seven-day wonder. Just to prove the sceptics wrong and also to continue with the networking here is the second issue of the newsletter.

First of all, an egroup has been formed to share information, thoughts and opinions on a daily basis. For those of you who have an email id and are still not part of the egroup, please click on http://health.groups.yahoo.com/group/IGHPM/

and then click on “Join This Group” button on the top right corner of the webpage. For those of you who do not have an email id, it is time to enter the 21^st century, or the world may pass you by.

AIIMS – New Delhi organised a “National Conference on Health Insurance and Financing” in October 2004. A brief report of the conference is presented here (courtesy an Ugandan colleague). Anybody else who attended the conference please do feel free to add more details. Deepti, this is a pointed reminder.

The Community health insurance website is up and for those of you who are interested, please click on www.comhealthins.org This is the work of Mr Manoharan of ACCORD. I would like to take this opportunity to thank him for all the effort he put in. It is still at an elementary stage and hopefully I will have more time now to develop it further. Would really appreciate your feedback, suggestions and comments to improve it. And if you or your institution has any documents, this could be an useful forum to share it with everybody. Even annual reports that have details of your health insurance would be good enough.

And finally, apparently the IRDA (Insurance Regulatory and Development Authority) has recognised community health insurance as an entity – it has developed a concept paper on “microinsurance” and had invited comments from interested stakeholders. The National Insurance Academy also conducted a workshop on Microinsurance at Pune in November. Would appreciate a report by anybody who had attended it.

I am also enclosing a write up about a Community based health insurance from Kerala – for your information. Hope that you enjoy the details provided.

Looking forward to hearing from you. I would appreciate if you could share more information, doubts, ideas about health insurance.

With regards

Dr. N. Devadasan

deva@devadasan.com

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Report on the Conference on Health Insurance and Financing, New Delhi, 16-17 October 2004

1.       Introduction

The conference on Health Insurance and Financing was organized by AIIMS.  The conference was held on 16 and 17 October 2004 at AIIMS. The conference was opened by the Union Minister of Health and family Welfare Dr Anbumani Ramados and closed by the Director General of Health Services, Dr S.P. Agarwal.

2.      Objective of the conference

To create a linkage between various stakeholders in the health care industry and bring them together all under one platform to jointly address the problems facing Indian people today and come out with sustainable and variable remedies relevant for the Indian set up.

3.      Program

The programme covered Health System Financing & Insurance, Health Insurance: Indian experiences of health insurance, the international experiences of SHI and finally the regulatory issues. A detailed programme is available for those who want it.

4.      Participants

The conference attracted 600 participants, who were both from local, international organizations and foreign countries namely the World Bank National Office, The World Health Organization Regional Office for South East Asia and Geneva. The International participants came from Tanzania, Uganda, Iran and Nepal.

5.      Key issues arising out of the conference

1.      Social Health Insurance is not a panacea but is one of the ways of improving the health system

2.      It is very important to take the right steps initially and move slowly but in sure way in development of SHI rather than falter.

3.      Initial process of development of SHI has to be compulsory.

4.      Initially, different schemes for example one for the formal sector and CHI have to be encouraged.

5.      Modalities for accreditation and regulation have to be worked out as one of the ways to ensure proper provision of quality care.

6.      The National Commission on Macroeconomics and Health of India is providing an enabling framework for review of the current health service delivery and in particular financing of health services. As such, this endeavor is a launching pad for discussions and design of national SHI scheme

 Dr. Robert Basaza

Senior Health Planner, Ministry of Health,

Uganda.

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Community Health Insurance -

Self Help Association for Development and Empowerment (SHADE)

Dr. Marina Rajan MD

Dept. of Community Medicine,

MOSC Medical College,

Kolencherry, Kerala.

Introduction

Five small self-help groups called Swasraya Credit Unions (SCUs) in Ernakulam district of Kerala have been implementing a community health insurance programme since December 1993. Their programme has recently (January 2004) been coordinated by SHADE (Self help association for development and empowerment). SHADE is a registered society under the guardianship of the Community Medicine Department of the Malankara Orthodox Syrian Church (M.O.S.C.) Medical College Kolenchery.

Location 

State – Kerala

District – Ernakulam

Blocks - Vadavucode, Muvattupuzha, Mulamthuruthy, and Piravom

Villages - Kunnackal, Kunnakurudy, Kandanad, Vettickal, Nechoor

The Community

The total population in the 4 blocks is about 5 lakhs. The community health project of the Medical College covers only selected areas around their health centers with about 100, 000 population. 30-40%  of the community are middle class, 30% labour class, 30% poor, 2-5% very poor and 2-5% rich people. The average family size is four. The community health insurance programme operates only in this project area. There are currently over 9000 members in the five SCUs. Anybody willing to pay Rs 10 as registration and contribute any multiple of Rs 5 as a weekly contribution to the group is eligible to join a SCU.

The Community health insurance programme

Only members of the SCUs and their families are eligible to join the health insurance programme.

There are basically two parallel schemes.

• The oldest scheme (started in 1993) was organized by the women themselves. They collected an annual premium of Rs 33 per person per year and purchased a Mediclaim policy from the National Insurance company (NIC). This was tailor made to suit the local women and covered hospitalization for a maximum of Rs 5000 per year. However, over the years, the premium started increasing because of high claims ratio. In 1998, the SCUs switched over to the Jan Arogya Policy which was popular. Then in 2003, they switched over to the Viswaragya policy. Now the premium is Rs 356 for an individual per year, Rs 530 for a family of 5 and Rs 720 for a family of 7. For BPL families there is a subsidy of Rs 100 on the premium. The BPL are identified by the ration card.

This premium is collected by the SCU representatives annually over a two month period and handed over to the NIC. The benefit package covers hospitalization in any hospital for an annual limit of Rs 15000 per individual or Rs 30,000 per family. There is a waiting period of one month for new members. At the time of hospitalization, the patient has to pay the hospital bills. S/he then submits the necessary documents to the local SCU who scrutinizes it to ensure completeness. If the claim is complete, it is handed over to the NIC. They reimburse the patient through the SCU. The SCU collects a 15% administrative charge on the reimbursement, which is used to meet the administrative costs of the insurance scheme as well as to subsidize the premiums of the poorest.

There are about 200 people who are still enrolled in the original scheme because the upper limits are higher.

• The second scheme was started in 2003 for the people around the Medical College hospital. Most of the members in this scheme are members of the SCUs living within a 10 km radius of the hospital. This is also a Viswarogya policy, but here the MOSC Medical College further subsidizes the premiums for the BPL families. They pay a token of Rs 10 per family and the rest is paid by the hospital on their behalf. APL families are requested to pay as much as possible – this usually ranges from 25 – 100% of the actual premium. The insured family gets an insurance card, which they need to present at the Hospital for receiving benefits. There is a special desk at the hospital for the insured patients.

The benefit package is the same as in the first scheme. Difference is that here there is only a single provider – the MOSC Medical College. Patients get admitted at the hospital and do not have to pay any money at the time of discharge (unless their bills exceed the upper limits). Their claims are processed by the hospital and sent to UIIC who in turn reimburses the hospital directly.

Other than this, all the insured members have access to the free OPDs conducted in their villages by the community medicine dept on a weekly / fortnightly basis.

SHADE helps now with the negotiation of the scheme with the insurance companies. Its workers also help out in the collection of the premium, especially in the second scheme. It also helps in the management and administration of the scheme. All accounts are audited annually.

Other than this, SHADE also provides a personal accident policy for which about 7000 members have joined.

Performance of the Community health insurance programme

• Scheme 1 – 850 families out of a potential of 2000 have joined the scheme in 2003 – 2004. There were about 100 claims amounting to about Rs 250,000. The claims rate = 30 /1000 insured and the claims ratio is 55%.

• Scheme 2 – 1226 BPL families and 257 APL families out of a potential of 7000 have joined the scheme in 2003 – 04. There were 261 claims in the same year amounting to about Rs 550,000. The claims rate = 66 / 1000 insured and the claims ratio is 65%.

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Announcements

The October 2004 issue of the IRDA journal is on health insurance. This document is available both at CHIN website and www.microinsurance-india.org

Editor – Dr. N Devadasan,

C/o The Valley School,

Thatguni Post, Kanakapura Road

Bangalore – 560062.

deva@devadasan.com