Community health insurance – can we learn from them?

Dr. N. Devadasan,
Institute of Public Health,
Bangalore
28/04/06


What is Community Health Insurance (CHI)?

Not-for-profit HI
For the Informal sector
Community is involved
 
Existing CHI schemes in India
 
Characteristics of Indian CHIs
•      All initiated by NGOs / CBOs.
•      Main objective is to increase access to health care
•      Have targeted the poorer sections of society. Usually the ‘organised’sections e.g. SHGs, unions, co-operative societies, students, 
  
Characteristics of Indian CHIs
•     Three basic models – provider, mutual and linked
•     Main benefit includes hospitalisation services
•     All use private sector providers
 
 Characteristics of Indian CHIs
•     Coverage ranges from 10,000 to 50,000 members
•     Many of them have been able to manage with existing funds
•     Have very inadequate data
  
Lessons learnt from Indian CHIs
•      The first question to be answered is
 
WHY HEALTH INSURANCE?
 
Lessons learnt from Indian CHIs 

HEALTH INSURANCE HAS TO BE ORGANISED & SERVICED BY AN INSTITUTION THAT IS INDEPENDENT, CREDIBLE AND TRUSTWORTHY.
 
Remember the people are placing money in your hands
Lessons learnt from Indian CHIs 

 INTRODUCE HEALTH INSURANCE ACTIVITIES THROUGH ‘ORGANISED’ SECTIONS OF SOCIETY.
 
It is easier to create awareness and later administer the scheme.
 
Lessons learnt from Indian CHIs

 NEED TO INVEST IN INSURANCE EDUCATION, both before and after starting the programme.
 
Have a long term perspective
 
Lessons learnt from Indian CHIs

KEEP THE PREMIUM AFFORDABLE AND THE COLLECTION MECHANISM SIMPLE.
 
The poorer sections are willing to pay about Rs 50 per person per year.
 
The premium for the poorest need to be subsidised even upto 100% - more like a social assistance.
 
 
Lessons learnt from Indian CHIs

KEEP THE BENEFIT PACKAGE ACCEPTABLE
 
A balance between community demands and technical needs

Minimise exclusions and preferably catastrophic cover

People prefer both OP and IP.

In remote areas, transport costs !!!

 
Lessons learnt from Indian CHIs

NEED TO IDENTIFY AND EMPANEL CREDIBLE PROVIDERS

NEGOTIATE COSTS AND QUALITY
 
Remember that this is the weakest link

Need to build up capacity to purchase care

What happens to government institutions ?
 
Lessons learnt from Indian CHI

 

 KEEP ADMINISTRATION TO THE MINIMUM ESPECIALLY FOR CLAIMS AND REIMBURSEMENTS
 
Cashless system is preferred

Remember that the cost for the patient in submitting the forms maybe very high

Keep copayments to the minimum

Lessons learnt from Indian CHIs

EFFECTIVE and ACCEPTABLE MEASURES TO MANAGE RISK ARE
 
–    Family as the enrolment unit
–    Definite collection period
–    Waiting period
–    Referral system
–    Case based payment
 
Lessons learnt from Indian CHIs

 

THERE IS A NEED FOR TECHNICAL AND MANAGERIAL SUPPORT
 
Most programmes maintain only financial data, but have very little information about process and outcome indicators
 
CONCLUSIONS

•      Remember that health insurance is a complex financing mechanism.
•      Health insurance can be used as a mechanism to empower the ‘patient community’ and strengthen solidarity.
•      There are a few pre-requisites that need to be in place before initiating health insurance programmes.
 
 
THANK YOU
Dr. N. Devadasan
Institute of Public Health
Bangalore
 
deva@devadasan.com