Community health insurance can we learn from them? : April 28, 2006

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 organisedsections 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