Innova&ons(in(Health(Microinsurance:((

(How$a$challenging$product$is$reaching$millions$$November$4,$2013$

Image: Partners in Health

Summary(!(•  Health(Microinsurance(Overview(

•  Barriers/Challenges((

•  Product(Design(Lessons(

•  Innova&on(Lessons(

Health(Microinsurance(Overview(Why!is!health!microinsurance!important?!

Poor are more vulnerable to illness •  Poor hygiene •  Less access to care •  Lower levels of health awareness •  Fewer preventative measures

Illness leads to hardship •  Lost income • High cost-of-care • Cost of transport • Debt from borrowing for health expenses

Insurance can reduce hardships • Reduces out-of-pocket health expenditure •  Improves access to care •  Financial preparation in advance, rather than debt afterwards •  Possibly improves health outcomes

Health(Microinsurance(Overview(Demand!for!health!microinsurance!•  Health(is(oAen(cited(as(the(top(risk(faced(by(lowFincome(popula&ons(

Graphic from FinMark Trust, Exploring market opportunities in Zambia, PowerPoint Presentation. Available: http://www.finscope.co.za/finscope/pages/Initiatives/Countries/Zambia.aspx?randomID=8b1174d1-2ef7-4c68-bb07-ee205f740531&linkPath=3_1&lID=3_1_16

Health(Microinsurance(Overview(Health!microinsurance!worldwide!•  Over(40(million(people(are(covered(by(health(microinsurance(products(

worldwide((majority(in(India)(

•  Just(over(2(million(people(covered(by(health(microinsurance(in(Africa(

Barriers(and(Challenges(Health!microinsurance!is!not!easy!!

Complex

Complicated Benefits/ Challenging to Educate Clients

Difficult to manage/monitor health provider networks

Many different treatments/costs

Client Value Clients need tangibility, need to see claims paid

Coverage must be useful, in line with client needs

High Fraud Risk Identification of individuals

Hard to monitor health facilities (over/under treatment, collusion)

Infrastructure

Poor quality health facilities

Lack of technology/interoperability

Varying types of facilities (Public, private, CBO, hospitals, clinics, etc)

Expensive to Operate

Must invest in client training/education

High cost of care and distribution

Lack of data makes pricing difficult and can result in high claims-ratios

Premium Difficulties

Challenging to collect Unsmooth income/spending among population

Preparing for healthcare costs is often not a priority

Barriers(and(Challenges(Can!be!overcome!through!careful!DESIGN!and!INNOVATION!

Complex

Complicated Benefits/ Challenging to Educate Clients

Difficult to manage/monitor health provider networks

Many different treatments/costs

Client Value Clients need tangibility, need to see claims paid

Coverage must be useful, in line with client needs

High Fraud Risk Identification of individuals

Hard to monitor health facilities (over/under treatment, collusion)

Infrastructure

Poor quality health facilities

Lack of technology/interoperability

Varying types of facilities (Public, private, CBO, hospitals, clinics, etc)

Expensive to Operate

Must invest in client training/education

High cost of care and distribution

Lack of data makes pricing difficult and can result in high claims-ratios

Premium Difficulties

Challenging to collect Unsmooth income/spending among population

Preparing for healthcare costs is often not a priority

Innovation

Innovation

Innovation

Innovation

Innovation

Innovation

Innovation

Innovation Innovation

Innovation

Innovation

Innovation

Innovation

Design

Design

Design

Design

Design

Design

Design

Design

Design

Design

Product(Design(Lessons!from!exisHng!products!•  Simple(structures(tend(to(work(the(best,(although(might(not(provide(the(highest(value(to(

client(

•  Successful(products(have(very(few(exclusions,(expanded(benefits(

•  Closed(provider(networks(ease(administra&on(and(reduce(fraud(

•  Work(in(conjunc&on(with(gov’t(through(PPP’s(F(can(provide(scale,(quality(assurance,(and(

dynamism,(and(poten&ally(leverage(subsidies(for(premiums(

•  Design(premium(collec&on(to(match(client(income(limita&ons((

•  Must(balance(fraudulent(claims(low(with(simple,(efficient(claims(process$

Innova&ons(Examples!from!exisHng!products!•  Mobile(Health((mHealth)(Insurance(

•  Smart(Cards(

•  ValueFAdded(Services(

•  Mobile(Data(Collec&on(

•  Comprehensive(Medical(Insurance(in(Kenya(

•  Launched(November(2012(

•  Innova&on:(Simple(enrolment,(allows(for(savings(

via(mobile(

Innova&ons(Mobile!Health!(mHealth)!Insurance!

Enrolment via handsets

Premium Collection via Airtime or Mobile

Money Claims Initiation Claims Payment

SMS

Image: iicd.org

•  Hospital(Cash(Replacement(Product(in(Tanzania(((

•  Launched(November(2012(

•  Innova&on:(Simple(enrolment,(auto(premium(

payment,(claims(via(phone(

Innova&ons(Mobile!Health!(mHealth)!Insurance!•  Other(mHealth(insurance(products(have(also(launched(recently(in(many(

African(countries(

•  Medaccess by Altfin

•  Hospital Cash Plan by Eagle

Zimbabwe

•  Tigo Hospitalisation

Ghana

•  Mobisure

Kenya

•  MyLife (MTN)

Uganda

Image: Erik Hersman, Flikr

Innova&ons(Smart!Cards!•  Pilo&ng(with(RSBY((Na&onal(Health(Insurance(Scheme)(India(

•  Could(poten&ally(reach(34(million(households(

•  Many(advantages,(some(limita&ons(remain(

Patie

nts •  No waiting

periods

•  Cashless Treatment

•  Real-time updates to insurance limits

Hos

pita

ls

• Electronic Medical Records

• Paperless transactions

• Quick payments

• Ease in administering treatment

Gov

ernm

ent • Improved

Identification of Patients

• Ease in performance monitoring

Insu

rers

• Reduced Fraud

• Simplified management and processes

• More reliable data on patients

Image: computer.howstuffworks.com

Innova&ons(Mobile!Data!CollecHon!•  Remote(pa&ent(data(collec&on(and(diagnosis(

•  Reduced(&me,(transport(costs(

•  Reduced(cost(of(care(through(communityFlevel(health(workers(

•  Fewer(inFpa&ent(visits(and(claims(

Image: environment.mkfc.se

Innova&ons(Value!Added!Services!•  A(lack(of(tangibility(can(prevent(clients(from(seeing(the(value(of(health(

insurance(products.(

•  ValueFadded(services(can(provide(this(tangibility(

Ask a Doctor

Health Camps

Ambulance Services

Discounted Medicines

Primary Care Visit

Image: cmi.no

Conclusion(Challenging!but!possible!!

Image: bps-research-digest.blogspot.com

Smart Product Design

Simple products

High-value products

Appropriate products

Innovation

Efficiency

Improved client value

Reduced costs and risk

Outside Factors

Infrastructure improvements

Increased insurance awareness

Supportive regulation

Better Outcomes

Demand/need for health

insurance met

Reduced out-of pocket

expenditure

Improved access to care