Transcript Document
Health Mutual Funds setup with Pune Slum-dwellers: An access to health for the poorest Heal th What is UpLift ? A group of Microfinance Organisations, NGOs working in India: Annapurna Parvati Disha Navnirman Swayam Shikshan Prayog Inter Aide Swabhimaan Working with poor communities people living in slums or in villages to provide: access to finance Training and business development services access to health care through mutual insurance systems …Sharing: Competencies : Training, Tools, MIS, Risk Management R&D 24X7 Guidance Agreements with > 70 Health Care Providers And democratically controlled 2 Pune , Mumbai slums Market Yard, Pune Ganpat Pada, Kalva Shivaji Nagar, Kalva Appapada/Kranti Nagar, Malad, Mumbai 3 Values & Unique Features Democratic member Control & Ownership Interest of the system = interest of clients = truly market led = financial incentive to good health Cooperation among cooperatives / mutuals instead of competition to have better deals, and economy of scale Solidarity & Equity instead of selection and exclusion Everybody or Nobody Professionalism Responsibility at each level = financial incentive to remain healthy Autonomy & Independence from insurers or health care providers Concern for Members’ Health first Information, Education and Communication Keep everyone aligned, owner. Full transparency on accounts and processes. 4 Micro Finance Loans for micro businesses Average loan around 70 €. 96% Reimbursement rates 15000 loans in 2007 5 6 Micro insurance 35 500 members insured on health. Claims managed by people 340 hospitalisations paid from fund in 2006 25% cheaper costs at equivalent quality Claim ratio 87% (claims/net Contributions) 18 health funds 7000 insured for life accident. 7 8 Annapurna members the founding group of health mutual funds in pune Annapurna Pune, Annual Meeting, 2003 9 Lilabai Dok, annapurna member 58 years old, “no son – no retirement”. Sells vegetables on Paud Phata market, Kothrud Her Husband, too old can’t work. She worries “What should I do if I fall sick?” 10 Contribution to the mutual fund 60Rs (1€) Per year and per person +60Rs (1€) for a person under alcohol/tobacco addiction +60Rs (1€) if at least one member of the family is excluded (or for people joining alone). 11 Finance Benefits for the UpLift Health Members • 80% of the hospitalisation costs up to 5000 Rs (100€) for hospitalisation cases, including difficult delivery • 100% if in a Public hospital , 40% if outside the network • 50 Rs per day as a wage loss when hospitalized • Whatever the health problem: guidance toward a quality health care center where rates were negociated with uplift health Information Qualité • A network of around 30 Hospital/health care providers • Counselling and guidance 24 hours a day, 7 days a week by phoneto be guided toward the closest and most adapted health care provider • A follow up often done in person to the hospital to be sure that a proper care is provided. • Monthly Health talks done on prevention and health awareness. • Health Check up Camps frequently organized thanks to a network of doctors willing to bring health to the poor • Each claim is discussed in the community along with the explaination of a doctor • FINANCE: All decisions are taken along with representative of the communities: they decide the reimbursing rates when behaviors are judged to be irresponsible. 12 A health care provider network >70 health care providers: Hospitals Dental Clinics Ophthalmologic Clinics Laboratories for medical analysis Pharmaceutical Laboratories Physiotherapist /orthopedical reeducation center Generalist and specialists) Negociated Memorandum of understanding on : Health Care quality Discounted rates 13 Field Operations : Information meetings, enrolments and contribution collection 14 Monthly Committee Meeting in Khilare Vasti (Pune) – Funds status, Claims review… 15 Ophtalmologic Checkup Camp in Nermadeshwar (Pune) 16 M. Satbhai, Rikshaw driver, Warje Malwadi. Cured of an appendicitis. Operation Cost: 2000 rs (40€) instead of 10 000Rs (200€) . Funds indemnity: 1600 Rs paid to M. Satbhai. 17 Indemnisation of Jitendra’s pneumonia 18 Indemnisation of Surekha Ghare’s Typhoïd 19 Elected members to the board under training 20 Some Figures Number of HMF: 17 Claim Ratio: 60% Frequency: 1.5% HEALTH Thank you!