Transcript Document

MICRO-INSURANCE WORKSHOP
HYDERABAD, 14-15 OCTOBER, 2005
FROM MICRO TO MACRO:
ADDRESSING THE FINANCING AND
DISTRIBUTION CHALLENGES
INTERNATIONAL LABOUR ORGANIZATION (ILO)
STRATEGIES AND TOOLS AGAINST SOCIAL
EXCLUSION AND POVERTY (STEP)
MICRO-INSURANCE:
THE RIGHTS-BASED APPROACH…
SOCIAL PROTECTION IS A FUNDAMENTAL HUMAN RIGHT (1948)
EACH GOVERNMENT SHOULD PROVIDE SOCIAL PROTECTION TO
EACH AND EVERY CITIZEN
UNDER ILO’S DEFINITION NINE MAJOR BENEFITS SHOULD BE
COVERED BY SOCIAL PROTECTION SYSTEMS (MEDICAL CARE,
SICKNESS BENEFITS, UNEMPLOYMENT BENEFITS, OLD AGE
BENEFITS, EMPLOYMENT INJURY BENEFITS, FAMILY BENEFITS,
MATERNITY BENEFITS, INVALIDITY BENEFITS, SURVIVOR’S
BENEFITS)
IN INDIA TODAY, ONLY 10% OF THE POPULATION ENJOYS SOME
LEVEL OF SOCIAL PROTECTION BENEFITS
WHILE 370 MILLION INFORMAL ECONOMY WORKERS CONTRIBUTE
TO SOME 63% OF THE GDP, MOST OF THEM REMAIN EXCLUDED
FROM SOCIAL PROTECTION SYSTEMS – THEY DO NOT BENEFIT
FROM THE WEALTH THEY CONTRIBUTED TO GENERATE
MICRO-INSURANCE IS ONE OF THE INSTRUMENTS THAT CAN BE
USED TO COMBAT SOCIAL INJUSTICE
SOUTH ASIA: THE MAGNITUDE OF
THE EXCLUSION PHENOMENON
98

o 90 %
o 950 MILLION
96
India
94


90
Nepal
88
Pakistan
%
BANGLADESH:
o 93%
o 134 MILLION
Bangladesh
92
86
INDIA:
NEPAL:
o 95%
o 23 MILLION

PAKISTAN:
o 97%
o 147 MILLION
INDIA: A UNIQUE MICRO-INSURANCE
EXPERIENCE…
THE BIGGEST CHALLENGE: HOW TO EXTEND SOCIAL PROTECTION
BENEFITS TO ALL?
A WIDER DIVERSITY OF RISKS (WEATHER, ASSETS, CROP…)
A WIDER DIVERSITY OF ACTORS (INS. COs, BANCASSURANCE…)
A WIDER DIVERSITY OF INNOVATIONS (RISK PACKAGES) AND
OPERATIONAL MECHANISMS
SOME OF THE LARGEST MICRO-INSURANCE SCHEMES IN THE
WORLD
SOME MICRO-INSURANCE SCHEMES HAVE ALREADY REACHED AN
IMPORTANT DEVELOPMENT LEVEL (SEWA, YESHASVINI…)
VARIOUS LINKAGE EXPERIENCES INCLUDING A SUBSIDY
COMPONENT (REDISTRIBUTION MECHANISM)
MULTIPLE NEW INITIATIVES AT THE STATE LEVEL
A NEW AMBITIOUS EXTENSION PROGRAMME: TO COVER 300
MILLION INFORMAL ECONOMY WORKERS (NATIONAL COMMISSION
DRAFT BILL - 2005)…
SOCIAL PROTECTION PRIORITY
NEEDS OF THE POOR
1
☺HEALTH CARE:
 A STRONG DEMAND FOR TOTAL COVERAGE
(WHOLE CARE VS RARE CARE)
 QUALITY IS A MAJOR CONCERN
2
☺ MATERNITY PROTECTION
 NEED FOR A BROADER RCH PERSPECTIVE
3
☺ OLD AGE PENSION
 A NEW BUT FAST INCREASING DEMAND
4
☺ LIFE
 A STRONG DEMAND FOR MATURITY BENEFITS
(CASH BACK SERVICES)
5
☺ ACCIDENTS
HEALTH INSURANCE:
CURRENT « POOR » COVERAGE
N0 OF BENEFIC.
EMPLOYEE S‘ STATE INSURANCE CORPOR.
31,000,000
MEDICLAIM
9,000,000
WELFARE FUNDS
7,000,000
UNIVERSAL HEALTH INSURANCE SCH.
MICRO-INSURANCE SCHEMES
80,000
7,500,000
TOTAL INFORMAL ECONOMY
23,580,000
GRAND-TOTAL
54,580,000
% OF POPULATION
5,1 %
FORMAL ECONOMY HI SCHEMES
ESIC AT A GLANCE…
ESTABLISHED IN 1948
APPLICABLE TO NON-SEASONAL POWER USING FACTORIES EMPLOYING
10 OR MORE EMPLOYEES
ELIGIBILITY CRITERIA: WORKERS EARNING LESS THAN Rs. 7,500 PER
MONTH
COVERAGE: 7,1 MILLION WORKERS (TOT. BENEFICIARIES: 31 MILLION)
BENEFITS: MEDICAL CARE (HOSPITALIZATION) + MATERNITY BENEFITS
+ SICKNESS BENEFITS + DISABILITY + FUNERAL EXPENSES
CONTRIBUTIONS: EMPLOYEE: 1.75% WAGES – EMPLOYER: 4,75 WAGES +
GOVERNMENT CONTRINTION: 12,5% OF ALL MEDICAL COSTS
EXAMPLE: FOR A MONTHLY INCOME OF Rs 5,000:
 EMPLOYEE WILL PAY: Rs 1,050 PER YEAR
EMPLOYER WILL PAY: Rs. 2,850 PER YEAR
CLAIM RATIO (2003-2004): 45%
INCOME RATIO (2003-2004): 40%
GOVERNMENT SUBSIDY (2003-2004): 112 CRORE
INFORMAL ECONOMY HI SCHEMES
THE TOP DOWN APPROACH…
MEDICLAIM:
 CONTRIBUTION VARIES ACCORDING TO INSURED SUM
 MANY EXCLUSIONS CLAUSES
 VERY HIGH CLAIM RATE (100%... OR MORE)
WELFARE FUNDS:
 MOSTLY: FINANCIAL ASSISTANCE IN CASE OF ILLNESS
 VERY LOW LEVEL OF REIMBURSEMENT (Rs. 200/EPISODE)
 ASSISTANCE MAY BE DECIDED ON A CASE BY CASE BASIS
UNIVERSAL HEALTH INSURANCE SCHEME:
 HOSPITALIZATION EXPENSES ONLY
 MANY EXCLUSIONS CLAUSES (WOMEN UNFRIENDLY)
 YEAR 1: Rs. 100 FLAT SUBSIDY FOR EACH BPL FAMILY
 1,1 MILLION COVERED (BUT ONLY 10,000 BPL FAMILIES)
 YEAR 2: SUBSIDY INCREASE: Rs, 200, Rs 300, Rs 400
 80,000 COVERED (20,000 BPL FAMILIES)
HEALTH MICRO-INSURANCE SCHEMES
THE BOTTOM UP APPROACH…
OWNERSHIP PROFILE
NGO
CBO
HP
MFI
OTHERS
TU
HEALTH INSURANCE:
LOOKING AT THE BPL ISSUE…

80
70
60
50
Rs. 13
Rs. 44
Rs. 88
40
30
20

10
0

%
PLANNING COMMISSION
DEFINITION: VALUE OF
A SPECIFIED NUTRITION
REQUIREMENT
o
o
26%
278 MILLION
o
o
35%
374 MILLION
o
o
80%
855 MILLION
UNDP DEFINITION: LESS
THAN 1 US/DAY/PERSON
UNDP ANALYSIS: LESS
THAN 2 US/DAY/PERSON
HEALTH MICRO-INSURANCE:
HOW MUCH CAN THE POOR
CONTRIBUTE?
Contributory Capacity
120%
100%
97%
100%
90%
85%
80%
54%
60%
42%
40%
31%
26%
7%
6%
5%
5%
4%
4%
3%
900
950
1000
7%
850
10%
800
11%
750
14%
700
18%
20%
650
600
550
500
450
400
350
300
250
200
150
100
50
0%
HEALTH MICRO-INSURANCE:
DO THE SCHEMES NEED FINANCIAL
ASSISTANCE?
SCHEMES
YESHASVINI
N0 OF
BENEFIC.
1,410,000
TYPE OF
SCHEME
TYPE OF
COVERAGE
TYPE OF
BENEFIT
TYPE OF
SUBSIDY
IN-HOUSE
TER.
CASHL.
DIRECT
DHARAMST.
300,000
P.AGENT
SEC.
CASHL.
INDIRECT
VHS
145,000
P.AGENT
PR/SEC.
CASHL.
INDIRECT
KARUNA
137,000
P.AGENT
PR/SEC.
REIMB.
IND/DIRECT
SEWA
133,000
P.AGENT
SEC.
REIMB.
INDIRECT
PREM
108,000
IN-HOUSE
SEC.
CASHL/REIM
INDIRECT
AROGYA
60,000
P.AGENT
SEC.
CASHL.
INDIRECT
ASHWINI
12,000
P.AGENT
PR/SEC.
CASHL.
IND/DIRECT
UPLIFT
10,000
IN HOUSE
SEC.
CASHL.
IND/DIRECT
P.AGENT
SEC.
CASHL/REIM
INDIRECT
HEALING F.
9,000
HEALTH MICRO-INSURANCE:
HOW MUCH WISH THE INSURANCE
COMPANIES CONTRIBUTE?
PUBLIC INSURANCE COMPANIES: MAY RECEIVE PUBLIC SUBSIDIES
(UHIS) BUT OPERATE NOW IN A NEW COMPETITIVE ENVIRONMENT
PRIVATE INSURANCE COMPANIES: MUST COMPLY WITH SOCIAL
OBLIGATIONS (INTERVENTIONS IN RURAL & SOCIAL SECTORS)
 NO PREVIOUS EXPERIENCE IN INDIA
 NO PREVIOUS EXPERIENCE IN HEALTH INSURANCE
 NO PREVIOUS EXPERIENCE IN WORKING WITH THE POOR
 INTERNAL CROSS-SUBSIDY MECHANISM ATTACHED TO ALL
PRODUCTS PROVIDED TO THE POOR (INCLUDING HEALTH)
 SOME SEE THESE INTERVENTIONS AS PART OF THE CORPORATE
SOCIAL RESPONSIBILITY PRINCIPLE AND ACCEPT TO LOSE MONEY
 SOME SEE THE HIGH DEVELOPMENT POTENTIAL OF THIS NEW
HUGE MARKET AND ACCEPT TO INVEST (FOR A WHILE)
 SOME SIMPLY WANT THE REGULATIONS TO BE WAIVED
 ALL COMPLAIN ABOUT THE LACK OF DATA – HENCE THE NEED
TO BE VERY CAUTIOUS (GO FOR THE EASY WAY: REIMBURSEMENT
OF HOSPITALIZATION EXPENSES ONLY– TIGHT ELIGIBILITY
CONDITIONS AND MULTIPLE EXCLUSION CLAUSES)
HEALTH MICRO-INSURANCE:
LOOKING FOR THE ELUSIVE DATA…
DATA SHOULD COVER EXTENDED PERIODS
 REFERENCE PERIOD IS STILL TOO SHORT (2 TO 3 YEARS)
DATA SHOULD COVER VARIOUS GROUPS IN DIFFERENT SETTINGS
 STILL A GREATER FOCUS IN THE SOUTHERN STATES…
DATA SHOULD BE COMPREHENSIVE
 MOST SCHEMES ONLY COVER HOSPITALIZATION COSTS…
DATA SHOULD BE RELIABLE
 BEING VOLUNTARY, MOST SCHEMES ARE AFFECTED BY AN
IMPORTANT ADVERSE SELECTION EFFECT…
DATA SHOULD BE THOROUGHLY ORGANIZED AND ANALYZED
 STILL A CHALLENGE IN A NON-REGULATED PRIVATE HEALTH
SECTOR AND UNDERMANNED PUBLIC HEALTH SECTOR…
DATA SHOULD BE SHARED
 TREND TOWARDS MORE COMPETITION…
HEALTH MICRO-INSURANCE:
WHAT’S NEW?
A FIRST STAND-ALONE HEALTH INSURANCE COMPANY TO BE
OPERATED SOON
 POSITIVE TREND BUT… WILL IT HAVE TO COMPLY WITH THE
SAME SOCIAL OBLIGATIONS APPLYING TO OTHERS (LIFE &
GENERAL)?
FIRST INTERVENTIONS OF PUBLIC HEALTH FACILITIES IN NETWORKS
ASSOCIATED TO HEALTH MICRO-INSURANCE SCHEMES
 POSITIVE TREND BUT… LEGAL AND FINANCIAL ISSUES STILL TO
BE DEALT WITH…
FIRST AGREEMENTS CONCLUDED BETWEEN STATE GOVERNMENTS
AND PRIVATE INSURANCE COMPANIES
 POSITIVE TREND BUT… WILL IT BE GENERALIZED?
MULTIPLE NEW INITIATIVES TAKEN AT THE CENTRAL AS WELL AS AT
THE STATE LEVEL
 RURAL HEALTH MISSION… HEALTH INSURANCE SCHEMES
INITIATIATED (OR PLANNED) IN KARNATAKA, GUJARAT, WEST
BENGAL, ASSAM, PUNJAB, KERALA, ANDHRA PRADESH…
 THESE NEW INITIATIVES INCREASINGLY RELY ON NEW
PATNERSHIP ARRANGEMENTS WITH COMMUNITY-BASED HEALTH
MICRO-INSURANCE SCHEMES…
HEALTH MICRO-INSURANCE:
WHAT IS NOT NEW?
SCALING UP: A BUMPY ROAD INDEED…
 YESHASVINI 700,000 MEMBERSHIP DROP IN YEAR III
INSURANCE EDUCATION FRONT: NOT MUCH TO SEE YET…
 URGENT NEED FOR EDUCATION PROGRAMMES AND TOOLS…
 HEALTH INSURANCE: MUCH MORE COMPLICATED TO EXPLAIN
THAN ANY OTHER INSURANCE PRODUCT…
RENEWAL RATES: STILL VERY LOW…
 TOP MARK SEEMS TO BE AROUND 50%?
ADVERSE SELECTION: STILL VERY HIGH
 SEWA INCIDENCE RATIO: FROM 3 TO 6 PERCENT
 YESHASVINI INCIDENCE RATIO: FROM 1 TO 7 PER THOUSAND
EXCLUSION CLAUSES: STILL PREDOMINENT…
 PREGNANCY-RELATED ILLNESSES (A CHOICE ?)
AND WHAT ABOUT THE ULTIMATE GOAL: QUALITY IMPROVEMENT?…
 WHERE IS THE EVIDENCE ?
THE FINANCING CHALLENGE:
EVERYBODY ALREADY SHARES THE
BURDEN SOMEHOW…
CENTRAL
GOVERNMENT
EXTERNAL
DONORS
STATE
GOVERNMENTS
INSURANCE
COMPANIES
NGOSs
HEALTH
PROVIDERS
MFIs
TPAs
TRADE
UNIONS
CORPORATE
SECTOR
EMPLOYERS’
ORGANIZATIONS
INDIVIDUALS
GRASSROOTS
ORGANIZATIONS
THE FINANCING CHALLENGE:
…BUT NOT IN A COORDINATED
WAY…
CENTRAL
GOVERNMENT
EXTERNAL
DONORS
STATE
GOVERNMENTS
INSURANCE
COMPANIES
NGOSs
HEALTH
PROVIDERS
MFIs
TPAs
TRADE
UNIONS
CORPORATE
SECTOR
EMPLOYERS’
ORGANIZATIONS
INDIVIDUALS
GRASSROOTS
ORGANIZATIONS
THE DISTRIBUTION CHALLENGE:
TARGET ORGANIZED GROUPS…
RELY ON ORGANIZED GROUPS BASED ON STRONG
SOLIDARITY MECHANISMS (COOPERATIVES, SELFHELP GROUPS, INFORMAL ECONOMY TRADE UNIONS
AND LOCAL ASSOCIATIONS…)
CONTRIBUTE TO THE FURTHER EMPOWERMENT OF
THESE GROUPS
FROM MICRO TO MACRO:
THE WAY FORWARD…
START WITH HEALTH MICRO-INSURANCE AS A STAND-ALONE PRODUCT
 THE PRESSING NEED OF THE DAY – MORE COMPLICATED
ADDRESS THE SPECIFIC PROTECTION NEEDS OF ORGANIZED GROUPS
 COMPREHENSIVE ADAPTED BENEFIT PACKAGE – EASY PAYMENT
MECHANISMS…
SET UP A NETWORK OF HEALTH PROVIDERS (PRIVATE/PUBLIC)
 CONCESSIONAL TARIFFS AND INTERVENTION REGULATIONS…
ORGANIZE ACCREDITATION/ MANAGEMENT/MONITORING SYSTEMS
 ENSURE THE PROVISION OF QUALITY SERVICES…
ENSURE SUSTAINABLE FINANCIAL SUPPORT
 LONG-TERM PUBLIC/PRIVATE PARTNERSHIP ARRANGEMENTS
AND FINANCIAL SUPPORT…
ENHANCE EMPOWERMENT AND SOCIAL INCLUSION
 MEMBERS SHOULD BE ABLE TO «VOTE WITH THEIR FEET» - NEW
COLLECTIVE RESPONSIBILITIES…
FROM MICRO TO MACRO:
TOWARDS THE ULTIMATE MODEL…
STABLE FINANCIAL CORPUS
EMPOWERMENT
LOCAL
SUPPORT
ORGANIZATIONS
INSURANCE MANAGEMENT
ORGANIZED
GROUPS
COMPULSORY
CASHLESS SERVICES
HEALTH
PROVIDERS’
NETWORK
WHOLE CARE
WHOLE BPL POPULATION
UNIVERSAL COVERAGE
ALL-INCLUSIVE
WHOLE POPULATION
FROM MICRO TO MACRO:
MORE
ADVOCACY IS NEEDED…
«THERE IS NO ADVOCACY WITHOUT EVIDENCE, HENCE,
THE NEED TO DEVELOP MORE KNOWLEDGE AMONG ALL
ACTORS THROUGH ACTIVE NETWORKS»
ADVOCACY
NEED TO INCREASE THE ACTIVE SUPPORT OF
POLICY MAKERS UNDER THE NATIONAL
SOLIDARITY PRINCIPLE
CAPACITY BUILDING
NEED TO ENHANCE THE TECHNICAL
CAPACITIES OF THE VARIOUS ACTORS
INVOLVED IN THE MANAGEMENT OF HEALTH
MICRO-INSURANCE SCHEMES
KNOWLEDGE DEVELOPMENT
NEED TO DEVELOP STRONGER EVIDENCE ON
HEALTH MICRO-INSURANCE BEST PRACTICES
AT THE GRASSROOTS LEVEL…
THE ASIAN MICROINSURANCE NETWORK
(AMIN)
230 SCHEMES…
SO FAR…
OBJECTIVES:
SET UP AN EFFICIENT MECHANISM ALLOWING FOR THE REGULAR
SHARING OF INFORMATION AND EXPERIENCE AMONG MICROINSURANCE PRACTITIONERS
DEVELOP THE DOCUMENTATION PROCESS ON MICRO-INSURANCE
INITIATIVES, INNOVATIONS AND ACHIEVEMENTS
BUILD UP TECHNICAL CAPACITIES OF MICRO-INSURANCE ACTORS
STRENGTHEN COLLABORATION AND PATNERSHIP AMONG MICROINSURANCE SCHEMES
HIGHLIGHT AND CLARIFY ISSUES, CHALLENGES AND OPPORTUNITIES
RELATED TO THE CONTRIBUTION OF MICRO-INSURANCE TO SOCIAL
PROTECTION EXTENSION
THE INTERNATIONAL
ALLIANCE FOR THE
EXTENSION OF SOCIAL
PROTECTION
ILO, ISSA, AIM,
IHCO, WIEGO, ICA,
ICMIF
OBJECTIVES:
ACT AS A GLOBAL CLEARING HOUSE FOR ALL ISSUES RELATED TO
SOCIAL PROTECTION
IDENTIFY, DOCUMENT AND SUPPORT ORIGINAL AND INNOVATIVE
EXTENSION APPROACHES
DEVELOP OVERALL CONSENSUS ON KEY EXTENSION ISSUES AND
BEST PRACTICES
BRING TRASFERABLE INNOVATIONS AND REGIONAL EXPERIENCES
TO THE INTERNATIONAL LEVEL
PLAY AN ADVOCACY ROLE TO ENCOURAGE NEW EXTENSION
INITIATIVES AT THE INTERNATIONAL LEVEL