Micro health insurance: Introduction and Complexity

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1 Pro MHI Africa EU-African MALAWI MICROFINANCE NETWORK - Improving Access to University Network to strengthen community-based Micro Health Insurance Financial Services : Introduction and Complexity Workshop on Micro Health Insurance Lilongwe, 2-3 June 2010 Gerald Leppert, Philipp Degens Financial Inclusion in Malawi (FIMA) Project Ministry of Finance Pro MHI Africa is kindly funded by the ACP-EU Cooperation Programme in Higher Education (EDULINK). A programme of the ACP Group of States with the financial assistance of the European Union.

2 What is micro health? is a risk management institution for low-income population (mostly working in the informal economy) that covers the costs of certain predefined illness-related losses (= limited benefit package) to a certain extent (= limited coverage). Definition by Pro MHI Africa 2

3 Key features of micro health I Risk pooling (sharing the risk between individuals) Regular payment of (small) premiums in advance (resource pooling, smoothing payments over time and individual) The premium level depends on the probability and the extent of the loss Pre-defined benefit package 3

4 Typical features of micro health II Often based on community-based organisations and local institutions (e.g. local NGOs, microfinance institutions, faithbased organisations, (non)profit hospitals, cooperatives, RoSCas) Fulfil other tasks besides (e.g. controlling the health care provider market (excess pricing), provide access to health care services, sanitation, health awareness, channelling governmental vaccination programs) 4

5 The (potential) clients Target group of micro health is lowincome population Usually working in the informal sector with irregular income They lack of understanding of principles Lack of (quality) health care providers need for simple and affordable products that respond to people's needs and preferences 5

6 6

7 Types of micro health 7

8 Mutual model 8

9 Mutual model members are clients and owners (risk carrier) at the same time members involved in decision-making members bear risk of loss, but benefit from surplus majority of MHI suppliers worldwide belong to this type 9

10 Strengths of the mutual model Serving the needs of the poor (width and depth of outreach) Geographic proximity Social proximity Flexibility Respecting interest and needs of members Participation, voluntary work and democratic structures Trust and social control (vs. moral hazard and fraud) 10

11 Weaknesses of the mutual model small financial resources low technical and actuarial knowledge small risk pools high safety loading conservative pricing and small benefit package high probability of insolvency 11

12 Partner-agent model 12

13 Partner-agent model Conventional/commercial insurer cooperates with intermediary organisation (e.g communitybased organisation/ngo/mfi) Community-based organisation focuses on distribution and product servicing Insurer develops and prices product, bears risks and profits. 13

14 Strengths of the partner-agent model At best: combination of management and actuarial skills of the company (partner) and the agent's proximity and trustful relationship to target group Access to reserves Legislative advantage (registration as company) High outreach, replicability 14

15 Weaknesses of the partner-agent model Conflict of interests (profit orientation of partner vs needs of target group / aims of agent) Possible lack of trust in partner Insurers tendency to uniform product vs need of adoption to local contexts Inflexibility (e.g. product design; contract language) Partner (agent) not in all contexts available 15

16 Part II: The complexity of micro health 16

17 Illness related costs direct cost of treatment - medicine, user fees, hospital bills indirect costs - transportation, food for inpatients and accompanying person opportunity costs - income loss through inability to work, sold assets, used saving, income loss of caring person hidden costs: - gifts or bribes for health personal / medication 17

18 Health risks from perspective Most health problems are highly random (=> insurability) Many different illnesses and treatments Everyone falls sick at some point of time High variance of treatment costs Common distinction: Low Probability, but high cost cases (e.g. hospitalization) High probability, but low cost cases (e.g. outpatient care) 18

19 What does an do? Ressource pooling Risk pooling 19

20 Risk pooling as solidarity Risk pooling implies the transfer of risks and resources between high and low risk groups. 20

21 The health triangle Three parties involved: 21

22 The health triangle Where do problems arise out of the involvement of these three? 22

23 Dependence on health care providers Without health care provider of reasonable quality within reachable distance micro health is considered not feasible. Critical f: - distance to health care provider - quality of health service - qualification of health care staff - availability of drugs 23

24 Health care providers and problems Health care provider holds about diagnosis and necessary treatment (effectiveness, alternatives) danger of over-utilisation and high costs needs skilled personnel to control claims 24

25 Asymmetry of Information: Moral Hazard Moral hazard refers to utilization of more or more costly services induced by being insured. This over-utilization can result from change of behaviour of the client or the provider knowing the client to be insured. But: The increase in utilization of health care services is one of the purposes of MHIs (financial access to health service). 25

26 Asymmetry of Information: Adverse selection Process whereby high-risk individuals (like chronical ill) insure, remain insured and low-risk individuals drop out or stay aside Leads to higher-than-expected levels of loss and to financial struggle insurer has to find mechanisms against adverse selection (e.g. group enrolment; compulsion) 26

27 MALAWI MICROFINANCE NETWORK - Improving Access to Financial Services Pro MHI Africa EU-African University Network to strengthen community-based Micro Health Insurance Thank you very much! gerald.leppert <at> uni-koeln.de philipp.degens <at> uni-koeln.de This publication is licensed under the Creative Commons Attribution-Share Alike (CC-BY-SA) 3.0 License

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