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MHI

MHI. Murali Srinivas 06-May’09. Objective Research Delivery Model About MHI Risk transfer MFI issues Lessons. Define objective Revisit and clarify after Research phase Make a road map - Phase wise approach. Research. Segment Needs assessment Cost of delivery Incidence.

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MHI

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  1. MHI • Murali Srinivas • 06-May’09

  2. Objective • Research • Delivery Model • About MHI • Risk transfer • MFI issues • Lessons

  3. Define objective • Revisit and clarify after Research phase • Make a road map - Phase wise approach

  4. Research • Segment • Needs assessment • Cost of delivery • Incidence

  5. Delivery Model • Resource base and mobilization (Estimate admin costs) • Marketing (Sensitizing & Training) • Distribution (Low cost + Flexible + Right incentives)

  6. Service delivery mechanism (need handholding + choice of hospitals) • Issue resolution processes (General + Crisis)

  7. About MHI Tech Aspects

  8. Expected Cost (Estimating future health costs) • Admin cost • Size of Risk pool • Reserves • Rating Risk (Community / Experience)

  9. Out of pocket costs • Deductible • Co-insurance • Elimination period • Limit (lifetime maximum benefit, benefit ceiling, Out of pocket maximum)

  10. Selection (Adverse, Cherry picking) • Fee for service (negotiated rates) • Exclusions • Moral hazard

  11. Group Policy • Advantages • Tax benefits • low adverse selction • economies of scale • Disadvantages (Take it or leave it! )

  12. Risk transfer • Self-Insured Advantages (no regulation + stop loss insurance) Disadvantages (low risk pool) • Insured • Advantages (Provider contracts + large risk pool + favorable reserves) • Disadvantages (Expensive + not flexible + poor knowledge transfer)

  13. MFI Issues • Staff overloaded - reluctant to promote new initiatives Need right incentives Promoters fear - negative impact due to any bad experiences Cost estimation & containment!

  14. Lessons • Flexible payments • Ensure solidarity of group • Larger risk pool Design keeping in mind community & household characteristics Associate with quality & viable health care provider Experience in rolling out insurance Demonstrate value

  15. My product! • Risk pool size - Aim for 10,000 lives • Deductible - Rs 1000/- • 25% Co-insurance • Coverage for Pre-existing diseases + Limited Exclusions Community rating Flexibility in premium payments • Pre/Post hospitalization reimbursements- with limits

  16. Questions?

  17. Murali Srinivas Mimo Finance, Dehradun

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