Extension of Social Protection : Community-based health insurance Céline Peyron, ITC- ILO, Trade Union Training on Soc

1. Extension of Social Protection: Community-based health insuranceCéline Peyron, ITC- ILO, Trade Union Training on Social Protection, 13 May 2004

2. Content • Health micro-insurance : a strategy for the extension of social security • Definition, principles and models of HMIS • Linkages • Limitations and impact of HMIS

3. 1. Health micro-insurance: a strategy for the extension of social security

4. ILO objective on Social Protection Enhance the coverage and effectiveness of the Social Protection for ALL

5. Strategies for extending health insurance • Strengthening of national health insurance schemes: • Extending social insurance coverage • Universal benefits • Social assistance • Encouraging decentralized mechanisms • Creation of linkages between both

6. 2. Definition, principles and models of health micro-insurance schemes

7. Health micro-insurance schemes: Objectives To support populations’ initiatives in organizing themselves their access to health : • Providing access to health to members • Negotiating with health care providers quality services at lowest possible costs • Prevention and information on Health problems • Income security and stability • Reinforcing solidarity and equity • Participation of all beneficiaries in social matters

8. Health Micro-Insurance Schemes: Definition “Micro-insurance refers to various schemes set up by self-employed and informal economy workers to meet their priority social protection needs. The mechanism used in these schemes is generally the provision of mutual support through the pooling of resources based on the principals of insurance. “ Source: ILO, World Labour Report 2000: Income security and social protection in a changing world, (ILO: Geneva).

9. Growth statistics in West Africa

10. Health micro-insurance:Schemes • Mutual Benefits Association (Trade Union) • Community Based Schemes • Integrated Schemes in an Hospital management • Micro-finance Institutes

11. INDIA : THE COMPENDIUM • 48 schemes found operational • 8 new shemes under preparation • intervention of multiple actors • 11 states already concerned • partnerships with insurance co. • around 2,6 millions beneficiaries

12. OWNERSHIP INDIA, 2003

13. LEVEL OF EXPERIENCE INDIA, 2003

14. AREAS OF INTERVENTION INDIA, 2003

15. SERVICES PROVIDED INDIA, 2003

16. BENEFICIARIES INDIA, 2003

17. TYPE OF CONTRIBUTION INDIA, 2003

18. RISK COVERAGE Out of 28 schemes : • 16 schemes cover only hospitalisation expenses • 7 schemes cover only primary health care services • 5 schemes cover both primary health care & hospitalisation costs INDIA, 2003

19. SCHEDULE OF CONTRIBUTION INDIA, 2003

20. Which are the main characteristics of health micro-insurance schemes in India?

21. THE CURRENT TRENDS, IN INDIA… • all insurance companies (both public and private) involved in the provision of health micro-insurance products to the poor mainly cover hospitalisation costs… • while…there is a world-wide recognition that the overriding need in developing countries is for primary health care…

22. Health micro-insurance: Principles • population excluded from formal social security schemes, often low incomes and vulnerable • solidarity and non-profit organisation • voluntary & contributory schemes • pooling of a group’s resources to share risks (health, pregnancy, death, accidents, belongings) & organize protection adapted to their needs • benefits package and contributions adapted

23. Health micro-insurance:Actors • Beneficiaries • Health care providers (Public services and private providers) • Finance institutes • Authorities (local and national)

24. Health micro-insurance: Different models • THE « PARTNERSHIP » MODEL • THE « INTEGRATED » MODEL • THE « INDEPENDENT » MODEL

25. THE « PARTNERSHIP » MODEL HMIS Health structure The HMIS is linked with the health provider by means of an agreement

26. THE « PARTNERSHIP » MODEL MicroCare Health Plan,UGANDA • 5000 MEMBERS • Collaboration with 5 hospitals • IT developed management

27. THE « PARTNERSHIP » MODEL MicroCare Health Plan,UGANDA • HEALTH CARE PROVIDED • medical consultations • hospitalisations • specialized tests • surgery • diagnostics and check-up • medicine • delivery services • dental care • ophtalmological consultations • COVERAGE Of HEALTH CARE COST 100% • ANNUAL CONTRIBUTION PER FAMILY : 60 $US (6 members)

28. THE “INDEPENDENT” MODEL HMIS Health provider The HMIS has no contractual links with the health provider

29. THE “INDEPENDENT” MODEL Vimo SEWA- INDIA • Created in 1992 • From a Women Workers ’ Trade Union, of the informal economy (created in 1972) • 90.000 beneficiaries

30. THE “INDEPENDENT” MODEL Vimo SEWA- INDE • CARE SERVICES PACKAGE INCLUDING : • Health Insurance (hospitalization), including services for delivery protection, • Life Insurance, including insurance in case of invalidity, • and Belongings Insurance (lost or damages to property or working material) • HEALTH CARE COVERED : 30 $USMAX PER YEAR • MATERNITY PROTECTION : 7,5 $US on the 8th month of pregnancy • CONTRIBUTION : 1,5 $US / Year

31. THE « INTEGRATED » MODEL HMIS Health provider The HMIS has developed its own health provision structure

32. THE « INTEGRATED » MODEL NOVADECI - Philippines • Created in 1976 • MANY SERVICES: Health, life/death, occupational injured, micro-credit, fire insurance, ... • covers 6500 families (it means 24000 beneficiaries)

33. THE « INTEGRATED » MODEL NOVADECI - Philippines Pharmacy

37. Steps in setting up health micro-insurance scheme • Diagnostic - information • Setting up steering committee • Pre- and feasibility study • Agreement-preparation providers • Preparation of management and monitoring tools • Lauching scheme • Functionning and monitoring HMIS

38. 3. Linkages

39. Social dialogue and the extension of SP Workers and their families Providers of services Government Workers Employers International organizations Citizens NGOs Community-based organizations

40. Conclusion: linkages HMIS with Trade-Unions • Promotion • Setting-up their own HMIS system • Negotiation to improve health care services (quality and quantity) • Campaign for prevention and health education

41. 4- Limitations and impact of health micro-insurance schemes

42. Health micro-insurance:Limitations • a partial and immediate response to an unmet collective responsibility • resource pooling & risks shared in a limited group of people, mostly low income and vulnerable • not necessarily a guarantee of equity for the poor • limited care services provides • capacity of poor to contribute fluctuates with income

43. Health micro-insurance: Risks • Moral hazard of over-consumption • Moral hazard of over-prescription • Adverse selection • Fraud and abuse • Catastrophic events

44. Group work 1.What can be the relevance of HMIS in terms of gender equality? 2. Is HMIS possible for HIV/AIDS affected targets?

45. 1. Gender and HMIS • Strenghtening of the status of the women • Health situation of women and access to health care • Methodology of supporting and promoting women • Fight against social injustice

46. 1. Gender and HMIS • Participation of women in management of HMIS • Reduce poverty and inequity between sexes • Protection of domestic workers • Women mainly employed in informal economy

47. 2.- HMIS and HIV/AIDS • Suitable if: • Expansion of the members (Affected / Infected) • Benefits package limited to primary health care • Funds from National campaigns and NGO’s projects

48. 2. Advantages of HMIS to prevent HIV/AIDS • Access to health care • Prevention • Voluntary and confidential counselling and testing • Improvement capacity of health providers • Address stigma and discrimination • Channel ressources to the local level

49. THANK YOU !