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Uplift Mutuals People Led Social Protection Kumar Shailabh. Why Mutuals. Unorganized Sector’s Need. Risks in PA Health Insurance. Numerous Exclusions Moral Hazard No people’s participation in Health -Risk Management Wrath of Claim rejection(affecting other business lines)

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Presentation Transcript
why mutuals
Why Mutuals

Unorganized Sector’s Need

Risks in PA Health Insurance

Numerous Exclusions

Moral Hazard

No people’s participation in Health -Risk Management

Wrath of Claim rejection(affecting other business lines)

Risk of premium increase due to high claim ratio

Increase in cost of Care

Risk of product inefficiency if very low claim ratio

Profit sharing?

  • Affordable product
  • Access to quality care services
  • Rationalization of costs(only)
  • Transparent procedures
  • Impact on Health
  • Value for money
  • Profit Sharing
so what can people really manage their own risk insurance
So what…can people really manage their own risk/insurance?

Why we do not believe that they can…

  • Community based models cannot be up scaled
  • It is not insurance!
  • Risk management should be done by professionals – insurers and re insurers (who can manage big losses)
  • Though nascent MI got regulations and a clear delivery model(PA)
  • No conclusive community based risk management business model in sight
yes people have been sharing risk and its growing
Yes , people have been sharing risk and its growing!
  • 21 Mutuals covering over 80000 lives in Maharashtra decide their premium, benefits, exclusions and claims and share and manage their health risks today.
  • They saved their 31 lakh of rupees in 2008 in form of discounts negotiated with a shared network of health care providers
  • While they paid 100 Rs/person/year the return on investment was 143Rs/person average only on amount saved- Claims paid were separate.
  • They not only get timely access to quality care (a real time 24X7 helpline) but dedicated preventive services through discounted OPDs, Health Camps and Health Talks.
ok how does it work

Costs

OK ! How does it work?
  • This works through the Mutuals Model of risk sharing - that is a value chain of families, communities, their organized structures who come together to form Uplift –Risk is managed at multiple levels

Many Colds, Flues, Gastros

Some fractures, pneumonia, Respiratory diseases, Caesareans

Rare ablations, Operations with Local Anaesthesia

Rarest Severe operations under GA (Heart by pass… )

Frequency

slide6

UPLIFT’s RISK MANAGEMENT MODEL

Frequency

Costs

UPLIFT Mutuals

 Local Branch n.n

 Local Branch n.n

MIU 2

MIU 1

Re -Insurance

 Local Branch n.1

 Local Branch n.1