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Action Research on Micro Health Insurance for Poor Experience of DHAN Foundation, India. A Umarani Director Tata- Dhan Academy. Health and Poverty. Human capital is essential to keep the people engaged in productive works. Health is one of the aspects to build the human capital

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action research on micro health insurance for poor experience of dhan foundation india

Action Research on Micro Health Insurance for PoorExperience of DHAN Foundation, India

A Umarani

Director

Tata-Dhan Academy

health and poverty
Health and Poverty
  • Human capital is essential to keep the people engaged in productive works. Health is one of the aspects to build the human capital
  • Morbidity is high among the low income households leading to poverty
  • The low income households are highly vulnerable to health risks
  • Two major approaches to manage risks by the communities are risk reducing (prevention and avoidance) and risk coping (reduce the effect after the event)
dhan s model
DHAN’s model
  • Building Social capital (SHG-Federations) as the basis for poverty reduction
  • Development and risk & vulnerability management are the twin approaches adopted by the SHGs and their federations
  • SHGs and their federations provide access to services such as microfinance, micro insurance, healthcare and education and livelihoods development services
risk and vulnerability management in dhan promoted people institutions
Risk and vulnerability management in DHAN promoted People Institutions

Risk reduction strategies

  • Reproductive child and healthcare
  • Anaemia control programmes
  • Community health promotion through safe drinking water, sanitation and hygiene
  • Malaria control programmes
  • Nutrition programmes
  • Ensuring entitlements through Primary health centers
  • SUHAM (Sustainable Healthcare Advancement) hospitals – primary and secondary care
  • Federation clinics for primary care
risk coping strategies
Risk coping strategies
  • Risk retention – savings and credit services through self help groups
  • Risk transfer – most appropriate solution for uncertain health risks through micro insurance
people institution model of dhan
People institution model of DHAN

Federation

150-200 SHGs

Cluster

1

15-20 SHGs

Cluster

2

SHG 1

SHG 2

SHG 3

SHG 21

SHG 22

SHG 23

subsidiaries of federation
Subsidiaries of Federation

Hospital

Vocational

Institute

Federation

Producer

Company

Mutuals

subsidiaries of federation1
Subsidiaries of Federation
  • The SHG federation acts as an development agency
  • In addition to promotion of Microfinance for poverty reduction, the federation also takes up other development programmes like health, education, business promotion etc, based on the need of the Kalanjiam members
  • Exclusive subsidiaries are promoted as separate institutions for each of the development programmes
hospital
Hospital
  • One of the subsidiaries of Kalanjiam Federation
  • Exclusive governance structure with inter linkage with Federation’s.
  • Provides primary care
  • Identifies referral hospitals for secondary and tertiary care
federation mutuals
Federation Mutuals
  • It is one of the subsidiaries of federation for providing mutual based solutions to the risks of members; Owned and controlled by the members
  • Adopts three approaches to promote Micro insurance among the members
    • Through partnership with other insurance companies
    • Offers mutual based own solutions
    • Combination of both
people mutuals
People Mutuals

Federation 1

Federation 2

People

Mutuals

Federation 3

Federation 4

people mutuals1
People Mutuals
  • Institution promoted by SHG federations
  • Separate entity (Trust) to implement the insurance programme for the members of DHAN promoted People Institutions
  • Promoted through collaboration between Oxfam Novib, Rabobank Foundation and Eureko Re, The Netherlands
micro health insurance models
Micro Health Insurance - Models
  • Partner-agent model
  • Combination of partner-agent and mutual model
partner agent model universal health insurance scheme
Partner Agent Model: Universal Health Insurance Scheme
  • Central Government sponsored Scheme
  • Implemented by all the four public sector general insurance companies
  • DHAN collaborates with National Insurance Company
  • Universal- includes all economic category-2/3 of premium is subsidized by the government for poor; covers preexisting illness also
combination of mutual and partner agent model
Combination of Mutual and Partner Agent model
  • Mutual solutions are offered in addition to the partner agent model
  • Mutual solutions are offered only where there are community owned hospitals are established
  • Federations act as nodal agency and People Mutuals is the risk carrier
slide19

Health Insurance

Back up insurance premium

Insurance

Companies

Federation Mutuals

(Nodal agency)

Member ID Card

Premium&

Member info

Claim

pay out

Third Party Administrator

Mutual insurance premium

Kalanjiam

Claim pay out

Premium&

Member info

SUHAM/Federation Hospital

Member

People

Mutuals

(Mutual Insurer)

Claim

pay out

insurance literacy
Insurance Literacy
  • Members
  • As consumers
  • As owners

2. Governing Board of Federation Mutuals

3. Management staff of Federation Mutuals

4. Field level staff

consumer education before selecting a solution product
Consumer Education: Before selecting a solution/product
  • Consultative workshops for selecting a product/ designing a mutual solution
  • Risks and vulnerabilities faced by the members
  • Current coping mechanisms- their pros and cons
  • Need for a special strategy for managing uncertainties- importance of insurance
  • Difference between banking and insurance
  • Group and personal insurance schemes- Pros and cons from the perspective of consumer
  • Various group insurance schemes and their benefits and limitations
  • Selection of a particular programme from existing schemes or devising mutual solutions or a combination of both
consumer education after selecting a solution product
Consumer Education : After selecting a solution/product
  • This is done for promotion of a particular product
  • Features/components of the solution and reasons
  • Insurable and non insurable risks
  • Entry procedures
  • Claim settlement
  • FAQs
literacy members as owners
Literacy: Members as owners
  • Enrollment procedures
  • Selection and anti selection
  • Claim servicing procedure
  • Orientation on financial management of Mutual programme
  • Need for Reinsurance/ Back up insurance
literacy governing board of federation mutuals
Literacy: Governing Board of Federation Mutuals
  • Enrollment procedure
  • Selection and anti selection
  • Underwriting procedure
  • Claim settlement procedure
  • Financial management for mutual health programme
  • Roles and responsibilities of Mutuals committee
literacy management staff of federation mutuals
Literacy: Management Staff of Federation Mutuals

In addition to all the above,

  • Models of micro insurance delivery- Corporate agency and Mutual solutions
  • Accounting and auditing
  • Management Information system
  • Financial planning
  • Insurance literacy to members and field staff
literacy field staffs
Literacy: Field staffs
  • Basics of insurance and mutual solutions
  • Details of the specific solution/programme of the federation (features with reasons, exclusions)
  • Insurance literacy to members
  • Collecting the data
  • Enrollment and renewal procedures
  • Usage of MIS
  • Claim settling procedure
institutions for providing literacy
Institutions for providing literacy
  • Federation Mutuals
  • Dhan People Academy
  • HRD of DHAN
  • Advanced Center for Skill and Knowledge for Mutual Insurance (ASKMI)of Tata-Dhan Academy
  • People Mutuals
collaboration with achmea re foundation
Collaboration with Achmea Re Foundation
  • Promotional support for 45 federation mutuals for three years
  • Philanthropic reinsurance support at the end of third year
  • Technical mission team from EAF provides technical assistance
prepositions for successful health insurance for poor
Prepositions for successful health insurance for poor
  • Health insurance is viable only when it is built upon micro finance initiatives
    • Social capital
    • Scale advantage which avoids adverse selection
    • Community based health care services to avoid moral hazard
  • Micro health insurance should focus on inclusion of primary health care and other health care related expenses, all diseases and all family members
  • Packaging of benefits by improving the product should ensure good and repeat enrolment
  • Pricing in Health insurance should ensure a right balance between viability and affordability
  • The reduction in health risks leads to improvement in human capital