Health

I. From Microinsurance Papers

Innovations and Barriers in Health Microinsurance presents innovations that can help move the field forward, including collaboration with public programmes.

• Cashless benefits can help clients overcome financial constraints when a claim is incurred: The insurer arranges to pay, often at negotiated rates, the healthcare provider on behalf of the patient instead of clients having to pay cash up front and then file a claim for reimbursement.

• The poor perceive more value in comprehensive coverage for healthcare, including preventive and routine healthcare services: Meeting this demand rather than concentrating on catastrophic risks only, can increase enrolment and retention, thus enhancing HMI programme viability, and stabilize risk pools.

• Private-public partnerships are a potential solution to the challenge of offering comprehensive HMI coverage: The public sector may be able to provide enabling regulation and access to underutilized healthcare facilities that the private sector can use to expand access and lower costs, and can promulgate and enforce quality and accreditation standards.

Third party payment mechanism in health microinsurance provides lessons related to the set-up and management of TPP mechanisms to provide “cashless” access to the insured:

• Capitation payment may be an appropriate way to cover outpatient care without jeopardizing the financial viability of the health care provider or burdening claims management, and seems better adapted to contexts where a critical mass of enrolment can be achieved with providers and where the full range of care can be delivered by the health care provider.

• Mixed payment methods (i.e. capitation for primary health care and per case for hospital cases) may have greater potential to contain costs than fee-for-service payment but often complicate administration and increase management costs. These methods are usually more difficult to negotiate with health care providers and require additional measures to manage quality of care. (click here for Briefing Note)

Value-added services in health insurance provides an overview of current developments, highlights the experiences of those already providing them, and points to the potential they hold. 

• Value-added services are an increasingly important component of health microinsurance. Though evidence on their impact is limited, they demonstrate potential to increase demand and improve health outcomes. 

For more information on the impact of payment mechanisms on the scheme performance see Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment.

II. From Research Papers

Health Care Utilization in Rural Senegal: The Facts Before the Extension of Health Insurance to Farmers found that insured persons were 2.4 times more likely to seek care than the uninsured. This increase in access to health care due to insurance was higher among the poorest individuals, suggesting that the effect of insurance on access to health care is greatest for the worse-off. LEARN MORE

Does microinsurance help the poor? Evidence from the targeted health microinsurance program in 2004-2008 shows that, participation in HCFP, Vietnam reduced the total out-of-pocket expenditure by 25 per cent (2004-2006) and by 34 per cent (2006-2008).. There is increase in willingness to visit a public hospital by 5.2 per cent (2004-2006) and in the number of visits for outpatient care by 1.11 times (2006-2008) while catastrophic spending is lowered by 19 per cent.

Microinsurance Utilization in Nicaragua: A Report on the Effects on Children, Retention, and Health Claims found low retention rates for a health insurance product after subsidies expired. Retention rates declined with increasing subsidy amounts, suggesting that those who were induced to enrol with the larger subsidy rate may be those who place the lowest value on the insurance product and might be less likely to continue payments. A survey of those who continued making payments concludes that educating individuals on how to make payments could be essential for retention.

Microinsurance Product Design: Consumer Preferences in Kenya indicates a strong preference for health insurance policies that offer a rebate (no-claim bonus) along with no deductibles, even though such policies have a higher premium. LEARN MORE

Client-value of microinsurance products: Evidence from the Mutual Assistance Fund in Vietnam concludes through a household survey that clients are willing to raise the premium five times from the current level (VND 1000 per week) in order to receive the relevant level of increase in benefit payouts and a simpler claim procedure.

Understanding and Information Failures: Lessons from a Health Microinsurance Program in India attempts to understand the factors underlying the low take up and renewal rates frequently observed in insurance programmes in poor countries. Based on experience in India, the findings suggest that deficient information about the insurance product and the functioning of the scheme, poor understanding of the insurance concept, and the resulting low use of the insurance products by eligible households are some of the main causes of low enrolment and renewal rates. 

What is a Health Card Worth? An Evaluation of an Outpatient Health Insurance Product in Rural India presents the results of a randomized control trial that evaluated the impact of CARE Foundation´s out-patient insurance cards. The insurance product encouraged more frequent visits to community health workers, leading to earlier identification of illnesses and more timely referrals to a doctor or hospital. Since patients were treated at an earlier stage, they spent fewer days in hospital and costs were lower. In the project, community health workers were trained and deployed in villages to offer preventive care consultations, make referrals to a doctor when needed, and sell outpatient health insurance.

III. From Innovation Partners

SSP, India: Discounted outpatient services: a way to keep clients. LEARN MORE

CIDR, Guinea: Product diversification to improve outreach. LEARN MORE

VimoSEWA, India: Prescription for improved health claims analysis: focus on diagnosis. LEARN MORE

Uplift Mutuals, India: Improving client value through better access to health care. LEARN MORE

Also, see results from the Facility's knowledge sharing forum on the impact of health microinsurance. The forum brought practitioners and researchers together to share evidence from health microinsurance impact studies.