Publication database

“Can health microinsurance (HMI) schemes achieve sustainability?” As with many seemingly simple questions, there is no simple answer. The answer to this question is of interest to a variety of parties. Insurance providers seek to understand if there is a viable business case for offering an HMI product. Health-care providers and pharmaceutical companies are interested in whether or not HMI can be a means for broadening coverage. Donors and other funding organizations want to know if HMI is a viable investment as a means to improve health-care access, health outcomes and financial protection for the low-income population. Governments consider how to use HMI schemes as a step towards universal health coverage.

Briefing Note 35 presents results from a review of the financial performance of five schemes in India, Pakistan and Bangladesh.

“Can health microinsurance (HMI) schemes achieve sustainability?” As with many seemingly simple questions, there is no simple answer. The answer to this question is of interest to a variety of parties. Insurance providers seek to understand if there is a viable business case for offering an HMI product. Health-care providers and pharmaceutical companies are interested in whether or not HMI can be a means for broadening coverage. Donors and other funding organizations want to know if HMI is a viable investment as a means to improve health-care access, health outcomes and financial protection for the low-income population. Governments consider how to use HMI schemes as a step towards universal health coverage.

This paper seeks to answer this simple yet crucial question based on the experiences of five schemes in South Asia.

Most providers of health microinsurance (HMI) can do more to understand the illness and claims patterns of insured clients. The objective of this study is to demonstrate that analysing claims data equips HMI practitioners with valuable insights to improve the client value and viability of HMI programmes. This brief summarizes a study that performs a comparative analysis of three South Asian HMI programmes – run by VimoSEWA, Uplift Mutuals and Naya Jeevan. These providers share a common geographic region and offer broadly similar insurance for hospitalization services to low-income households.

Most providers of health microinsurance (HMI) can do more to understand the illness and claims patterns of insured clients. The objective of this study is to demonstrate that analysing claims data equips HMI practitioners with valuable insights to improve the client value and viability of HMI programmes. The study performs a comparative analysis of three South Asian HMI programmes – run by VimoSEWA, Uplift Mutuals and Naya Jeevan. These providers share a common geographic region and offer broadly similar insurance for hospitalization services to low-income households.

The paper reviews the pilot experiments conducted from 2011 onwards in eight districts across six states to test the provision of outpatient (OP) benefits under RSBY, India’s Social Health Insurance Scheme for low income populations. Administrative data on enrolment, empanelment of care providers and outpatient claims was analysed for the review. The paper also discusses the status of primary care in India and outpatient care provision in similar schemes in other developing nations (Vietnam, Ghana, Indonesia, Philippines and Thailand).

Rashtriya Swasthya Bima Yojna (RSBY) is a programme that needs no introduction. Launched in 2008 to provide secondary care to below poverty line (BPL) households, the scheme has expanded rapidly. Today, it covers nearly 38 million households and is present in 512 districts (out of a total 640) across all 28 states and union territories. This paper analyses key performance indicators (KPIs) for the programme, so as to identify ways of improving the scheme’s performance. 

The study focuses on three KPIs:

Enrolment ratio, measuring the percentage of eligible households enrolled, so as to estimate outreach;
Hospitalization ratio, to estimate utilisation;
Claims ratio, one of the key metrics that determines whether the scheme is profitable for the insurers.

The objective of this study was to conduct a community-based retrospective analysis of primary, secondary and tertiary care utilization over a 12 month period by 5000 urban slum dwellers in the context of an integrated health insurance plan (outpatient and inpatient) that was introduced by Naya Jeevan into Sultanabad (an urban slum in Karachi) during the 2013 calendar year.

Research paper #40 evaluates the financial viability of CARE Foundation’s rural primary-health-care delivery model, which includes an outpatient insurance product. The model is aimed at providing access to affordable primary health care in rural areas. The paper assessed the value proposition of the programme to clients and reviewed the performance of the outpatient insurance product, taking into account the contextual factors affecting the product and the model. Since technology plays an important role and is considered key to contributing greater efficiency, the programme’s use of technology and the impact of this are analysed in detail.  

Financing health for low income households is a significant challenge. Naya Jeevan is trying an innovative approach: in order to make quality health services affordable to low-income workers in Pakistan, it seeks sponsors to pay the majority of the premium on behalf of workers whom they employ or have a business relationship with.

Microfinance institutions have started to bundle their basic loans with other financial services, such as health insurance. Using a randomized control trial in Karnataka, India, Research Paper #37 evaluated the impact on loan renewal from mandating the purchase of actuarially-fair health insurance covering hospitalization and maternity expenses. Bundling loans with insurance led to a 16 percentage point (23%) increase in drop-out from microfinance, as many clients preferred to give up microfinance than pay higher interest rates and receive insurance. There was no adverse selection in insurance enrollment, but only because there was a total absence of demand for health insurance. Further, the decrease in microfinance loan renewal reduced clients' access to credit and had negative impacts on their businesses.