Uplift Mutuals People Led Social Protection Dr Deepali Kulkarni

Why Mutuals Unorganized Sector’s Need Affordable product Access to quality care services Rationalization of Health care costs(only) Transparent procedures Impact on Health Value for money Profit Sharing 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 ?

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 So what…can people really manage their own risk/insurance ?

21 Mutuals covering over 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. Yes, people have been sharing risk and its growing!

5 Costs Frequency UPLIFT Mutuals    Re -Insurance  Re -Insurance  MIU 2  MIU 2  Local Branch n.n  Local Branch n.1  MIU 1  MIU 1  Local Branch n.n  Local Branch n.1

Uplift Mutuals…four defining values Inclusive Risk pooling Community Owned -Shared Health/Services need focused Technically Sound 6

Communities can manage their health risks provided they have a strong technical support and a good governance mechanism. In those insurance products where the control over the insured event is higher – the insured should be involved-hence community participation in health insurance just does not make only empowerment sense but also business sense. The poor need to see value for their money and meeting of their health needs-hence a simple hospitalization product will not work- access to quality care needs to come in very strongly-health micro insurance needs to be understood differently for it to have impact on poor’s lives. LEARNINGS for the sector

Listening to the community cannot be limited to selling the product-it should happen in all the processes to keep the scheme meaningful for the communities Transparency and information dissemination coupled with relevant education should be part of the health insurance product and not just a marketing need. Its only because that Uplift oils with information,that communities drive the mutuals car as their own. Insurance can be done in more than the commercial way where cost of care increases. Uplift has shown that collective bargaining can help save lakhs of the communities hard earned money get quality care at reasonable rates. LEARNINGS

The capacity to pay for premium is limited and hence coverage is limited and instances of out of pocket expenditure high-the need to align with govt schemes is high to provide high end coverage for the poor. The need for information dissemination is ever increasing with growth-it was easier to disseminate when we were small-with growth managing information without increasing costs is a challenge- the need for appropriate technology is strongly felt. Governance is key to Mutual's hence investment in elaborate trainings is essential with growth. ISSUES