MHI Murali Srinivas 06-May’09. Objective Research Delivery Model About MHI Risk transfer MFI issues Lessons.

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Presentation transcript:

MHI Murali Srinivas 06-May’09

Objective Research Delivery Model About MHI Risk transfer MFI issues Lessons

Define objective Revisit and clarify after Research phase Make a road map - Phase wise approach

Research Segment Needs assessment Cost of delivery Incidence

Delivery Model Resource base and mobilization (Estimate admin costs) Marketing (Sensitizing & Training) Distribution (Low cost + Flexible + Right incentives)

Service delivery mechanism (need handholding + choice of hospitals) Issue resolution processes (General + Crisis)

About MHI Tech Aspects

Expected Cost (Estimating future health costs) Admin cost Size of Risk pool Reserves Rating Risk (Community / Experience)

Out of pocket costs Deductible Co-insurance Elimination period Limit (lifetime maximum benefit, benefit ceiling, Out of pocket maximum)

Selection (Adverse, Cherry picking) Fee for service (negotiated rates) Exclusions Moral hazard

Group Policy Advantages Tax benefits low adverse selction economies of scale Disadvantages (Take it or leave it! )

Risk transfer Self-Insured Advantages (no regulation + stop loss insurance) Disadvantages (low risk pool) Insured Advantages (Provider contracts + large risk pool + favorable reserves) Disadvantages (Expensive + not flexible + poor knowledge transfer)

MFI Issues Staff overloaded - reluctant to promote new initiatives Need right incentives Promoters fear - negative impact due to any bad experiences Cost estimation & containment!

Lessons Flexible payments Ensure solidarity of group Larger risk pool Design keeping in mind community & household characteristics Associate with quality & viable health care provider Experience in rolling out insurance Demonstrate value

My product! Risk pool size - Aim for 10,000 lives Deductible - Rs 1000/- 25% Co-insurance Coverage for Pre-existing diseases + Limited Exclusions Community rating Flexibility in premium payments Pre/Post hospitalization reimbursements - with limits

Questions?

Murali Srinivas Mimo Finance, Dehradun