1. Extension of Social Protection: Community-based health insurance Céline Peyron, ITC- ILO, Trade Union Training on Social Protection, 13 May 2004

2. ContentContent 1. Health micro-insurance : a strategy for the extension of social security 2. Definition, principles and models of HMIS 3. Linkages 4. Limitations and impact of HMIS

3. 1. Health micro-insurance: a strategy for the extension of social security

4. ILO objective on Social Protection Enhance the coverage and effectiveness of the Social Protection for ALL

5. Strategies for extending health insurance lStrengthening of national health insurance schemes: –Extending social insurance coverage –Universal benefits –Social assistance lEncouraging decentralized mechanisms lCreation of linkages between both

6. 2. Definition, principles and models of health micro- insurance schemes

7. Health micro-insurance schemes: Objectives To support populations’ initiatives in organizing themselves their access to health : lProviding access to health to members lNegotiating with health care providers quality services at lowest possible costs lPrevention and information on Health problems lIncome security and stability lReinforcing solidarity and equity lParticipation of all beneficiaries in social matters

8. Health Micro-Insurance Schemes: Definition “ Micro-insurance refers to various schemes set up by self-employed and informal economy workers to meet their priority social protection needs. The mechanism used in these schemes is generally the provision of mutual support through the pooling of resources based on the principals of insurance. “ Source: ILO, World Labour Report 2000: Income security and social protection in a changing world, (ILO: Geneva).

9. Growth statistics in West Africa

10. Health micro-insurance: Schemes lMutual Benefits Association (Trade Union) lCommunity Based Schemes lIntegrated Schemes in an Hospital management lMicro-finance Institutes

11. INDIA : THE COMPENDIUM 48 schemes found operational 8 new shemes under preparation intervention of multiple actors 11 states already concerned partnerships with insurance co. around 2,6 millions beneficiaries

12. OWNERSHIP INDIA, 2003

13. LEVEL OF EXPERIENCE INDIA, 2003

14. AREAS OF INTERVENTION INDIA, 2003

15. SERVICES PROVIDED INDIA, 2003

16. BENEFICIARIES INDIA, 2003

17. TYPE OF CONTRIBUTION INDIA, 2003

18. RISK COVERAGE Out of 28 schemes : 16 schemes cover only hospitalisation expenses 7 schemes cover only primary health care services 5 schemes cover both primary health care & hospitalisation costs INDIA, 2003

19. SCHEDULE OF CONTRIBUTION INDIA, 2003

20. Which are the main characteristics of health micro-insurance schemes in India?

21. THE CURRENT TRENDS, IN INDIA… lall insurance companies (both public and private) involved in the provision of health micro-insurance products to the poor mainly cover hospitalisation costs… lwhile…there is a world-wide recognition that the overriding need in developing countries is for primary health care…

22. Health micro-insurance: Principles lpopulation excluded from formal social security schemes, often low incomes and vulnerable lsolidarity and non-profit organisation lvoluntary & contributory schemes lpooling of a group’s resources to share risks (health, pregnancy, death, accidents, belongings) & organize protection adapted to their needs lbenefits package and contributions adapted

23. Health micro-insurance: Actors lBeneficiaries lHealth care providers (Public services and private providers) lFinance institutes lAuthorities (local and national)

24. Health micro-insurance: Different models lTHE « PARTNERSHIP » MODEL lTHE « INTEGRATED » MODEL lTHE « INDEPENDENT » MODEL

25. THE « PARTNERSHIP » MODEL HMIS Health structure The HMIS is linked with the health provider by means of an agreement

26. l5000 MEMBERS lCollaboration with 5 hospitals l IT developed management MicroCare Health Plan, UGANDA THE « PARTNERSHIP » MODEL

27. lHEALTH CARE PROVIDED 4medical consultations 4hospitalisations 4specialized tests 4surgery 4diagnostics and check-up 4medicine 4delivery services 4dental care 4ophtalmological consultations lCOVERAGE Of HEALTH CARE COST 100% lANNUAL CONTRIBUTION PER FAMILY : 60 $US (6 members) MicroCare Health Plan, UGANDA THE « PARTNERSHIP » MODEL

28. THE “INDEPENDENT” MODEL The HMIS has no contractual links with the health provider HMIS Health provider

29. lCreated in 1992 lFrom a Women Workers ’ Trade Union, of the informal economy (created in 1972) l90.000 beneficiaries Vimo SEWA- INDIA THE “INDEPENDENT” MODEL

30. lCARE SERVICES PACKAGE INCLUDING : 4Health Insurance (hospitalization), including services for delivery protection, 4Life Insurance, including insurance in case of invalidity, 4and Belongings Insurance (lost or damages to property or working material) lHEALTH CARE COVERED : 30 $USMAX PER YEAR lMATERNITY PROTECTION : 7,5 $US on the 8th month of pregnancy lCONTRIBUTION : 1,5 $US / Year Vimo SEWA- INDE THE “INDEPENDENT” MODEL

31. THE « INTEGRATED » MODEL HMIS Health provider The HMIS has developed its own health provision structure

32. lCreated in 1976 lMANY SERVICES: Health, life/death, occupational injured, micro-credit, fire insurance,... lcovers 6500 families (it means 24000 beneficiaries) NOVADECI - Philippines THE « INTEGRATED » MODEL

33. NOVADECI - Philippines Pharmacy THE « INTEGRATED » MODEL

37. Steps in setting up health micro- insurance scheme lDiagnostic - information lSetting up steering committee lPre- and feasibility study lAgreement-preparation providers lPreparation of management and monitoring tools lLauching scheme lFunctionning and monitoring HMIS

38. 3. Linkages

39. Social dialogue and the extension of SP Government Workers Employers Providers of services Workers and their families Community- based organizations NGOs International organizations Citizens

40. Conclusion: linkages HMIS with Trade-Unions Promotion Setting-up their own HMIS system Negotiation to improve health care services (quality and quantity) Campaign for prevention and health education

41. 4- Limitations and impact of health micro-insurance schemes

42. Health micro-insurance: Limitations la partial and immediate response to an unmet collective responsibility lresource pooling & risks shared in a limited group of people, mostly low income and vulnerable lnot necessarily a guarantee of equity for the poor llimited care services provides lcapacity of poor to contribute fluctuates with income

43. Moral hazard of over-consumption Moral hazard of over-prescription Adverse selection Fraud and abuse Catastrophic events Health micro-insurance: Risks

44. Group work 1. What can be the relevance of HMIS in terms of gender equality? 2. Is HMIS possible for HIV/AIDS affected targets?

45. 1. Gender and HMIS Strenghtening of the status of the women Health situation of women and access to health care Methodology of supporting and promoting women Fight against social injustice

46. 1. Gender and HMIS lParticipation of women in management of HMIS lReduce poverty and inequity between sexes lProtection of domestic workers lWomen mainly employed in informal economy

47. 2.- HMIS and HIV/AIDS lSuitable if: lExpansion of the members (Affected / Infected) lBenefits package limited to primary health care lFunds from National campaigns and NGO’s projects

48. 2. Advantages of HMIS to prevent HIV/AIDS lAccess to health care lPrevention lVoluntary and confidential counselling and testing lImprovement capacity of health providers lAddress stigma and discrimination lChannel ressources to the local level

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