2017年-世界发展银行全球_Micro_Insurance_Academy___Improving_Health_Insurance_Coverage_in_India_32页_780kb

Summary of Micro Insurance Academy: Improving Health Insurance Coverage in India

Core Content

The Micro Insurance Academy (MIA) is a social enterprise in India that focuses on improving health insurance coverage among the poor through a bottom-up approach. It provides technical assistance, training, and research to local NGOs, enabling them to design and manage community-based health insurance (CBHI) schemes. MIA's mission is to empower poor communities to reduce financial vulnerabilities through customized micro insurance solutions that are aligned with local needs and risk profiles.

Main Challenges

• High out-of-pocket healthcare spending: In India, 94% of healthcare expenditure is out-of-pocket, with 81% occurring in private clinics and hospitals.
• Healthcare poverty: Nearly 39 million people are pushed into poverty due to ill health annually.
• CBHI limitations: Existing CBHI schemes have not effectively reached the poorest segments of the population due to:
  • Irregular cash flows of poor households
  • Lack of awareness about the value of health insurance
  • Illiteracy and difficulty understanding insurance terms
  • Limited access to healthcare facilities

Main Innovations

• Community-based health insurance (CBHI): MIA promotes CBHI as a not-for-profit model that pools community resources to cover health-related costs.
• Customized solutions: MIA designs insurance packages based on local risk data and community input, ensuring relevance and affordability.
• Community rating: MIA uses community rating instead of individual risk assessment, promoting inclusiveness and risk diversification.
• En-bloc affiliation: Entire communities are encouraged to join, which reduces adverse selection and transaction costs.
• CHAT Decision Tool: A game-like tool used to involve communities in defining their health insurance benefit packages and premiums, even among illiterate populations.

Key Implementation Components

• Three-tier structure:

  1. Grassroots level: Communities participate through Claims Committees, Insurance Coordinators, and Insurance Activists.
  2. Intermediary level: NGOs serve as field partners, providing local support and infrastructure.
  3. Apex level: MIA acts as a technical and resource agency, offering advisory and training services without selling or promoting products.

• Implementation phases:

  • Baseline survey
  • Design and development of the scheme
  • Enrollment and premium collection
  • Claims processing and management

Impact and Results

• Coverage: MIA-supported schemes have covered over 40,000 people in India and Nepal.
• Claims ratio: The cumulative claims ratio is reported at 65%.
• Insurance literacy: There has been an 80% increase in the community's understanding of insurance.
• Renewal rates: High enrollment and renewal rates indicate increasing acceptance of the schemes among the poor.

Sustainability and Scale-Up

• Grant-based model: MIA operates on an independent, grant-based model, which allows it to remain non-profit and accessible to the bottom of the pyramid (BoP).
• Technology investment: Increased use of technology and evidence of development impact are expected to aid scaling up and partnership development with government and private sector entities.
• Federated structures: MIA is exploring federated structures and larger schemes to mitigate risks such as catastrophic events wiping out pooled contributions.

Lessons Learned

• Inclusiveness is key: Excluding vulnerable groups leads to unfairness and inefficiency. MIA's community rating model promotes inclusiveness and equity.
• Community involvement: Engaging the community in decision-making and implementation increases trust, acceptance, and sustainability.
• Education is critical: Insurance literacy and awareness campaigns are essential to increase participation and understanding.
• Local partnerships: The capacity and trustworthiness of local NGOs are crucial for the success of CBHI schemes.

Future Directions

• Expand geographic reach: MIA aims to reach more low-income communities in India and Nepal.
• Diversify into other sectors: MIA has started exploring climate-related micro insurance to address composite risks such as drought, flood, and health issues.
• Strengthen governance: MIA supports governance reforms and capacity building for Community Health Funds in Tanzania and Cameroon.
• Research and dissemination: MIA conducts action-research and RCTs to evaluate impact and disseminate findings to policymakers and practitioners.

Conclusion

MIA has successfully implemented CBHI schemes in India and Nepal, significantly improving health insurance coverage among the poor. By combining local knowledge with technical expertise, MIA has created a sustainable model that empowers communities to self-manage their insurance needs. The organization continues to expand its reach, diversify its offerings, and promote inclusiveness through community rating and en-bloc affiliation.