Kenya’s public health insurance scheme—the National Hospital Insurance Fund (NHIF) provides much of the country’s health insurance. However, the percentage of citizens covered by the NHIF falls short of Kenya’s national goals related to healthcare access. One key way that the NHIF can improve participation rates is by partnering with health microinsurers (HMIs).
In his article “Benefits of public-private partnerships in health microinsurance: the Kenyan context,” Milliman’s Mitchell Momanyi provides an overview of the NHIF and the reasons for low participation in the program. He also outlines several ways it can work with HMIs to enhance its benefits and increase its health insurance coverage.
Here is an excerpt from the article:
HMIs offer simple and affordable benefits that, when paired with public schemes such as the NHIF, can encourage beneficiaries to participate in and use their public insurance benefits when necessary. An example of such a benefit offered by many HMIs is ‘hospital cash.’ Hospital cash pays a fixed amount of money to the beneficiary when a qualifying inpatient hospital stay is triggered. This money can be used to pay for costs related to seeking treatment such as transportation, food and partial replacement of lost income. These costs aren’t covered by the NHIF and would present a barrier to some individuals seeking treatment. The SAJIDA Foundation in Bangladesh and the Microfund for Women in Jordan are examples of organisations that have successfully launched hospital cash products.9
A second way in which the NHIF can increase its reach is by pairing its benefits with an HMI policy that provides value-added services. Examples of such services may include access to discounted medication and access to preventive services such as free health check-ups. Value-added services are included in some HMI policies in order to increase client value by making the benefits more tangible. Beneficiaries don’t have to wait for catastrophic events such as an inpatient admission in order to use their benefits. An example of an HMI that has successfully implemented value-added services is Uplift in India. Its ‘dial-a-doctor’ service is popular among beneficiaries.10
The government can also partner with HMIs in order to increase awareness of the NHIF programme. The Impact Insurance Facility describes the lack of awareness of public benefits as a key emerging lesson in Ghana. In discussing a field test conducted to gauge citizens’ awareness of the country’s National Health Insurance Scheme, the Facility states that the test group did not know about the costs and eligibility requirements of the programme. It went on to state that ‘this lack of understanding is an initial barrier to enrolment and a factor in low retention in the scheme – even with a government sponsored scheme intended to provide universal cover.’11 In order to distribute their products effectively, HMIs typically build valuable partnerships with entities such as local community groups, unions and cooperatives. The NHIF can leverage these partnerships in order to promote the programme effectively in remote areas that the government would otherwise be unable to reach.
Although there is an increasing recognition of the value of microinsurance in developing countries, health microinsurance products are still relatively new. In 2016, Milliman joined PharmAccess Foundation, a non-government organisation (NGO) based in the Netherlands, to do an analysis involving the establishment of a health insurance pricing scheme in a state in an African country. Milliman’s role in this initiative was to provide actuarial, clinical and financial review of PharmAccess’s modelling of the anticipated costs under the health insurance pricing scheme.
In this article, Milliman authors Lynn Dong, Briana Botros, and Judith Houtepen write about this most recent microinsurance project and the way in which the firm was able to provide tools and analysis to help support this health insurance scheme.
In her article “m-Health: Remote access,” Milliman consultant Lisa Morgan discusses how mobile technologies, specifically telehealth services, are being used around the globe, from their incorporation into health microinsurance schemes in sub-Saharan Africa to rural health clinics in California, increasing provider reach.
Here is an excerpt:
There are many examples of telehealth in HMI [health microinsurance] schemes (typically telephone contact with a nurse or doctor).
‘Dial-a-doctor’ programmes are already reaching millions of members of large HMI schemes, as shown in Tables 1 and 2 (below). Unsurprisingly, tech-savvy youngsters under 40 have proved to be the earliest adopters.
…m-Health not only increases efficiency but has huge potential to change health-seeking behaviour. This in turn could translate to significant savings for entire healthcare systems. With recent experience in Africa, Jonathan Govender of Bupa sees shifting customers’ behaviour towards trusting mobile interactions as a key challenge. In the UK, Vitality has just launched its new app, ‘Vitality GP’. Time will tell whether we are ready for video chats with our doctors in the UK rather than face-to-face visits. Available to all members, the Vitality app provides direct access to a private GP from home or anywhere, video consultations within 48 hours, calls to doctors 24/7, direct referrals to consultants and delivery of written prescriptions.
…m-Health is increasing provider reach, effectiveness and productivity as much as it enables consumers to move to the centre of the healthcare universe and to receive care more naturally in daily life, whether in emerging or developed markets.
As this relatively young technology matures, generates more insightful data, and comes to be better understood, it may help propel provider and insurance transactions beyond the zero-sum logic that has historically limited options for patients.
The Atlantic reported last month about an unconventional aid organization in Pakistan that appears to be overcoming some of the barriers to traditional aid programs:
So while USAID is very good at quickly mobilizing assistance to disaster-afflicted communities, it carries a lot of political baggage — so much so in places like Pakistan that the U.S might be better off in the long run by downsizing USAID’s direct activities there and working through alternative programs.
One good model might be the Rural Support Programmes Network. A sprawling collection of local NGOs, the RSPN was founded by the Agha Khan Network in 1982, and has since become its own, separate program. While the stats about its reach are impressive — reaching millions of the poorest homes across a vast swath of Pakistan — what’s especially fascinating about RSPN are its methods.
Put simply, RSPN has a different focus than normal aid programs. They emphasize the development of institutions first, and only after that institution is established do they worry about its output or performance. The NGO also heavily invests in the smallest scale of the community, from conceptualization to execution, hiring mostly locals to administer projects. Lastly, they have extraordinarily long project timelines — sometimes as long as 15 years from start to finish.
RSPN’s activities might be of interest to readers of this blog because they run a significant health microinsurance program:
But the most interesting project RSPN has done in rural Pakistan is a collaborative micro-healthcare insurance system. For very little money — $3.50 a year in some cases — poor people can get access to basic medical care (especially maternity care) and assistance if they face hospitalization.
The earthquake in Haiti has called attention to the role that micro-finance can play in developing countries, especially following a catastrophe. The largest microinsurer in Haiti was in a position to respond more quickly than many traditional financial entities, a story reported in Newsweek last month:
Hollywood couldn’t have done it better. Late in the afternoon on Jan. 22, an armored car packed with $2 million in cash rolled out of J.P. Morgan Chase headquarters in downtown Miami, headed to the Homestead Air Force Base. Thirty-four bricks of bank notes packed into ordinary office supply boxes were loaded onto a C-17 transport plane redeployed from Langley, Va., and dispatched to Haiti, lighting up switchboards at the United Nations, the U.S. State Department, the Federal Reserve, and military rescue bases in Port-au-Prince.
Before dawn the next day, the stash was on a helicopter bound for 34 branches of microlender Fonkoze. While Port-au-Prince’s nine commercial banks were in a shambles and Western Union was paralyzed, half of Fonkoze’s 42 agencies were up and running in four days, and all but two of the rest within a week. The amounts were trifling: no more than a few dollars per client. But for tens of thousands of desperate Haitians, the nimble infusion of cash amid the chaos and ruin literally meant survival. For the legions of aid bureaucrats, charities, civic groups, and emergency organizations struggling to get a grip on the Western hemisphere’s worst natural disaster in memory, Fonkoze’s nationwide client base of 200,000 depositors (50,000 of whom are also borrowers) was a ready-made lifeline. Could microcredit be the new Red Cross?