The situation of health insurance in India is quite dismal. There have been government policies like the Rahstriya Swasthya Bima Yojana to cater to the insurance needs of the families below the poverty line where the premium amount was to be shared by the Central and State government. The scheme was widely lauded for its success. But yet, according to a survey conducted by NSSO in 2016, 85.9% of the rural and 82% of the urban population was not covered under any insurance plan. Mostly this is due to the lack of financial resources to avail that scheme.
According to a blog post of Oxfam, health payments move 6 crore people below the poverty line. The study called ‘Increasing Out-of-Pocket Health Care Expenditure in India – Due to Supply or Demand’ by Jaykrishnan T, Jeeja MC, Kuniyil V and Paramasivam S it was stated that over 80% of the health expenditures are made from out of the pocket – both the urban and rural population depended heavily on their income/savings and borrowings to foot their hospital needs. Public expenditure on health amounted to Rs. 1,49,538 in the year 2015-16. Government expenditure on health in India is less than 1% of the total world health expenditure despite of it housing 16% of the world population.
A look at other developing countries shows how we can combine problems to create wonderful solutions. In this article, I would concentrate on two micro-insurance health schemes – one in Kenya and one in Indonesia.
The Kenyan scheme is known as Changamka Microhealth. Changamka Microhealth describes itself as mobile based health financing products for low income populations comprising health savings, health vouchers and health insurance. Their product reached 60,000 consumers in just two years and aim to reached another 3,00,000 beneficiaries in the next two years. This scheme uses the opportunity presented in the form of high usage of mobile phones by the population to enable people to be medically secured. This scheme followed a crowd funding model to ascertain the demand in the first place. The idea behind this scheme was to make insurance easy for the poor population and provide a mechanism for management of their savings to be used for health purposes only. There is a partnership with the mobile wallet system M –Pesa which accepts payments in denominations as small as 10 cents and also a health insurance company. This reduces the costs of insurance drastically proving to be a more suitable insurance model for the low income group. This solves a social problem while being a for profit model.
Why is this model suitable for India? Because mobile penetration is very high here as well, the teledensity is at 82.82%. There are 292 million smartphone users alone (statista.com). As for the mobile payment system, India figures second in the whole of Asia Pacific for usage of mobile payment systems. According to a study by GrowthPraxis, the market for mobile enabled payments has increased by more than 15 times between 2012 to 2015. With a little campaigning and advocating of the benefits of this program, a higher proportion could be encouraged to have mobile wallets. It would be a onetime investment to teach them how to use it but mobile payment systems are useful for a host of other kind of transactions; even government programs.
Similarly, one could look at an even simpler model from Indonesia – the Garbage Clinical Insurance. This model tackles the problems of providing health insurance and garbage collection all at once. Here, the people are given insurance in return for submitting garbage worth 10,000 Indonesian Rupiah (which is less than a dollar). This system would obviously work better if there are bigger numbers. As per their calculations they estimate that out of 1,000 people participating in this program, only 150-200 would need monthly medical attention. So, the value of the waste minus the costs of providing healthcare to these people would be used to pay the healthcare providers taking part and for providing other preventive, curative and rehabilitative services. This insurance service provider distributes health booklets, conducts laboratory studies and home visits and its members can even avail of the telemedicine service for free. Of the waste that is collected, the biodegradable components are used to create compost; the inorganic matter is reused or recycled. Sometimes through active community participation programs, the waste is upcycled. The waste is generated daily so there is no problem on that end either. There are some problems that need to be perfected with this model as well – such as the occurrence of a widespread disease affecting a large proportion of the population. Also, there are a large number of volunteers required for this program and this might be tricky to ensure. Care will also have to be taken to prevent the formation of some kind of a garbage mafia. A small proportion of the excessive funds collected could be maybe invested to have a safety net to fall back on. But all of this first starts with undertaking a proper survey in the areas it is to be initiated. Data about their access to healthcare, the prevalence of sickness etc should be collected to reach the optimum amount of “premium” in terms of garbage. This could yield good results in our country especially with the “Swach Bharat Abhiyan” in practice.
However, these are just mere suggestions of how a private party could contribute to enable better healthcare for all. Even though they required initial grants and funding, they have developed into self sustaining models. We could take a leaf out of their books and conduct research and operations to look into the same.
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