3. 3
Marginalized populations and insurance
Health insurance…
what’s that?
I should only
pay for insurance
if I use it
I don’t visit
a doctor unless
I’m really sick
My village does not
have a doctor
I can’t afford to pay
user fees
Health providers
don’t want to treat
people like me
Our well is
contaminated
I lose wages when I
queue up at the clinic I haven’t told anybody
I have HIV
I don’t have my
own money
4. 4
What has to go right
Sources: 1) Koven et al., 2013 MILK brief #26; 2) Koven and McCord, Best’s Review, Oct 2014; 3) Weilant, M. Study on drivers of viability for HMI schemes (forthcoming )
Scale
Efficiency
Revenue
Admin
Benefits
Losses
The “upside-down cost triangle”
(when things are wrong)
Surplus
Admin
Benefits
Desirable
allocation possible
at scale
9. 9
Applying the 3Ps: Community-based schemes
Uplift Mutuals, India 250,000 clients
Core product Processes Partnerships
Clientvalue
Affordable
Hospitalization, value-
added services
(health camps,
consultations)
Client reminders via
text message
24/7 helpline
Community-led
Provider network
Viability
Lower admin cost
Retention
Group enrollment
Standard procedures
Web-based MIS
Microfinance
institutions, NGOs
Donor support
10. 10
Applying the 3Ps: Mobile phone-
enabled health insurance
Airtel/MicroEnsure, Africa: 3.74m clients in 7 countries
Core product Processes Partnerships
Clientvalue
Simple: Lump sum for
3+ days in hospital
Free to clients using
$2 air time per month
SMS enrollment,
updates
Claims filed, paid via
mobile
3 partners:
Airtel
MicroEnsure
(intermediary)
Insurer
Viability
Encourage client
retention
Build a culture of
insurance; potential
for upselling
Efficient-use existing
IT platforms
Limited pay out per
policy
Leverage trusted
telecom brand
Mass market model
source: USAID mHealth Compendium Special Edition 2016: Reaching Scale