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Magnoni Integrated Services Microfinance and Health


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Presentación para el taller sobre Microfinanzas Integradas en Foromic 2012. Revisa la experiencia de los microseguros de salud.

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Magnoni Integrated Services Microfinance and Health

  1. 1. 1 Acceso a servicios de salud: Enlaces a servicios y financiamiento adecuados Consideraciones en el diseno de un producto Foromic: Mas Alla del Acceso October 2012 Barbara Magnoni EA Consultants
  2. 2. The Problem & the Opportunity Healthcare and health financing options for low-income women in Guatemala are limited • 60% of the population uses free or low cost public services, but these are underresourced (1% of GDP) • 85% of population has no social security health or private insurance • Expensive private care and poor quality public options prevent women from seeking healthcare for illnesses • Low usage of preventative and primary care leads to higher risk of costly illness 2 Banrural’s insurance company, Aseguradora Rural, obtains a grant to implement health insurance from the ILO’s MI Innovation Facility • Began by selecting a target segment: low income women savers
  3. 3. The Context Banrural is committed to improving the livelihoods of its clients and is convinced that health is an urgent need • Banrural is one of the largest banks in Guatemala with a broad and deep distribution network throughout the country • Clients are 90% rural or semi-rural and 63% of indigenous background • 51% are women, 44% are illiterate, and 75% are below the poverty line 3 Using what we know about client demand and value to inform product design • Market study conducted with 268 Banrural clients to learn more about health concerns, healthcare usage, & willingness to pay • “Client Math” studies and other research allow us to learn from other programs about what clients want, will use, and will benefit from
  4. 4. What health problems worry clients? Women’s concerns for their own health Condition % of survey respondents Cancer 71% Diabetes 48% Heart problems 35% Hypertension 15% HIV/AIDS 10% Stress/anxiety/nerves 9% Common perception that health insurance should cover children because women care prioritize their children’s health over their own. • Women we surveyed only skipped health care 11% of the times their kids were sick. • They skipped care for themselves 30% of the time when they were sick. • For their children, they primarily use the public sector. When asked about their own health needs, women express a strong concern for illnesses that are expensive such as cancer, and chronic illness such as diabetes and heart disease
  5. 5. What health problems worry clients? 5 I’m overweight, but I don’t have time to lose weight I would rather not know I am sick, I can’t afford treatment 46% of women suffered from stress or anxiety. Stressed women spend US$70 a year more on health each year and US$12 more on each medical visit than women without stress My husband will think I am cheating on him if I go to the doctor I have pain in my lower abdomen, maybe it’s cancer If something happens to me, who will take care of my children?
  6. 6. What do clients do when they get sick? 6 Traditional Medicine Private Clinics Private Doctors Public Health Centers Public Hospitals Pharmacies Skipping Care
  7. 7. Designing an Insurance Product to Address Needs 7
  8. 8. Designing an Insurance Product to Address Needs 8 Servicios Médicos para la asegurada: • 2 Consultas Anuales con Ginecólogo • Exámenes preventivos. • 1 examen de Papanicolaou • 1 examen de orina o uro cultivo • 1 Colposcopia • Tratamientos • 1 Crioterapia • 1 Conización tipo Lletz • Descuentos en Medicamentos • Precios Especiales en la Red Médica Banrural B. Indemnización en caso de Diagnóstico de Cáncer Maligno. Si se diagnosticara Cáncer, de cualquiera de los siguientes casos, se indemnizará por el valor asegurado. Esta cobertura aplica 90 días después de la emisión del seguro C. Indemnización de muerte por cualquier causa. Seguro de vida de muerte por cualquier causa por Q. 6,000.00
  9. 9. Finding the right balance in product design 9 Accessible price Valuable coverage • Shed coverage that would be ideal but makes the product unaffordable • In Guatemala, this balance led us to cover only a “slice” of the many possible healthcare needs. • Compensate with discounts and medicines • Buld more coverage in over time • Leverage public resources Meet Demand Improve Health • Need to address the health concerns that clients are most worried about- COVER CANCER • But also need to cover preventive services to AVOID CANCER • To improve health outcomes, cover services along the spectrum of early stage treatment needs fully so clients will use them. • In India, clients skipped follow-up care because it wasn’t covered (detailed on next slide). • Communicate outpatient coverage clearly. • Cover services that people show quick health results (gyn infections) • In India we also found that clients rarely used outpatient services and many were unaware of them (detailed on next slides).
  10. 10. Learning from “Client Math”: Understand what services clients use 10 0 20 40 60 80 100 120 140 160 180 200 INSURED UNINSURED USD Client Math in Karnataka, India Cumulative Hospital Expenses Lost Income Follow-up Visit Expenses Readmission Expenses Indirect Hospital Expenses Direct Hospital Expenses 193 104 • “Client Math” uses surveys after a shock has occurred to understand the full cost of a shock and how it was financed, for insured and uninsured clients • In a Client Math study, in India, with Grameen Koota, we find that limiting coverage to only first admission, prevented clients from following doctors’ recommendations on re-admission.
  11. 11. Other Lessons from “Client Math” in Health: Understand the Full Cost 11 • A product may be well designed to cover health, but fall short in meeting clients needs for related costs. • Adding up the total costs of a health event, we see that indirect expenses and lost income are substantial costs not covered by the insurance. 0 50 100 150 200 250 300 350 400 INSURED UNINSURED Client Math in Maharastra, India Hospitalization Expenses Follow-Up Visit Expenses Readmission Expenses Lost Income Indirect Hospital Expenses
  12. 12. Thank You! Contact: Barbara Magnoni EA Consultants