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. 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. 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. 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. 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. What do clients do when they get
sick?
6
Traditional
Medicine
Private
Clinics
Private
Doctors
Public
Health
Centers
Public
Hospitals Pharmacies
Skipping
Care

7. Designing an Insurance Product to
Address Needs
7

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. 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. 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. 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. Thank You!
Contact:
Barbara Magnoni
EA Consultants
bmagnoni@eac-global.com
www.eac-global.com