This presentation was given by Jeanna Holtz at a side session at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand, on January 29, 2017.

1. Designing private health insurance
products to serve marginalized
populations
Jeanna Holtz, Abt Associates
January 29, 2017

2. 2
Pathways to UHC

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

5. 5
Health insurance can work for the poor
• Focus on 3 Ps
Client value
Viability

6. 6
3Ps: Products
Core product Value-added services Link to savings
Clientvalue
 Understandable,
simple
 Complement
public programs
 Tangible, save money
 Complement insurance
 Finance premiums,
other costs
Viability
 Easier to sell
 More efficient,
accurate claims
 Reduce claims
 Enhance sales
 Fewer lapses
 Cross-selling

7. 7
3Ps: Processes
User-friendly Technology Monitoring
Clientvalue
 Fast turnaround
 Easy, flexible
 Facilitate premium
collection
 Cashless, paperless
 Feedback mechanism
Viability
 Promote enrolment
 Cost-effective
 Reduce leakage
 Reduce fraud
 Product, process
improvements

8. 8
3Ps: Partnerships
Govt, donors Distributors Health providers
Clientvalue
 Expand coverage
 Affordable
 Direct client contact
 Convenient, trusted
points of access
 Better access and
quality
 Reduce out-of-
pocket costs
Viability
 Scale
 Subsidies
 Improve infrastructure
 New markets
 Efficient processes
 Lower claim costs
 Reduce fraud

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

11. 11
Summary: The 3 Ps

12. 12
Health insurance can work for the poor...
... but only when carefully orchestrated.