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Ähnlich wie Uplift Mutuals Community Owned Risk Management May10
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Uplift Mutuals Community Owned Risk Management May10
- 1. Uplift Mutuals Understanding why Communities managing their health risks makes sense Kumar Shailabh
- 4. Non solidarity based systems will Increase Inequity and will NOT reduce poverty Health Care Financing through Private Insurers Individualisation of premia Source: FGDs No Compulsory coverage for all means exclusion of the poorest: INCREASE OF INEQUITY Control by private sector: PROFIT ORIENTED not Health Oriented. Each one pays what he/she costs. NO SOLIDARITY-opportunity for high moral hazard No prevention- Coverage function of the wealth: Higher Wealth Higher Health…
- 6. Why Uplift chose Community Owned Health Risk Management System
- 10. Under Construction Costs Frequency UPLIFT Mutuals Re -Insurance MIU 2 Local Branch n.n Local Branch n.1 MIU 1 Local Branch n.n Local Branch n.1
- 12. So how does Uplift Mutuals manage all these issues?
- 13. INCLUSIVE,RISK POOLING AND MANAGEMENT
- 14. MUTUALS COMMUNITY OWNED SHARED
- 16. HEALTH SERVICES -NEED FOCUSSED
- 17. OPERATIONAL STRUCTURE 05/21/10 HEALTH CARE PROVIDERS JANATA VASHAT BR. ArogyaNidhi LOHIYANAGAR BR. ArogyaNidhi DATTAWADI BR. ArogyaNidhi PSW Impl.Org APVS Impl.Org HADAPSAR BR. ArogyaNidhi UPLIFT INDIA ASS. UPLIFT HEALTH PROGRAMME MANAGEMENT UNIT
- 18. Mutuals Governance- the bottoms up approach
- 19. Uplift Mutuals- Value for the poor’s money
- 20. Community Managed Risk Ratio
- 21. Claim Frequency trends Reporting year Frequency 2005 1.2% 2006 1.1% 2007 1.5% 2008 1.3% 2009 1.7%
- 22. Review of the “Arogyanidhi 2” OOPEs The New Product has substantially reduced OOPEs by 20%, and is even greater when additional savings from Uplift’s network are included.
- 23. Top 10 illnesses Top illnesses, based on ICD codes from Syslift – 2 nd level illness category
- 24. Uplift Mutuals- Way forward
- 25. Performance Indicators 2009 UPLIFT MUTUALS Jan-Dec 2009 (PROVISIONAL) Global Uplift Policies Enrolled 25,442 Contribution collected in Rs 95,54,150 Average Renewal Ratio 49% Nbr. of on going policies 24,319 Nbr. Of on going Members 87,758 Earned Contribution allocated to Claims fund in Rs 46,70,867 Unearned Contribution Amount in Rs 26,90,741 Nbr. of Claims Opened 1,584 Claims Amount disbursed in Rs 43,37,937 Claims Ratio 93% 12 Months Frequency Ratio 1.8%
Hinweis der Redaktion
- Individualisation of risk: each person has its own risk: the path of private insurer is clear: reward those who are not sick, avoid the others and exclude them. Exclude the poor, exclude the old, exclude the fragile new lives. So forms will be increasing data collecting information anyway. Up to incredible details (cf norwegian pensions) Other way solidarity:
- Lack of faith leading to exclusions Moral Hazard leading to high claim ratios and rise in premiums Product inefficiency seen in terms of low claim ratios Rise in cost of care thanks to insurance Individualization of risks leading to differential premiums
- )
- We chose to pool risks (than transferring them) and designed a product that didn’t exclude people based on age and a risk management model that relied on solidarity of both communities and families and trusted their decision making competence
- We understood that the basic logic of the SHG /JLG model success was indispensable-after all it was members money –they should decide –how to design –how to benefit.
- As we chose the in-house risk pooling model it became pertinent that we should be technically sound and as competent as the dominant model to offer a viable alternative in health protection
- And we now know that for health insurance to be effective to the poor –it has to be able to create value for the contribution they make-a range of health services which facilitate access to quality health care on time added with preventive and promotive aspects of health form the design of health mutuals today.