Implementing a Participatory Model of Micro Health Insurance among Rural Poor with Evidence from Nepal

David M Dror,Denny John,Atanu Majumdar,Pradeep Panda,Ruth Koren

doi:10.1057/gpp.2013.31

Abstract

This paper reports on two voluntary, contributory, contextualised, community-based health insurance (CBHI) schemes, launched in Dhading and Banke (Nepal) in 2011. The implementation followed a four-stage process: initiating (baseline survey), involving (awareness generation and engaging community in benefit-package-design), launch (enrolment and training of selected community members) and post-launch (viable claims ratio, settled within satisfactory time, sustainable affiliation). Both schemes were successful on four key parameters: effective planning; affiliation (grew from 0 to ~10,000) and renewals (>65 per cent); claims ratio (~50 per cent); and promptness of claim settlement (~23 days). This model succeeded in implementing CBHI with zero premium subsidies or subsidised health-care costs. The successful operation relied in large part on the fact that members trust that they can enforce this contract. Considerable insurance education and capacity development is necessary before the launch of the CBHI, and for sustainable operations as well as for scaling.

Highlights

In countries where governments can neither mandate contributory universal health coverage (UHC) nor subsidise its full cost, one of the great challenges is reducing private out-ofpocket expenditure (OPE) for health care payable at the point and time of service
The Government of Nepal has shown interest in universal health care (UHC) through implementation of health insurance10; it has neither launched a national scheme nor entered into arrangements with commercial insurers to secure an ample supply of health insurance, notably in difficult-toreach locations
This paper addresses the question whether and how it is possible to operate sustainable health insurance in the informal sector in rural Nepal without premium subsidies, and what useful role communities can play in the self-governance of their insurance

Summary

Introduction

In countries where governments can neither mandate contributory universal health coverage (UHC) nor subsidise its full cost, one of the great challenges is reducing private out-ofpocket expenditure (OPE) for health care payable at the point and time of service. The Government of Nepal has shown interest in universal health care (UHC) through implementation of health insurance; it has neither launched a national scheme nor entered into arrangements with commercial insurers to secure an ample supply of health insurance, notably in difficult-toreach locations. Rather, it has designated several “pilot” districts for experimentation with several models, notably CBHI. This paper addresses the question whether and how it is possible to operate sustainable health insurance in the informal sector in rural Nepal without premium subsidies, and what useful role communities can play in the self-governance of their insurance

Results

Discussion

Conclusion