MHIMurali Srinivas

06-May’09

•Objective

•Research

•Delivery Model

•About MHI

•Risk transfer

•MFI issues

• Lessons

•Define objective

•Revisit and clarify after Research phase

•Make a road map - Phase wise approach

Research

•Segment

•Needs assessment

•Cost of delivery

•Incidence

Delivery Model

•Resource base and mobilization (Estimate admin costs)

•Marketing (Sensitizing & Training)

•Distribution (Low cost + Flexible + Right incentives)

•Service delivery mechanism (need handholding + choice of hospitals)

•Issue resolution processes (General + Crisis)

About MHI

• Tech Aspects

•Expected Cost (Estimating future health costs)

•Admin cost

•Size of Risk pool

•Reserves

•Rating Risk (Community / Experience)

•Out of pocket costs

• Deductible

• Co-insurance

• Elimination period

• Limit (lifetime maximum benefit, benefit ceiling, Out of pocket maximum)

•Selection (Adverse, Cherry picking)

•Fee for service (negotiated rates)

•Exclusions

•Moral hazard

•Group Policy

• Advantages

• Tax benefits

• low adverse selction

• economies of scale

• Disadvantages

• (Take it or leave it!

•)

•••

••

Risk transfer• Self-Insured

• Insured

• Advantages (Provider contracts + large risk pool + favorable reserves)

• Disadvantages (Expensive + not flexible + poor knowledge transfer)

• Advantages

• (no regulation

•+ stop loss insurance)

•Disadvantages

•(low risk pool)

MFI Issues• Staff overloaded -

•reluctant to promote new initiatives

• Need right incentives

•Promoters

•fear - negative impact due to any bad experiences

•Cost estimation & containment!

•

Lessons

• Flexible payments

• Ensure solidarity of group

• Larger risk pool

•Design keeping in mind community &

•household characteristics

•Associate with quality & viable health care

•provider

•Experience in rolling out insurance

•Demonstrate value

My product!• Risk pool size

• Deductible

• 25% Co-insurance

• Coverage for Pre-existing diseases

• Pre/Post hospitalization

•reimbursements

•- with limits

•+ Limited Exclusions

•Community rating

•Flexibility in

•premium payments

•- Rs 1000/-

•- Aim for 10,000 lives

•Questions?

•Murali Srinivas

• Mimo Finance, Dehradun