MHI Murali Srinivas 06-May’09. Objective Research Delivery Model About MHI Risk transfer MFI...
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Transcript of MHI Murali Srinivas 06-May’09. Objective Research Delivery Model About MHI Risk transfer MFI...
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