MR Microinsurance_2012_03_29.indd - International Labour ...

124 Health insurance
5.3.2 Organizational models and public-private partnerships
The organizational model used to provide HMI plays a key role in determining
the impact of the programme, as the structure affects pricing, benefits and even
long-term funding. Dror (2008), examining the insurance industry in India,
found that HMI programmes can change models over time. For example, communities
may start out by purchasing group insurance from commercial insurers,
but later shift to community-based health insurance models, which offer more
flexibility and relate better to the client need for customized products. In addition,
members may agree to ration benefits more readily when they have a role in
the decision-making process rather than when they attempt to understand the
acceptance and rejection decisions of a distant and impersonal company. This
suggestion hints at just a few of the possible connections between organizational
model, marketing and product design.
Typically, grassroots HMI programmes understand low-income communities,
but do not understand health insurance, while traditional insurers do not
know how to reach communities or gain their trust. Insurers can bridge this gap
by working in partnership with delivery channels that are more in touch with
poor communities; grassroots HMI programmes can fill their capacity gaps by
participating in training and receiving technical assistance. With any potential
solution, however, understanding and meeting clients’ needs should remain a
priority.
When public- or private-sector intervention alone cannot accomplish
enough, public and private players may need to join together in innovative and
more substantive ways. Importantly, research reveals that advancing the goals of
fighting poverty and providing access to health care often requires the cooperation
and blended competencies of public- and private-sector actors, with complementary
resources and roles (Marek et al., 2005; Cowley and Ehrbeck, 2007;
Lomas, 2009).
Up to this point, this chapter has emphasized private-sector interventions
and programmes that directly or indirectly provide HMI and access to health
care. However, innovative PPPs have the potential to catalyse a greater quantity
and quality of healthcare options for low-income individuals and groups. In particular,
PPPs can exploit the creativity and efficiency of the private sector in concert
with the fund-raising capability of the public sector. Public money may be
necessary to pay for most preventive care, for health promotion or to subsidize
HMI premiums. Government support for public-private partnerships can be
provided effectively in a number of ways. In Ghana and Rwanda, the public-
private partnership relationship is one where the government provides significant
subsidies to pay for premiums. In Laos PDR, the government subsidizes health
care directly. In Cambodia, the government finances equity funds; donors also