MR Microinsurance_2012_03_29.indd - International Labour ...

130 Health insurance
The best solution is a coordinated effort to tackle multiple challenges simultaneously,
involving players from many different aspects of the HMI sector. This
effort should be combined with active communication between actors, sharing
their discoveries of what works – and what does not.
5.4.3 Public- and private-sector collaboration
The presence (or co-creation) of underlying health services provision is critical to
advancing HMI and to improving health outcomes in general. Certainly, no
HMI programme can be successful unless adequate healthcare services and personnel
are in close proximity to the patient. In addition, public health programmes
can create supportive environments to strengthen the impact of HMI.
For example, public players can improve sanitation conditions to reduce overall
systematic health risk and to support the viability of HMI programmes. They
can also promote health education and preventive care. Such activities will
encourage the kind of behaviour change that will enable HMI to have a greater
impact and may also reduce risks for programmes.
In addition, to create an enabling environment, private-sector players need to
make full use of the presence of any organizing bodies that consolidate groups of
people on non-health criteria. This practice is critical to addressing the adverse
selection and risk-pooling problem (Ito and Kono, 2010). Management of health
care through treatment protocols, discharge planning and other forms of care
coordination can improve consistency and efficiency.
Ideally, governments should provide 1) sustainable sources of financing, 2) a
stable yet flexible regulatory environment, and 3) consistent political support.
With some or all of these factors in place, the probability of HMI programmes
being valued sufficiently by clients to stimulate enrolment and the programmes
thriving long enough to achieve scale increases significantly.
5.4.4 Improve evaluations
Another element that deserves consideration is improved metrics for programme
evaluation. Programmes where managers are testing innovations will certainly
move through a trial-and-error stage and evolve over time; some will fail and
most will require at least several years to break even. Thus, programme longevity
may not be the best indicator of a viable and sustainable HMI programme.
Other relevant metrics include standard financial indicators and ratios examining
both clinical and administrative performance, robustness of management
information systems, credible pricing reviews, and staff training and incentives
(Biswas and Devi, 2008).