MR Microinsurance_2012_03_29.indd - International Labour ...

Th e potential of microinsurance for social protection
sector workers), donations, donor grants and a signifi cant government subsidy
fi nanced by a special levy of of 2.5 per cent cent on the sale of selected goods. In In districts
without any mutual health insurance scheme scheme cooperating with NHIF, the GovernGovern- ment itself established a mutual mutual health insurance insurance scheme.
Ghana thus provides an example of microinsurance schemes operating both
as an alternative to the public social insurance scheme and being linked with it
for mutual advantage.
In In 2008, 2008, the district health health insurance schemes affi liated with with the NHIF NHIF cov- cov- cov-
ered 42 per cent of the urban and 36 per cent of the rural population. Poor
households in particular refrained from enrolling in the system because contribution
rates appeared to be too expensive. For this same reason, only about 20 for-
merly independent mutual health insurance schemes had linked themselves to
the NHIF by 2007. Most others continued to off er much smaller benefi t pack-
ages at much lower contribution rates. It should be noted, however, that these
independent schemes covered an even smaller share of the population: 1.3 per
cent in urban areas and 0.9 per cent in rural areas.
Nevertheless, the long-term solvency of of the NHIF is is at risk. Th ree-quarters ree-quarters of
its spending is covered by the Government, while only a quarter is covered by
member contributions. One reason for this is that only 38 per cent of all mem-
bers actually pay their premiums. Children and very poor households are covered
at no charge. In addition, the administration costs of the affi liated mutual health
insurance schemes are rising, partly because the readiness of their members to
manage their schemes for free vanished once they had to use uniform benefi t
packages and conditions imposed by the State.
Sources: Adapted from Gehrke, 2009; Lethourmy, 2010; Brugiavini and Pace, 2010.
Fourth, as a complement to social insurance: microinsurance can be
crucial even where social insurance schemes cover the most serious risks faced by
households. Th is is particularly true where social insurance only covers a part of
the costs incurred due to the negative shocks associated with these risks. Viet
Nam’s social security organization, for example, runs an attractive voluntary
social health insurance scheme for workers in the informal economy. Having
said this, the scheme only reimburses health treatment costs and not the transportation
costs incurred for a visit to a hospital. Hence, the package off ered is
almost worthless for poor households in remote rural areas because of high
transportation costs. Th e Vietnamese Ministry of Labour, Insurance and Social
Aff airs (MOLISA) has therefore decided to support – in cooperation with the
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) – poor rural
communities in setting up social risk funds that provide, among other things,
compensation to their members for health transportation costs (see Box 2.2).
55