Delivering Health Microinsurance through Savings Groups in Benin

CORE Global Health Conference

Tom Shaw

Senior Technical Advisor - Microfinance

April 15, 2015

Overview of HMI Product, Enrollment, and SILC

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HMI product • Primary healthcare only • 100% of consultations covered • 70% of health services covered • 30% co-pay • Maximum annual coverage $80 • $200 term life coverage • Monthly cost is ≈ $0.58 per person covered

SILC Groups at a glance - 15–30 self-selected, members - User-owned and managed - Weekly savings meetings - Loans to members - Share out after 12 month cycle - Useful lump sum at shareout - Accessible, transparent, flexible

Enrollment FEBRUARY 2012 252 policies 715 covered 6.8% SILC member coverage

DECEMBER 2014 552 policies 1,351 covered 12.9% SILC member coverage

Why Use Savings Groups to Deliver a Health Microinsurance Product

Advantages: • Come together to save and borrow not to buy insurance • No adverse selection or covariant risk • Have income generating activities and thus regular income • Strong social cohesion within the savings groups • Mutual support in times of difficulties • Already have a social fund for emergencies so easier transition to

the idea of formal insurance • Have both savings and access to loans to pay for premiums • Excellent platform to deliver additional knowledge and skills

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Lack of knowledge and understanding about insurance • Survey Responses

– 88% of respondents < a primary school education (grade 6) – 89% have never used any type of insurance before HMI – 97% understand they must renew membership when it expires – 81% understand that they cannot get their premium back if they did

not use health services – 95% would like to receive more information on:

• Benefits of enrolling in HMI • Package of services covered by the HMI plan • Procedures to submit claims in case of death or permanent disability

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CHALLENGES

Inability to pay premium for all dependents • 84% of respondents have 4 or more dependents • 57% have seven or more • Avg. dependents currently covered per policy holder: 2.45

• 11 of 12 focus groups reported their inability to pay the premium for all family members as one of their top concerns

• 79% willing to increase their social fund contribution to facilitate enrollment and/or renewal to cover more family members

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CHALLENGES

Dissatisfaction with participating health centers • Survey Responses

– 30% of those enrolled in HMI waited one hour or more at health center before receiving treatment

– Top two problems at the local health centers • The staff do not treat patients with kindness • The waiting period is too long

• Focus Group Discussions: – 9 of 12 focus groups reported long waiting periods at local health centers – 26 of 41 SILC groups participating in HMI are > 5k from health center

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CHALLENGES

Difficulties in adoption of ICT devices • Field agents

– Low education level, no experience using computers or tablets – Project coordinator ended up redoing the field agents’ work

• Health center staff – Turnover or unavailability of staff trained in use of mini-iPads – Some staff unwilling or unable to attend trainings – Some staff currently prefer to use another system and find that

entering patient data on mini-iPads duplicates their work – Communication challenges:

• In case of technical difficulty, staff do not like paying for phone credit to contact Caritas or waiting for them to arrive on site to resolve the issue

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CHALLENGES

Low enrollment = financially unattractive to insurance company • With 552 policies and 1,351 persons covered

– Total annual premium revenues: $9,785 • Annual revenue per client: $7.25

– Total annual administrative costs: $151,176 • Annual cost per client: $112

• Minimum policies and persons covered to reach breakeven: (Total Revenues = Total Costs)?

– 5,213 policyholders and 20,852 persons covered • Five-year target:

– 20,000 policies and 60-100,000 persons covered

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CHALLENGES

Still not reaching the poorest members • 73% of those that do not frequent health centers in case of

illness said that they do not do so because it is too expensive • Poorest SILC members are not enrolling in HMI or not renewing • Results of Benin’s Progress out of Poverty Index survey:

– Sample size: n = 300 individuals – Mean score for those who never enrolled in HMI (n = 180): 30 out of 100 – Mean score for those who enrolled in HMI (n = 120): 32 out of 100 – On average, those who renewed enrollment in HMI were 6.5% better off

than those who did not – On average, an increase of one point in the PPI score increases the

probability of renewing enrollment by 3%

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CHALLENGES

Recommendations and Potential Solutions Recommendations 1. Improve HMI messaging and marketing strategies 2. Simplify product design, policies, and procedures 3. Add the public health centers to the list accepted institutions 4. Improve training design, increase frequency of training, and

access to technical support to facilitate adoption of ICT tools 5. Conduct financial analysis with NSIA to closely monitor

enrollment targets to achieve sustainability

Potential Solutions 1. Offer discounted premium for each additional dependent 2. Introduce savings or lending mechanism in SILC specifically for

HMI premium 3. Provide incentive to participating health centers by charging an

administrative fee per insured patient

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Questions?