Insurance is intrinsically a mutual concept. However the commoditised approach to insurance emphasises on the individual insured person as a customer and consumer. It represents the individualisation of risk amelioration, and the conversion of the insurance policy as a product. Insurance thus becomes a commodity, to be bought and sold in the market like other products.
Against this background health becomes an interesting risk to cover because of its strong base in human behaviour and cultural beliefs that puts the design of commercially developed health insurance products with their primary motive of profit into question.
When the context is of the poor, low income groups, this situation is further compounded as their risks are perceived to be higher and their paying and understanding capacity to be lower. Thus health with its complexities and insurance with its profit motive make the paradigm of health micro insurance a challenging task.
It was this challenge that motivated Uplift Mutuals a decade ago to begin a journey of setting up health mutual aid for the poor, that could provide them not just with meaningful risk management but took their needs as the main input and their decision making as the prime mover.
There are four pillars on which the Mutual model designed by Uplift works
1. Inclusive Risk Pooling
2. People-Community centred
3. Technically Sound
4. Health Services as an ecosystem
Inclusive Risk Pooling
Insurance companies often practice what is commonly known as cherry picking and lemon dropping. Picking good risks and leaving out bad risks is a typical formula used by commercial insurance products.
At Uplift,discussing and debating with communities especially women, a lot of learning emerged vis a vis risks. As a result of these discussions it was realized that for risk pooling to make sense for the poor, it has to be inclusive and respond to the real needs of the people.
The many features imbibed thanks to this learning is no age based pricing-one price for all, no age entry bar, product exclusions validated by the community based on their context (normal maternity is covered in some communities), informed risk management (rationalized utilisation of services) and focus on family enrolment to ensure that girls are covered.
People Community Centred
The main component of a mutual aid scheme is that the buyers and sellers of insurance are not different, they are often the same. As such at Uplift Mutuals right from product design to claims decision community via their elected representatives play the role of decision makers.
An elaborate Information education and communication process is built in in the entire scheme that brings in a great amount of transparency and accountability.Community representatives are trained over a period of time that enables them to take claim decisions and run the scheme according to set rules and guidelines.
Often one of the main complains of community based programmes are that they are technically not robust or do not have a good MIS in place. Uplift understood that data is at the core of any decision making and if the community has to decide it will need copious amounts of data in a manner that is easy to understand and use for decision making.
Uplift was one of the earliest schemes to have a dedicated desktop MIS that has enabled its communities to make responsible and rational decisions over the last decade.it has one of the most detailed and granular level of data over a decade that has helped refine its product and services in consonance with feedback received from communities. Scheme data has regularly been presented to community representatives and explained to them in the most lucid manner.
Uplift has recently upgraded its MIS to a sophisticated web based system (UTTAM) that has allowed it bring greater efficiency in enrolment and claims management and an array of reports that will help its communities better manage their mutuals.
Uplift has a set of skilled technical human resource that work on right from product design, process design, back office management,training and capacity building, and medical services provision
Health Services as an Ecosystem
One of the earliest realizations that came through community feedback was that for the Mutual aid scheme to provide value to its members it should invest in access to health services as it was critical for the mutual scheme to work. After a decade the single most important learning of Uplift has been that health insurance is a lot about health care management.
Uplift has created a multilevel access for its members by creating a preferred provider network, a 24X7 helpline managed by doctors for emergency and normal guidance, a referral system and dedicated human resource to guide people to relevant health care and follow up and a dedicated Out Patient service system to provide the first level of quality care.
This has helped Uplift communities in saving a huge amount of money in out of pocket expenses by knowing where to get a good treatment at a good rate. The tangibility brought by these set of services has helped the communities understand the consumption of health care and its merits and demerits.