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In 2002, members of a Pune-based women’s group, following difficulties faced by a member after a heart operation, decided to address and increase their capability to hedge themselves against such risks. When an insurer presented a product matching their capacity to pay, the immediate question was:“Can we get the money back if we are not sick?” On receiving a negative answer from the insurer they concluded that they had no incentive to join this plan.
This incident made Uplift to think risk sharing as a more relevant model than transferring the risks. We realized that risk sharing would also help in reducing the traditional ills of health insurance (moral hazard and fraud) as members would own the programme and since the contribution is theirs they should be the one deciding the benefits. Further a baseline survey with families living in the slums to assess capacity to pay brought out three critical issues, that any health financing for the poor should address-families wanted to know the right doctor, right treatment and right cost. Here was born the idea of access to health care.
Starting with 300 women in 2003, today Uplift’s Mutuals model associates more than 200,000 lives across five partner organisations in Maharashtra and Rajasthan.
Uplift has a technical team that designs the entire end to end Health Mutuals scheme that includes actuarial, medical , capacity building, monitoring and evaluation and IT skills.