THE FIGHT FOR SOCIAL INCLUSIONTHE FIGHT FOR SOCIAL INCLUSION

GREATER INCLUSION: POSSIBILITIES AND PROSPECTS

Sa-Dhan Annual Conference 17-18 January 2007

GREATER INCLUSION: POSSIBILITIES AND PROSPECTS

Sa-Dhan Annual Conference 17-18 January 2007

ILO SUBREGIONAL OFFICE, NEW DELHI

STEP (Strategies and Tools against social Exclusion and Poverty) Asia Coordination

SOCIAL PROTECTION:A RIGHTS-BASED APPROACH…

SOCIAL PROTECTION:A RIGHTS-BASED APPROACH…

SOCIAL PROTECTION IS A FUNDAMENTAL HUMAN RIGHT (1948)

EACH GOVERNMENT SHOULD PROVIDE SOCIAL PROTECTION TO EACH AND EVERY CITIZEN

UNDER ILO’S DEFINITION NINE MAJOR BENEFITS SHOULD BE COVERED BY SOCIAL PROTECTION SYSTEMS (MEDICAL CARE, SICKNESS BENEFITS, UNEMPLOYMENT BENEFITS, OLD AGE BENEFITS, EMPLOYMENT INJURY BENEFITS, FAMILY BENEFITS, MATERNITY BENEFITS, INVALIDITY BENEFITS, SURVIVOR’S BENEFITS)

UNDER A BROADER DEFINITION AND IN THE INDIAN CONTEXT MORE BENEFITS COULD STILL BE ADDED...

MEASURING THE MAGNITUDE OF THE CHALLENGE…

MEASURING THE MAGNITUDE OF THE CHALLENGE…

POPULATION: 1.1 BILLION

370 MILLION WORKERS OPERATING IN THE INFORMAL

ECONOMY

92% OF THE LABOUR FORCE LEFT WITHOUT ANY

SOCIAL PROTECTION BENEFIT

HEALTH PROTECTION: STILL

A DREAM FOR CLOSE TO ONE

BILLION PEOPLE…

… THE BIGGEST EXTENSION

CHALLENGE IN THE WORLD…

SOCIAL PROTECTION PRIORITY NEEDS OF THE POOR

SOCIAL PROTECTION PRIORITY NEEDS OF THE POOR

☺HEALTH CARE:

A STRONG DEMAND FOR COMPREHENSIVE COVERAGE (WHOLE CARE VS RARE CARE)

QUALITY IS A MAJOR CONCERN

☺ MATERNITY PROTECTION NEED FOR A BROADER RCH PERSPECTIVE

☺ OLD AGE PENSION A NEW BUT FAST INCREASING DEMAND

☺ LIFE A STRONG DEMAND FOR MATURITY BENEFITS (CASH

BACK SERVICES)

☺ ACCIDENTS

1

2

3

4

5

HEALTH PROTECTION EXTENSION:HOW TO ANSWER THE CHALLENGE?HEALTH PROTECTION EXTENSION:

HOW TO ANSWER THE CHALLENGE?

A UNIQUE CHALLENGE: NO ROADMAP AVAILABLE… HENCE THE NEED FOR A DIVERSITY OF INNOVATIVE MECHANISMS…

GIVEN THE MAGNITUDE OF THE EXCLUSION PHENOMENON, MANY MORE ACTORS HAVE A ROLE TO PLAY… HENCE, THE NEED FOR MORE ADVOCACY AND FOR A MULTI-PARTNERSHIP APPROACH…

THERE IS NO ADVOCACY WITHOUT EVIDENCE… HENCE, THE NEED TO DEVELOP MORE KNOWLEDGE AMONGST ALL ACTORS…

ACCESSING, WITHOUT FINANCIAL BARRIERS, QUALITY HEALTH CARE SERVICES IS THE PRESSING NEED OF THE DAY… HENCE, THE NEED TO FOCUS ON HEALTH PROTECTION INCLUDING MATERNITY PROTECTION…

THE BEST WAY FORWARD: LET A THOUSAND FLOWERS BLOOM… AND LEARN FROM BEST PRACTICES BEFORE SCALING UP…

HEALTH PROTECTION:ESTIMATED PRESENT COVERAGE

HEALTH PROTECTION:ESTIMATED PRESENT COVERAGE

FORMAL AND INFORMAL SYSTEMS No. BENEFEMPLOYEES’ STATE INSURANCE SYSTEM (ESIS) 32,500,000

CENTRAL GOVERNMENT HEALTH SCHEME (CGHS) 4,300,000

DEFENCE/POLICE EMPLOYEES 6,600,000

RAILWAYS EMPLOYEES HEALTH SCHEME 5,500,000

CESS-BASED CENTRAL WELFARE FUNDS 4,000,000

STATE-LEVEL WELFARE FUNDS 3,000,000

EMPLOYER-SPONSORED INSURANCE SCHEMES 20,000,000

INDIVIDUAL COMMERCIAL INSURANCE 6,000,000

MEDICLAIM 18,000,000

UNIVERSAL HEALTH INSURANCE SCHEME 1,100,000

HEALTH MICRO-INSURANCE SCHEMES 7,000,000

TOTAL 106,100,000

% OF POPULATION 9.7%

MAIN HEALTH PROTECTION EXTENSION MECHANISMS

MAIN HEALTH PROTECTION EXTENSION MECHANISMS

ESIS COVERAGE: GRADUAL EXTENSION TO INFORMAL ECONOMY WORKERS

WELFARE FUNDS: FUNDS CREATED THROUGH CESS / CONTRIBUTION CATERING FOR A SPECIAL CATEGORY OF WORKERS – TRIPARTITE MANAGEMENT – BROAD RANGE OF BENEFITS: EDUCATION GRANTS, OLD-AGE PENSION, MEDICAL CARE, LIFE… (EXAMPLE: KERALA - 24 WELFARE FUNDS)

MICRO-INSURANCE PRODUCTS: PROVIDED BY INSURANCE COMPANIES (BOTH PUBLIC AND PRIVATE) AND TARGETING THE DISADVANTAGED GROUPS (RURAL & SOCIAL SECTORS)

IN-HOUSE MICRO-INSURANCE SCHEMES: DEVELOPED BY A WIDE DIVERSITY OF ACTORS

SPECIAL FUNDS: ALLOCATED BY STATE GOVERNMENTS TO PAY FOR SURGICAL PROCEDURES NEEDED BY BPL POPULATION (EXAMPLE: JHARKHAND – US$ 2.2 MILLION/YEAR)

CENTRAL GOVERNMENT: HEALTHPROTECTION EXTENSION STRATEGIES

CENTRAL GOVERNMENT: HEALTHPROTECTION EXTENSION STRATEGIES

PUBLIC INS. Co. (4) PRIVATE INS. Co. (11)

WITH / WITHOUT SUBSIDY THROUGH REGULATIONS

MICRO-INSURANCE

HEALTH PROVID.

NON-GOV. ORG.

MICRO-FINANCE

CO-OP. MOVEM.

TRADE UNIONS

LOCAL GOVERNM.

LOCAL GOVERNM.

IN-HOUSE (30%)

PARTNER-AGENT (70%)

TRADE UNIONS

CO-OP. MOVEM.

MICRO-FINANCE

NON-GOV. ORG.

HEALTH PROVID.

UHIS (SUBSIDY)

INSURANCE SCHEMES

HEALTH MICRO-INSURANCE: TOWARDS SELF-RELIANCE? HEALTH MICRO-INSURANCE: TOWARDS SELF-RELIANCE?

SCHEMES N0 OF BENEFIC.

TYPE OF SCHEME

TYPE OF COVERAGE

TYPE OF BENEFIT

TYPE OF SUBSIDY

YESHASVINI 1,850,000 IN-HOUSE TER. CASHL. DIRECT

DHARAMST. 400,000 P.AGENT SEC. CASHL. -

SEWA 174,000 P.AGENT SEC. REIMB. INDIRECT

VHS 124,000 P.AGENT PR/SEC CASHL. INDIRECT

PREM 108,000 IN-HOUSE SEC. CASHL/REIM INDIRECT

RAHA 74,000 IN-HOUSE PR/SEC. CASHL. IND/DIRECT

NAANDI 60,000 IN-HOUSE PR+SEC+TER CASHLESS IND/DIRECT

AROGYA 55,000 P.AGENT SEC. CASHL. INDIRECT

INDORE 49,000 P.AGENT SEC. CASHL. DIRECT

H.FIELDS 30,000 P.AGENT SEC. CASHL/REIM INDIRECT

UPLIFT 16,000 IN HOUSE SEC. REIMB. INDIRECT

KARUNA 12,000 P.AGENT PR/SEC. REIMB IND/DIRECT

ASHWINI 12,000 P.AGENT PR/SEC CASHL. IND/DIRECT

HEALTH MICRO-INSURANCE:THE FINANCING CHALLENGE… HEALTH MICRO-INSURANCE:

THE FINANCING CHALLENGE…

0

10

20

30

40

50

60

70

80

%

Rs. 13Rs. 44Rs. 88

PLANNING COMMISSION DEFINITION: VALUE OF A SPECIFIED NUTRITION REQUIREMENT

o 26%o 278 MILLION

UNDP DEFINITION: LESS THAN 1 US/DAY/PERSON

o 35%o 374 MILLION

UNDP ANALYSIS: LESSTHAN 2 US/DAY/PERSON

o 80%o 855 MILLION

…AT THE END OF THE DAY… NOT MUCH LEFT TO PAY FOR INSURANCE…

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER

INCOME: Rs. 2,000/MONTH

ESIS CONTRIBUTIONS: RS 1.700

INCOME: Rs. 2,000/MONTH

MI CONTRIBUTIONS: Rs. 365?

LIMITED CONTRIBUTION RESOURCES

LARGE CONTRIBUTION RESOURCES

CONTRIBUTIONS FROM WORKERS, EMPLOYERS AND GOVERNEMENT

WORKERS LEFT ALONE TO PAY FOR THEIR OWN PROTECTION?

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER

INCOME: Rs. 2,000/MONTH

ESIS CONTRIBUTIONS: RS 1.700

INCOME: Rs. 2,000/MONTH

MI CONTRIBUTIONS: Rs. 365?

REDUCTION OF RESOURCES ALLOCATED TO BENEFIT PAYMENTS

FULL ALLOCATION OF RESOURCES TO BENEFIT PAYMENTS

NO ADMINISTRATIVE COSTS ADMINISTRATIVE COSTSTO BE BORNE BY THE SCHEME

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

HEALTH MICRO-INSURANCE: THE EQUITY CHALLENGE: NEED TO SHARE THE BURDEN…

FORMAL ECONOMY WORKER INFORMAL ECONOMY WORKER

INCOME: Rs. 2,000/MONTH

ESIS CONTRIBUTIONS: RS 1.700

INCOME: Rs. 2,000/MONTH

MI CONTRIBUTIONS: Rs. 365?

VERY LIMITED SCOPE AND LOW LEVEL OF BENEFITS

BROAD SCOPE AND HIGH LEVEL OF BENEFITS

COMPULSORY SYSTEM AND OWNERSHIP/CONTROL OF

HEALTH FACILITIES

LESS COSTS OF ADVERSE SELECTION AND OVER PRESCRIPTION

HEALTH PROTECTION: LOOKING AT SOME CO-CONTRIBUTION EXPERIENCES…

HEALTH PROTECTION: LOOKING AT SOME CO-CONTRIBUTION EXPERIENCES…

UNIVERSAL HEATH INSURANCE SCHEME (THROUGH

PUBLIC INSURANCE COMPANIES) – CENTRAL GOVERNMENT

CONTRIBUTION

YESHASVINI (NO INSURANCE COMPANY) – STATE

GOVERNMENT CONTRIBUTION

INDORE MUNICIPAL CORPORATION (THROUGH PUBLIC

INSURANCE COMPANY) – LOCAL GOVERNMENT CONTRIBUTION

NAANDI FOUNDATION (NO INSURANCE COMPANY) –

CORPORATE SECTOR/CIVIL SOCIETY CONTRIBUTION

JHARKHAND (NO INSURANCE COMPANY) – CORPORATE

SECTOR/STATE GOVERNMENT CONTRIBUTION

YESHASVINI CO-OPERATIVE FARMERS HEALTH SCHEME (KARNATAKA)

YESHASVINI CO-OPERATIVE FARMERS HEALTH SCHEME (KARNATAKA)

PRIVATE TRUST (HEALTH PROVIDERS / GOVERNMENT)

MARKETED THROUGH THE COOPERATIVE MOVEMENT

COVERS ONLY SURGICAL PROCEDURES (1.600 PROCEDURES) UP TO Rs. 100,000 PER YEAR

PREMIUM: Rs. 120 /PERS /YEAR (Rs. 60 FOR CHILDREN UNDER 18)

IN-HOUSE MODEL (NO INS. CO)

TPA (FAMILY HEALTH PLAN)

HOSPITAL NETWORK (295)

CASHLESS SERVICES

GOVERNMENT DIRECT CONTRIB.

COVERAGE (2006): 1,854,731

SECOND LARGEST IN THE WORLD

YESHASVINI:EVOLUTION OF PERFORMANCE INDICATORS

YESHASVINI:EVOLUTION OF PERFORMANCE INDICATORS

0

20

40

60

80

100

120

Year 1 Year 2 Year 3 Year 4

Premium Subsidy

00.5

1

1.52

2.53

3.5

44.5

5

Year 1 Year 2 Year 3

Cost/Ins Net Cost

0

500000

1000000

1500000

2000000

2500000

Year 1 Year 2 Year 3 Year 4

N0.Insured

PREMIUM VERSUS SUBSIDY PER INSURED ADMINISTRATIVE COST PER INSURED

EVOLUTION OF NUMBER OF INSURED

THE MICROFINANCE AVENUE: THE WAY FORWARD…

THE MICROFINANCE AVENUE: THE WAY FORWARD…

EMPHASIZE THE INSURANCE SOLIDARITY CORE PRINCIPLE

RELY ON STRONGER INSURANCE AWARENESS AND EDUCATION

ACHIEVE THE FINANCIAL TRINITY: SAVINGS, CREDIT, INSURANCE

ORGANIZE LONG-TERM CO-CONTRIBUTION AGREEMENTS

WORK TOWARDS AUTOMATIC/COMPULSORY ENROLMENT MECHANISMS

DEVELOP EFFICIENT PARTNERSHIPS WITH HEALTH PROVIDERS’ NETWORKS