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Uplift Mutuals People Led Social Protection Kumar Shailabh

Uplift Mutuals People Led Social Protection Kumar Shailabh. Why Mutuals. Unorganized Sector’s Need. Risks in PA Health Insurance. Numerous Exclusions Moral Hazard No people’s participation in Health -Risk Management Wrath of Claim rejection(affecting other business lines)

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Uplift Mutuals People Led Social Protection Kumar Shailabh

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  1. Uplift Mutuals People Led Social ProtectionKumar Shailabh

  2. Why Mutuals Unorganized Sector’s Need Risks in PA Health Insurance Numerous Exclusions Moral Hazard No people’s participation in Health -Risk Management Wrath of Claim rejection(affecting other business lines) Risk of premium increase due to high claim ratio Increase in cost of Care Risk of product inefficiency if very low claim ratio Profit sharing? • Affordable product • Access to quality care services • Rationalization of costs(only) • Transparent procedures • Impact on Health • Value for money • Profit Sharing

  3. So what…can people really manage their own risk/insurance? Why we do not believe that they can… • Community based models cannot be up scaled • It is not insurance! • Risk management should be done by professionals – insurers and re insurers (who can manage big losses) • Though nascent MI got regulations and a clear delivery model(PA) • No conclusive community based risk management business model in sight

  4. Yes , people have been sharing risk and its growing! • 21 Mutuals covering over 80000 lives in Maharashtra decide their premium, benefits, exclusions and claims and share and manage their health risks today. • They saved their 31 lakh of rupees in 2008 in form of discounts negotiated with a shared network of health care providers • While they paid 100 Rs/person/year the return on investment was 143Rs/person average only on amount saved- Claims paid were separate. • They not only get timely access to quality care (a real time 24X7 helpline) but dedicated preventive services through discounted OPDs, Health Camps and Health Talks.

  5. Costs OK ! How does it work? • This works through the Mutuals Model of risk sharing - that is a value chain of families, communities, their organized structures who come together to form Uplift –Risk is managed at multiple levels Many Colds, Flues, Gastros Some fractures, pneumonia, Respiratory diseases, Caesareans Rare ablations, Operations with Local Anaesthesia Rarest Severe operations under GA (Heart by pass… ) Frequency

  6. UPLIFT’s RISK MANAGEMENT MODEL Frequency Costs UPLIFT Mutuals  Local Branch n.n  Local Branch n.n   MIU 2  MIU 1  Re -Insurance  Local Branch n.1  Local Branch n.1

  7. Uplift’s Business Model

  8. Uplift Mutuals…four defining values

  9. INCLUSIVE,RISK POOLING AND MANAGEMENT

  10. MUTUALS COMMUNITY OWNED SHARED

  11. TECHNICALLY SOUND

  12. HEALTH SERVICES -NEED FOCUSSED

  13. Mutuals Performance as on Dec 2008

  14. Services Report for Mutuals 2008

  15. Portfolio Growth 2003-08

  16. Claims experience and frequency 2004-2008

  17. Health Services 2004-2008

  18. Savings thanks to services

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