Implementing community-based health insurance and measuring impact.

Submitted by francesco on Thu, 08/20/2009 - 14:11.
Starting July 2009, some of the world's leading experts in the field of micro health insurance have united forces under the auspices of the European Commission Research Directorate to combine implementation with impact evaluation in the field of microinsurance.

The project, which will unravel from 2009 till 2014, is called “Developing efficient and responsive community-based micro health insurance in India”, is funded by the European Commission under its 7th Framework Programme health section (FP7). In this EU-funded, 5-year collaborative project the Micro Insurance Academy partners with two top European universities (Erasmus University Rotterdam, University of Cologne) and three pioneer Indian grassroots organisations (BAIF Development Research Foundation, Nidan, Shramik Bharti) to take up a research effort unprecedented both for its academic scope and potential impact on current sectoral practices.

The consortium will be guided by an Advisory Board of eminent scholars in relevant disciplines, notably Prof. Peter Berman (Lead Health Economist, HDNHE, World Bank), Dr. Kent Ranson (Alliance for Health Policy and Systems Research WHO), Prof. Rainer Sauerborn (Chair and, Director of the Department for Tropical Hygiene and Public Health at Heidelberg University), Prof. Peter Smith (Professor of Health Policy, Imperial College Business School and Institute for Global Health), Prof. Ruth Koren (Tel Aviv University Medical School), Prof. Jacky Mathonnat (Vice-Président Auvergne university & CERDI, France) and Dr. Hengjin Dong (leader of the Junior Group of International Health Economics and Technology Assessment at Heidelberg University).

By combining the rollout of three new showcase micro insurance units (MIUs) and an unprecedented emphasis on scientifically rigorous evaluation of their impact on the lives of the target population in terms of equitable healthcare access and financial protection over several years, this project seeks to build a solid and comprehensive knowledge base for micro health insurance initiatives.

Implementation and Research - the two pillars of this project - will progress side by side in this 5-year project.

On the implementation side, the MIA will support BAIF, Nidan and Shramik Bharti to establish three Community-Based Health Insurance (CBHI) schemes in Kanpur Dehat and Pratap Districts in Uttar Pradesh, and in Vaishali Discrict in Bihar. The CBHI schemes to be implemented will be based on MIA's innovative micro insurance model, stressing inclusiveness (en-bloc affiliation against adverse selection, collaborative design of the package and community-rating mechanisms), sustainability (self-administration of the scheme) and solidarity (social-capital as a response to moral hazard and other market/insurance failures).

In a parallel effort, a continuous assessment of CBHIs' impact on the target population will be undertaken, testing the scalability and reach of the model across diverse socio-economic local patterns. Through the use of diverse methodologies (quantitative, qualitative, field observation, economic experiments, spatial data and structured data on the costs of economic implementation) the consortium will assess various dimensions of impact of the schemes as well as enhance the understanding of increasing efficiency of implementation. Some of the main questions that will be explored include whether being affiliated to an MIU improves access to healthcare and what impact on health-related financial exposure does this insurance have, due to a reduction of out-of-pocket healthcare spending among low-income rural households.

The balanced mix of skills and perspectives represented in the consortium is set to be uniquely far-reaching. Beyond answering the sectoral need for scientifically more rigorous theoretical frameworks, the project aims at offering precious policy-relevant insights into micro community-based insurance.

The findings will hopefully enable to understand cause-effect relations between insurance status and healthcare-seeking behaviours, health status and financial exposure due to catastrophic events, the impact of micro insurance on the local healthcare supply and many other areas of crucial medical and socio-economic relevance.

Who's who: meet our partners !

Erasmus University Rotterdam: Strong of a solid international fame for excellence in the fields of economics and health studies, particularly through quantitative research, this century-old university hosts two of the main minds behind this EU-funded project: Prof. Frans Rutten, former President of the International Health Economics Association, and Prof. David Dror, our MIA Chairman as well as an internationally recognized leading expert of micro health insurance. They will lead the project and be responsible for its overall coordination.

University of Cologne : by far the largest university in Germany and famous worldwide for the quality work of its Faculty of Economics and Social Sciences, this world-class institution hosts a Department of Co-operative studies at the forefront of micro and community-based health insurance schemes qualitative research and is widely involved in implementation initiatives across Africa and Asia.

BAIF Development Research Foundation: one of the first and for long the largest grassroots NGO in India to be thoroughly committed to the development of rural India in more than 45,000 villages, this 50 years-old Charitable Trust followed since its foundation Ghandi's teching according to which “Development without research will be static and research without development will be meaningless”. BAIF will be largely involved into the field research as much as the implementation and monitoring phases of the project in the Indian state of Uttar Pradesh.

NIDAN: a model non-profit grassroots organisation active in six districts across Bihar, Delhi and Rajasthan, Nidan excels in an original three-pronged approach currently impacting on the lives of over 60,000 informal and unorganized workers. Through the integrated promotion of sustainable collective business models, thrift and credit programs and micro-insurance schemes, Nidan is a pioneer in empowering the poor to get organized for their own aims, with an important focus on health awareness. Nidan is an implementing partner and will be primarily responsible of implementation the CBHI scheme in Bihar.

SHRAMIK BHARTI: with an impressive reach of 50,000 families, this not-for-profit grassroots development organization aims at eradicating poverty and empowering the poor and underprivileged through structured initiatives in the fields of micro-finance, preventive healthcare and democratic local self-governance. Along with Nidam and BAIF, Shramik Bharti will manage implementation of field experiments, collection of data and, crucially, the dissemination of the results.