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.
Uplift’s product design is the result of over a decade of working and setting up nine mutuals across urban rural and tribal geographies. The biggest learning that Uplift has had is the fact that members, families, women, need health more than health insurance.
Also, in the claims- only design of commercial health insurance companies, out of 1000 members only 10-30 members will get claims. The rest 950 odd members get almost nothing. And its not that they don’t have health expenses-paying for OPD, medicines, diagnostics is across most of the families, but they do not benefit from this claims’ only model. The other part of this story is if such Outpatient preventive and promotive services are provided at the point where member stays it serves as a gate keeping mechanism that allows them to take care of their health.
Uplift Biradaree’s model caters to the daily health needs of its members as much as hospitalization expense needs.
Consequently, Uplift has developed and deployed very strategic health services using its learning and insights coming from its members. The following services form the mutual product design at Uplift Biradaree:
Uplift deploys a medical professional to offer cashless out- patient medical services and guidance for members close to where they stay. These are one of the most utilised services at Uplift as they bring preventive care right to the door step of the members and their families. A family has to spend anywhere between 100-500 Rs on one-time OPD consultations otherwise, which they get as a cashless service.
Uplift’s business model is focussed on keeping its members healthy and as such bring preventive care in an organised manner to them. Uplift will organise speciality and multi-speciality health screenings for members every quarter where they can get checked up and take care of any health issues. Uplift team follows up with members who have medical issues so that they get all the help required in taking care of themselves.
One of the most useful services offered cashless by Uplift Biradaree is access to medical help over phone. This has been extremely beneficial in cases of medical emergencies and information needs of members. The fact that a member can freely talk to a doctor online has been instrumental in members being able to get the right information on health care access at the needed moment.
Several macro level studies have pointed out that the out of pocket expense in India on health is 70% and out of this 70%, Medicines constitute 70% of this expense known as the 70-70 paradox. Uplift also realized that its member families regardless of hospitalisation were spending huge amounts of their hard-earned money on buying medicines every month without getting the right price and at times quality for it. Uplift as part of its product design provides its members with Medicines on discount using the pharmacy license it has got for this purpose.
Like commercial TPAs, Uplift has built a health care provider network where it negotiates for the best possible rates for its members. Uplift has a formal agreement with these providers that contain also a quality charter.However, unlike TPAs it guides its members to the best possible price available within the network that help members to reduce their out of pocket expenses. Uplift has saved lakhs of rupees of its members, using this health care intelligence and price discovery mechanism.
Since most of the members of Uplift have been women, Uplift has designed coachingsessions where it informs and educates its women members on their health issues especially related to nutrition, reproductive health, diseases specific to women, and other seasonal health issues. Here is a video link of one such event: https://www.youtube.com/watch?v=lxQiohtlNOk
Uplift’s capacity to offer technically sound Mutual aid is bolstered by the fact that it has technical support from three of the largest mutual insurance companies from Canada Sweden and the Netherlands. In the past its co-founder has been an actuary who actively supports the Uplift team in determining the best that the product can offer. The Uplift product does not have any age-based premiums and age-based exclusions. The contribution is kept the same for everybody to make the product inclusive. However, this is only possible when families join in groups to avoid any mis-selection.The product features contribution, cover, exclusions etc have to be validated by the community before the on boarding process begins.