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CARE Foundation

About the Project
Project Name: 
Insuring primary care - A sustainable financing solution for rural primary health
Type of Facility Project: 
Innovation Grant
Country of Operation: 
India
Region: 
Asia and the Pacific
Project Thematic Focus: 
Product design
Product: 
Health
Type of Risk Carrier: 
other self-insurance scheme
Type of Distribution Channel: 
Healthcare centre
Project Description: 

The project aims to study the impact of microinsurance coupled with healthcare services delivered through handheld devices. In rural areas, the population generally can only access poorly qualified medical professionals for primary care. Additionally, high illiteracy, and a general lack of awareness about good health practices and the importance of managing risks makes microinsurance very difficult to implement in rural India.

To address these challenges, CARE Foundation plans to educate and train Village Health Champions (VHCs) to maintain a health database for their village and to facilitate access to medical advice from specialists through mobile communications. The role of the VHC includes health education, illness prevention, promotion of hygiene, assistance with referrals and transportation to medical facilities. The VHC network is supported by a primary health centre staffed by a medical officer, remote doctors consulting team, Nurse, Pharmacist and laboratory technician, and which can provide minor procedures, drugs and, diagnostic services.

CARE Foundation is partnering with CIRM to create a microinsurance product sold by the VHCs or suitable channels through pre-paid health cards. Members will receive services at fee for services at nominal prices from the VHC network plus assistance to obtain hospitalization wherever required. The enrolment campaign will be supported by an insurance literacy program and distribution of highly discounted preventive products or services to provide clients with some immediate value for their money. Renewals will be encouraged by discounted premiums, and/or increased benefits. Action Research Program with discounted vouchers will be done for a year and an updated product will be introduced in later years of the project period.

Through voluntary health insurance, the project will enable consumers to make informed choices. It is expected that the overall treatment cost will be reduced through prevention, early diagnosis and timely care emphasizing best practices at the hospital. Tele-monitoring will be used for after-care service to prevent re-hospitalization and conduct quality control.

Consortium Members: 

The Centre for Insurance and Risk Management (CIRM) is a non-profit organization engaged in a variety of action research initiatives with insurers, NGOs and regulators to design and promote innovative insurance products and to improve knowledge on risk-mitigating mechanisms. CIRM is one of 6 specialized centres associated with the Institute of Financial Management and Research (IFMR).

Beneficiaries: 

The project targets agricultural workers whose average household income is below INR 2500 per month (US$ 55). It will also benefit low-income communities in rural areas such as nomadic tribes that have scarce access to healthcare facilities. The Foundation plans to provide health microinsurance in 50 villages that have approximately 100,000 residents.

Lessons from the Project
Learning Agenda: 

The overall goal is to ascertain the efficacy and viability of outpatient financing and health care delivery in four key aspects:

  • To what extent does technology enhance access and utilization of health care, facilitate claim processes, reduce costs and increase savings?
  • How does the model support the efficiency of the scheme in terms of claims management, cost reductions, healthcare expenditures, operating costs and renewal rates?
  • To what extent are VHCs effective in the prevention of diseases and promotion of healthy behaviour?
  • To what extent does the model contribute to health care delivery, and patient and provider satisfaction?
Emerging Lessons: 
  • If CARE had it to do over again, it would use a mobile phone based solution that has a biometric card reader and thermal printer, as connectivity may be better and the cost may be about half.
  • Development and implementation of CDSS software is complex, both from a technology and a human perspective, and thus requires adequate time and money to allow for variables
  • Identification of insured patients using biometrics is much more challenging when it is being done with a HHD with functional limitations driven by cost, user, location and technology constraints (e.g. memory and connectivity).  
  • Back-up options for vendors are an essential part of good project management and essential for technology driven solutions.
  • Back up options for a critical functionality of the HHD, i.e. connectivity to the server via GPRS, are required. 
  • Hardware solutions developed in an urban context must be tested in a rural/local context to uncover potential issues.
  • Comprehensive field surveys are essential to provide data to develop more relevant product features and to understand attitudes, health seeking behavior and willingness to pay.
  • Because use of the HHD by VHCs is innovative, earlier and more comprehensive testing of the CDSS would have provided important knowledge about referral rates, diagnoses, drug use, etc., leading to greater confidence about how to design and price the product. 
  • Pharmacy management is a leading determinant of the sustainability of an outpatient insurance product.
  • A bias for injections and intravenous fluids as a usual treatment option exists.
  • Promotion and prevention programs can vary in cost, thus budgets should be determined up front to aid efficient development. 
  • Prospective clients in rural Maharashtra do not appear to understand the concept of insurance, so it can be useful to avoid use of insurance terms, and emphasize good health, avoidance of disease, etc.
  • Regulatory requirements are important to understand and use in developing both clinical and VHC drug dispensing protocols.
  • Marketing and awareness building about insurance should target male members of households as well as females.
  • The Clinic is also a source of potential insurance for clients.
  • People with a history of self-employment and dynamism are better candidates to become successful entrepreneurs (VHCs). 
  • Setting up a VHC program from scratch is a tremendous undertaking, complicated by the training requirements of using the HHD.
  • It is difficult to get specialist doctors to visit the hub clinic when patient volume is low, and difficult to attract patients to the clinic without an array of specialists.  
  • It’s important to recognize training needs of VHCs, clinical staff, and project staff and partners:
    • Dedicated, regular implementation team training is invaluable to ensure commitment and focus on a very complex project multiple components.
    • Targeting capacity building is necessary depending on gaps observed (clinical operations, insurance concepts, project management, etc.)
  • Contingency plans should be considered for all key inputs to the project:  technology, insurance literacy, clinical staff and clinic operations, VHC hiring and training, etc. 
  • Development of systems and procedures to handle servicing of non-insured clients requires separate consideration.
  • Establishing a new distribution channel may sound like a good solution to increase enrolment, but developing a financially viable channel is another matter.
Learning Journey: 
Learn more about the lessons that CARE Foundation is learning in this project.
About the Organization
Relationship with the Facility: 
Innovation grantee
Country of Head Office: 
India
Region : 
Asia and the Pacific
Type of institution : 
Non government organization
Participation in Microinsurance: 
Risk carrier
Organizational Overview: 

CARE Foundation is a non-profit organization with the mandate to make quality health care affordable and accessible to all through the appropriate use of technology. The Foundation implements its mission in three main ways: a) conducting research and providing specialized training, b) developing cost-effective medical products, and c) providing healthcare to low-income populations.

To increase access to health in rural areas, the Foundation relies on local capacity building and technology solutions, implements solutions to create a more efficient supply chain, and has launched a microinsurance program. The Foundation works with innovative health care approaches such as tele-medicine, digital catheterization laboratory, and robotic surgery.

More about the Organization
Websites: 
CARE Foundation
News : 
Care in the News