Breaking the Deadlock Using Private Health Insurance Schemes Chris van der Vorm & Joep M. A. Lange Health Insurance Fund Pharm. Access Foundation Center for Poverty-related Communicable Diseases Academic Medical Center / University of Amsterdam
Milestones in Bringing HAART to Resource Poor Settings • Price reduction of antiretrovirals (Accelerating Access Initiative, etc) (2000) • Declaration of Commitment of the UN General Assembly Special Session on HIV/Aids (2001) • $48 bn US grant for Aids, tuberculosis and malaria over a period of five years (2008)
Aids Response Creates Island of Sufficiency in a Swamp of Insufficiency * Gorik Ooms, MSF
Major Challenges • Limited capacity local governments • 50 -70% of healthcare expenditures financed out-of-pocket * – Leads to financial shocks – Minimal risk sharing – Limits investments • Crowding out effect * WHO, 2006
Health Insurance Riskpooling • Risk sharing between different population groups • Limit financial shocks Pre-paid financing • Predictable and sustainable financing • Reduced financial risk facilitation of investments Prevent crowding out • Utilize existing out-of-pocket resources
Health Insurance Fund • Not-for-profit, established in 2005 – Subsidized Community Health Schemes – Executed locally by HMOs/Insurers • Board of Directors chaired by Kees Storm – Others include former Dutch Minister and CEO’s of 5 largest Dutch insurers and banks • Pharm. Access contracting agency • € 100 m grant from Dutch Ministry of Foreign Affairs – 6 years / 4 African countries • Potential Grant from World Bank – Further funding sought • Operational Research
Our Vision Sustainable systems of healthcare delivery and financing, by introducing private health insurance for people with low / medium income in Africa
Key Characteristics Subsidized Premiums Delivery Quality and Capacity Output-based Contract Local Embedding Data Collection/ OR • Stimulate demand • Decreasing premium/ co-payment over time • Upgrading of clinics and hospitals • Ongoing monitoring and evaluation • Accountability • Transparency • Commitment local champions • Coordination public programs • Medical and financial data • Program improvement
Health Insurance Fund in Nigeria • Target population > 200, 000 people – 75, 000 farmers in Kwara State – 40, 000 market (wo)men in Lagos – 70, 000 farmers in Kwara State* – 30, 000 ICT workers in Lagos* • Current scheme enrollment – > 40, 000 • 23 clinics and hospitals – 14 upgraded to date; others to follow – Three rounds of monitoring and evaluation conducted * In development
“Before”
“After” Increase in utilization from < 20 patient visits per month to > 1, 500 patient visits per month (Shonga Clinic, Kwara State)
Community Enrollment
Acknowledgements Pharm. Access Foundation • Onno Schellekens • Max Coppoolse / Mayte Oosterveld • Michèle van Vugt Hygeia HMO • Professor Elebute • Fola Laoye Kwara State Government Center for Poverty-related Communicable Diseases • Professor Joep Lange Amsterdam Institute for International Development • Professor Jacques van der Gaag Dutch Ministry of Development Corporation • Aaltje de Roos • Representatives of DDE and DSI
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