During illness and especially at time of hospitalizations the problems of the poor are:

§  Financial distress of the family: hospital expenses and loss of daily wages, which is a double burden.

§  Lack of health understanding and health consciousness

§  Poor access to adequate healthcare facilities

Hence a need for a service which gives an entry point to access quality health care at most affordable prices.

Health mutual funds allow people to share the risk through saving a small amount on the basis of ‘One for all, all for one’ so that in times of health crises a lump sum amount can be made available to meet the hospitalization expenditure, smoothening the financial shock when facing such events.

While the system is similar to the insurance industry, here the risks are not “transferred” to an insurer, but shared under the community’s responsibility.

In 2002, a group of women from Annapurna Parivar (Pune) faced the shock of a heart operation that one of them had to cope with. They decided to react and looked for solutions. When an insurer presented a product matching their capacity to pay (50Rs per head per year at that time), the immediate question was: "Can we get the money back if we are not sick?" On receiving a negative answer from the insurer they concluded that they had no incentive to be healthy in joining this plan. They understood very well the insurance pooling concept, not its management.

So they decided to setup 6 "Arogya Nidhis" and chose to contribute 50 Rs per person per year, which was enough to bear a hospital cover of Rs. 5000 Rs per person in case of hospitalization (revised to Rs100/person with a cover of Rs 15000 / person/year)

These "Arogya Nidhis" idea flowed to Parvati Swayamrojgar (MFI in Pune) and Sakhi Shashakt Sanstha  (Marathwada)- so that today around 60000 people are pooling their risk in their 21 health mutual funds. These ArogyaNidhis are physically situated in bank accounts with communities and facilitating organisations being the joint signatories.

The organisations facilitating this ArogyaNidhis against many odds decided to setup a federal organization that would become the milestone for developing people led professionally managed social security systems by the name of UpLift which today shelters resources, skills and competences that are commonly shared : professionals, a network of 150 health care providers, encoders and statistical unit, software development and testing, call centre and actuarial skills

Thus a professionally managed system today is controlled via communities.

Informal Sector: Urban Slums Dwellers and Rural Populace

60000 lives ongoing (2008)

Mutual risk Sharing (not risk transfer), Community Based and Managed

Per Family with individual Pricing - Automatic as micro credit rider/Stand Alone

APVS Pune, APVS Mumbai, PSW Pune, SSS Osmanabad- Solapur

Federative organization with technocratic and democratic group/governance design

Network of 150 Health Care Providers with negotiated rates (Public and Private)

Centralized Business Processes (TPA like services)

Technical Risk Management Support(Actuarial Product design and Risk Management)

Operations Setup, Quality Control, Personnel training

MIS –In house Software SYSLIFT for data management and analysis

Solidarity fund and Reinsurance options

SWABHIMAAN

INTERAIDE

MACIF

TIETO

Fund is created and governed by communities; fund money is kept in community’s name.

Product design, Fund rules ,Health services network, Exclusions are validated by communities

Claims are settled in democratic and transparent way by communities themselves

Referral and guidance services provided through localized branches and field workers.

Preventive and promotive health measures, member education is a key component of the programme

No Age Limit

No Prior Health Check Up

Family Based Enrolment 100Rs/year/person

Pre Existing covered after 3 years membership

100% event related expenditure in Public Facilities

80% of event related expenditure within internal limits 1o days before and 10 days after in Network Health Care Provider

15000Rs max coverage/person/year

Complex maternities covered up to first two live births

OPD DISCOUNT COUPONS (10-50%)

5 Coupons/policy

Targeted Health Check up Camps every month

Targeted Health Talks on Prevention

Localised Referrals Guidance and follow up

Real time 24X7 Helpline

Any intentional Self injury, suicide attempts.

Addictions related hospitalizations

Cosmetic/plastic surgery or aesthetic treatment not arising out of an accident.

Infertility related health care

Dental and optical care not arising out of an accident. Cataract operations are not excluded.

• Software developed jointly by UpLift and Tieto for community based health insurance to manage micro insurance activities and especially health insurance.
• Reporting customized for various levels of decision: includes claim ratios and claims frequencies per branch, accounting, health funds balances…
• Comprehensive Database for statistical research. Capacity to handle infinite products under 3 categories : Health - Accident – Property
• User Friendly : Fully open to Development specification suggestions.
• Coming developments: web based version, consolidation of all user-organization in a single database accessible to all.

KUMAR SHAILABH

GENERAL MANAGER

UPLIFT INDIA ASSOCIATION

14 LANDMARK APTS

SADHUWASWANI CHOWK

PUNE-01

MAHARASHTRA

INDIA

Phone: 020-26051013

Email:krshailabh@gmail.com