Success Story: Boosting Access to Healthcare Through Health Insurance

Boosting Access to Healthcare Through Health Insurance

Our client is a public healthcare intervention project funded by a leading international donor agency. Their mandate is to partner with Federal and State governments, provider associations and other stakeholders in the healthcare value chain to improve the quality of healthcare available to Nigerians through public health facilities.

The Challenge

They wanted to enhance access to healthcare for the poor by giving them access to health insurance. They realized they needed someone with private sector experience to forge partnerships with providers of health insurance and develop a workable model.

Our Response

After meeting with the team to clarify expectations we knew we had to answer a number of important questions before we could craft a winning strategy.

-          Are poor people willing to pay for health insurance? If so, how much?

-          Which health insurance providers are best suited to serve this segment of the market?

-          What benefits plans would interest the poor? Can they be delivered profitably?

-          How would the scheme be marketed?

-          How would premiums be collected in a reliable way?

-          And many more…

Having chosen to start with a pilot in Lagos before rolling out to other project states, we began with a mapping of the most active health management organization (HMOs). We chose a few candidates who appeared well-positioned to serve the poor. We gave high points to those who had already shown interest in the lower end of the market by developing some products for that segment.

With our client's approval, we engaged a research firm to conduct a willingness-to-pay study in our target markets. Their study would also help determine which health issues were most important to our segment of interest.This would help us guide the HMOs in development of attractive benefits plans.

Armed with information from these studies, we assembled a team of actuarists and health insurance experts to work with the chosen HMOs and come up with possible benefits packages and determine profitable delivery models. They would also explore marketing strategies, reliable premium collection methods and address risk pooling issues.

It became clear that the HMOs did not have the market presence to effectively sell insurance to the target market. That meant we needed a partner who has market presence and is familiar with financial transactions. We therefore decided to invite microfinance banks to partner with HMOs as marketing agents.

We encouraged HMOs and MFBs to form paired partnerships in their markets and facilitated negotiations on how to share responsibilities and returns. Five of such HMO-MFB partnerships were formed. To support the marketing effort, the donor agency agreed to commit funds towards behavior change communication by promoting the adoption of health insurance in the target markets. We were thus confident we had a winning strategy in place.

Results

Four of the five HMO-MFB partnerships are still active two years after, though one of them is struggling because the MFB partner encountered some solvency challenges. The MFB's ability to drive sales is a key success factor. Working with our team some MFBs found creative ways of bundling health insurance into their credit products. Others created products that enabled them finance the annual insurance premium payment and recover it in installments from daily/weekly savings.

As at December 2013 over 8,500 new clients had signed on to a health insurance plan in Lagos State. More than half of those were family plans that covered the couple and up to four children.

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