Health Microinsurance Scheme Design and Pricing: Lessons from Four Countries

Designing effective health microinsurance schemes at best prices
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This note focuses on the challenges and the factors that must be considered in premium setting while designing health microinsurance (HMI) schemes. It summarizes the findings of a comprehensive literature review on health insurance experience in four countries: Kenya, Ghana, Colombia, and India. The note identifies the key findings, challenges, and lessons emerging regarding the design and pricing of HMI schemes. The underlying literature review on which the note is based focuses on key elements of health insurance risks that can practically be taken into account in price setting. It also explores the extent to which open sources of relevant data can be used to develop a more consistent approach for the process of premium determination for HMI products to low-income countries. This note gives attention to the important topic of effective management of provider networks. It covers the following sections in detail:

  • Scope of the note and motivation for the study;
  • Prepaid healthcare trends and challenges;
  • Leading cost drivers to consider in premium setting;
  • Importance of provider network management;
  • Conclusion with a focus on cross-cutting issues and lessons learned.