Extend health insurance cover

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Extend health insurance cover

Monday, 11 February 2019 | Moin Qazi

Extend health insurance cover

Low-income communities often find themselves in debt traps because of shocks to their savings. Micro-insurance can end their cycle of poverty and provide safety net to their families

People in low-income communities live in risky environments and in constant fear of a catastrophe or tragedy that may strike anytime. They live on the edge, vulnerable as they are to numerous perils, multiple risks, family misfortunes, economic shocks, accidental death or disability, loss of property due to theft or fire, agricultural losses and disasters, both natural and man-made. They are also the one’s who are the least able to cope with a crisis. A small misfortune can push them down into a tailspin. Yet, they aren’t considered as ‘insurable’ at reasonable levels of premium. This makes a case for high demand for insurance schemes for them, particularly in sectors of health and life, agricultural and property. Cover for natural disasters, too, must be considered. For the poor, insurance is the only hedge against financial ruin.

Poverty and vulnerability reinforce each other in an escalating downward spiral. Exposure to these risks not only result in substantial financial losses but vulnerable households also suffer from ongoing uncertainty about whether and when a loss might occur. Often, the trigger for poverty is illness, which can eat away hard-earned savings of low-income communities. The net result is bankruptcy and a slip into poverty. It is, therefore, essential that micro-insurance be made an integral component of financial inclusion if India wants to keep this segment away from the poverty trap.

Women are the most vulnerable among the rural population. Yet, they are largely excluded from the insurance market. According to National Bank for Agriculture and Rural Development’s (Nabard) All India Rural Financial Inclusion (NAFIS) Survey, 2016-17, overall, 25 per cent of the Indian households had at least one or the other kind of insurance. Fifteen per cent of them reported having at least one person with life insurance; two per cent had accident insurance; six per cent had health insurance; and five per cent  had vehicle insurance.

The poor usually face two types of risks — idiosyncratic (specific to household) and covariate (the most common, for example, drought and epidemics). The poor need insurance more than the rich because they have no cushion and are more vulnerable to the many risks. The state, too, has failed to help them. Micro-insurance, by definition, envisages protection of low-income people against debt traps that often imperil their livelihood and lives. This is mostly an outgrowth of micro-finance, with micro-finance institutions (MFIs) being the leading providers.

Given its focus on low-income people, micro-insurance usually differs from regular insurance schemes in terms of types of risks covered, delivery channels, premium levels and documentation requirements. The working group of the Consultative Group to Assist the Poor (CGAP) defines micro-insurance as “the protection of low-income households against specific perils in exchange for premium payments proportionate to the likelihood and cost of the risk involved.”

The poor prefer health insurance to life insurance. They say, “We die once but go to the doctor many times every year”. According to the Union Health Ministry, 25 per cent of the people admitted to the hospital were driven to penury by the costs involved. Added to this was the loss of a day’s wage. By managing risks and avoiding debt, those who have micro-insurance policies, are in a position to protect the wealth they accumulate, generate more income and even get a fair chance to rescue themselves and their families out of the mire of poverty.

The cost of insuring against an unforeseen development is considerably lower than self-insuring through savings. Governments, donors and other development actors engaged in combating poverty and designing social protection measures need to have insurance as one of the weapons in their arsenal. The key challenge for micro-insurance is the high cost of administering the same. The poor live off the banking grid. Families are scattered, this makes physical access difficult. The transaction costs of issuing millions of small policies through service agents, too, are high.

The difficulties in making micro-insurance viable stems from the fact that it is a ‘low ticket’ business, requiring huge volumes for sustainability. India also lacks the distribution channels appropriate for lower-income groups. But rapid advances in digital payment systems are creating opportunities to connect poor households to affordable and reliable financial tools, through mobile phones and other digital interfaces. Micro-insurance can piggyback on the exploding reach of cellphone banking and infrastructure created by micro-credit institutions. Insurance coverage can be widened by coupling services with existing mobile financial products or creating new mobile solutions that bring insurance services straight to a consumer’s phone.

There are three major types of micro-insurance products:

Life insurance: It is the most common form of micro-insurance, facilitated by the extension of the micro-finance model into the area of coverage. However, the life insurance provided by micro-finance institutions (MFIs ) is mainly a way of insuring loans (credit life insurance) rather than providing income support in the case of the policy holder’s death.

Agricultural insurance: This mainly consists of crop insurance that covers farmers against multiple shocks and pays out against losses that the insurer assesses by observing harvest yields. Index-based insurance pays out fixed sums to farmers when an independently observed trigger (often rainfall levels, crop yields or livestock mortality rates) shows that an insured event has occurred. 

Health insurance:  Many countries are developing public, private and community-based health insurance programmes to pool the risks associated with health shocks. The coverage of these schemes remain quite low, particularly among the poor, but there is some growth in community health insurance for low-income populations.

Typically, rural insurance products are clones of products introduced in urban areas and are not suited to the rural context. Risk mitigation mechanisms are weak and complexity of people and problems make underwriting and claim processing and resolution a very challenging process. Crop insurance has surprisingly been a bright spot on the insurance horizon. It has emerged as the third largest line of business after motor insurance and health insurance following the launch of the Pradhan Mantri Fasal Bima Yojana (PMFBY); though it is a market-driven scheme where insurers quote market rates. The farmer pays only two percentage points of the sum insured as premium and the rest is subsidised by the Government.

Micro-insurance is now acknowledged as a highly effective tool to end the cycle of poverty by providing a robust safety net that families need. If the poor know that they are covered, they are more likely to plan their future better, invest in expanding businesses, diversify crops or send their children to school without the fear of losing their savings if something were to happen. The whole capacity to take risks changes. Thus, from just being a safety net, micro-insurance provides benefits that earlier generations could never imagine: Hope for the future.

(The writer is Member, NITI Aayog’s National Committee on Financial Literacy and Inclusion for Women)

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