Mutual benefit
A community-owned and -led self-help group is revolutionising healthcare and treatment in villages across different states in India, finds Geetanjali Krishna
In a pretty red bandhej sari, Pyari Devi of Dungarpur looks like any other woman one might encounter in a Rajasthani village. But this spunky, illiterate woman is a key player in a self help group (SHG) which has transformed health insurance in this tribal area. Every member of the SHG contributes a premium and from this corpus, claims of up to ~15,000 are settled. Run by India’s first mutual health insurance non-profit, Uplift Mutuals, Pyari Devi’s group provides financial support, transportation to hospital and, most crucially, information to the claimant about where she or he could get the best and most cost-effective treatment. Much of her work focuses on prevention — her group arranges health camps, screenings and health meetings to ensure that fewer members fall sick in the first place.
“Our model is community-owned and -led,” says Kumar Shailabh, founder and secretary of Uplift Mutuals. “Members pay a premium ranging from ~700 to ~1,800 per family per year and the focus is for the community to collectively manage their own health with the corpus.” The folks at Uplift Mutuals realised early on that sudden medical events often pushed families into poverty. “This was often because they had no way of comparing what medical procedures cost in different hospitals,” says Kumar. “So we developed a helpline manned by doctors which members can access to plan the logistics of their medical treatment.” He gives the example of a member whose husband, a construction worker, had an accident. In a private hospital, his treatment would have cost ~3.5 lakh. “Our support staff found that the doctor treating him also practised in a charitable hospital,” he says. “Eventually the man got treated by the same doctor, but for only ~35,000!” Their role didn’t end with partially funding the claim. “We also helped the family secure a micro loan at a low interest rate to cover the rest of the cost...” says Kumar. When another member needed hospitalisation, the doctor on Uplift Mutuals’ 24/7 helpline found two suitable hospitals. One was a private facility where her treatment would cost about ~70,000; the other, a charitable hospital where she could be treated for under ~10,000. The member chose the charitable hospital. An auto driver, a member of the same community, drove her immediately to hospital. “The Mutual settled her claim, helped her choose between differently priced options and also provided her with critical support when she most needed it,” he says.
The concept of mutual insurance grew out of a conversation that Kumar, along with a bunch of actuaries and volunteers from France, had with a group of women in Dungarpur. “People there had little access to healthcare,” he recounts. “They’d go across the state border to a private medical hub in Modassa (Gujarat) for treatment.” Talking about medical insurance, a village woman said something that struck a nerve. “She said that buying medical insurance became worthwhile only if one fell sick,” Kumar recalls. “There was no incentive for staying healthy!”
Getting communities to understand and adopt a mutual insurance model hasn’t been easy. “It’s taken us six years to build trust and an information database in Rajasthan,” Kumar says. Today, Uplift Mutuals works with 10,000 households in Maharashtra (including Mumbai and Pune), Gujarat and Rajasthan. Kumar and his cohorts have designed medical insurance policy for poor students, wherein donors can support their premiums for three to five years. They also operate a non-profit pharmacy where members can buy medicines at prices that are 30 to 35 per cent cheaper than the market. Uplift Mutuals aims to scale the mutual to about a million new lives by 2022 using the Biradaree Model in which different communities will collectively share their health risks.
To this end, they’ve created India’s first mutual insurance app Uttam, and a software that enables them to settle claims in merely two hours. “Collectively taking charge of their health has helped communities to not just reduce their medical bills,” says Kumar. “It’s helped them become healthier too…”
The folks at Uplift Mutuals realised that sudden medical events often pushed families into poverty