Microinsurance closing gaps in social safety nets
“I was very worried [about the hospital bill] because my father was in [intensive care] for a long time,” said Sheryl Tan, recalling the two painful months leading up to her father’s death last year. “So I was relieved when I heard that MediShield Life paid S$28,500 (US$20,300) out of the total bill of S$30,000.”
MediShield Life is Singapore’s public medical insurance system, which covers expenses for serious illnesses. To support a rapidly ageing society, the government has been enhancing state assistance. A policy change in November 2015 allowed people — like Tan’s father — with existing health problems to enroll in the programme.
In the past few years, other Asian countries have been busy implementing or bumping up public social security plans. Thailand achieved universal health coverage on paper in 2002, with a programme that included self-employed workers and farmers. Indonesia is trying to follow suit with goals of universal health coverage by 2019.
Cases such as Tan’s remain exceptions to the rule, however, as there are gaping holes in many public programmes.
“I’ve seen my sister, who is chronically ill with lupus but is not covered by any insurance,” said Dian Kuswandini, a United Nations agency officer in Indonesia. Kuswandini’s sister is yet to be covered by the country’s “universal” health coverage scheme, BPJS Kesehatan, which is notorious for the complicated bureaucracy involved in applications and claim procedures.
“Her treatment is very expensive. Every year she has to seek medical treatments several times, and spend some 10 million rupiah ($749) or more for each doctor’s visit,” she said.
“I thought, if only she had been subscribed to insurance like mine, which covers lupus, she may not be suffering this much” from her medical bills.
Fiscal constraints are a drag on governments’ drive to expand social security programmes. Indonesia and Malaysia registered fiscal deficits for 2015, according to the International Monetary Fund, and Vietnam is forecast to do so. This makes rapid expansion and implementation of social security schemes difficult.
The inadequacies of government programmes are a pressing problem, especially for the poor, who have to rely on them for treatment. But one insurance instrument is fast gaining traction as a possible solution: microinsurance.
India’s crop insurance programme offers an example. Last year, Prime Minister Narendra Modi introduced a new programme called Pradhan Mantri Fasal Bima Yojana, replacing two earlier ones.
PMFBY is implemented by private and public insurance companies, with the central government and the states shouldering most of the cost. The premium charged to farmers for summer crops is set at a maximum of 2% of the sum insured; for winter crops, it is 1.5%.
“PMFBY instills confidence in the farmers,” Modi tweeted back in January 2016, when the plan was announced. “We should integrate as many farmers as possible with this scheme.”
Other Asian officials have realised the importance of microinsurance. Indonesia’s Financial Services Authority in February issued guidelines for such products, aiming to expand insurance coverage for those with low incomes. The Philippines has a national strategy on microinsurance in place.
“Microinsurance not only enhances our resiliency to disasters, shocks, and crises — I actually think it is a key element to strengthening the economy and making growth sustainable,” Gil Beltran, the Philippine finance undersecretary, said during his country’s chairmanship of the Asia-Pacific Economic Cooperation (Apec) forum in 2015.
”It is always a win for the economy when the most vulnerable are protected and empowered. In a way, boosting microinsurance coverage rates is an effective anti-poverty measure.”