balancing health microinsurance

Abstrakt

Health Microinsurance is a controversial microinsurance product as it is the most demanded type of microinsurance amongst the poor while it is also the most technically difficult type of microinsurance because of high adverse selection, low quality of health infrastructure in developing countries and high operational costs. This study aims at contributing to the field of health microinsurance management by exploring the recent topic of performance measurement and long term balance between financial and social performance. This is done by investigating how the delivery models of Health Microinsurance in India relate to performance measurement and affect the balance of social value and financial viability. In order to explore and explain the topic, the research starts by selecting the Mutual and the Partner agent models as representative of the common delivery structure of Health Microinsurance in India. The features of the two models are applied as parameters in the comparison of different performance measurement practices. The performance measurement is analyzed according to the 16 Key Performance Indicators created by the microinsurance industry, adding two more Health Microinsurance specific indicators. As the literature indicates lack of academic review on the balance between financial and social performance and further lack of performance tools that combine both, this research realizes its main contribution to be presenting such framework to the Health Microinsurance industry. The Balanced Scorecard, adapted from Paul Niven since the social mission is the leading force for organizations that provide Health Microinsurance, incorporates the PACE model on client value and the financial viability methodologies. The core argument of the study consists of two parts: 1) the type of delivery model affects the performance indicators that are measured and 2) there is a negative relationship between financial and social performance within both delivery models. In the case of the Mutual model, measures are monitored and interpreted in a social value light while the Partner-Agent model emphasizes the importance of viability through actuarial monitoring of financial performance measures. There is an overlap of financial and social measures but the different models interpret the results according to either more social or more financial performance. At the same time that creates a trade-off between outreach and better health benefits on the one side and financial viability and amount of subsidization on the other. The paper’s research strategy is constructed towards a multiple-case study design with qualitative methods as the primary technique. The core block of empirical data consists of data from five case companies that were selected for the model of their innovative scheme and the outreach of their operations. The outcomes of the study point out at substantial differences between the two delivery models but also significant differences among the organizations’ performance practices.