One Dollar Health Insurance

This book contains a health insurance model that aims to provide affordable premiums for low-income populations in countries with different levels of development and economy. The model is constructed on the basis that health care services are a top priority when people are sick. In many situations, low-income people work hard to come up from poverty and become sick accidently. Despite all their efforts, all the investments they have suffered to acquire are spent to cover medical treatments. When reviewing why health insurance does not cover those with a low income, the high level of premiums is ranked as the main reason. Then, the question is how to lower the premiums to allow low-income individuals and families to enroll in health insurance schemes to prevent sickness that could lead to significant costs and impoverishment. The hard work involved finding the data on disease prevalence, health care services and costs, and health financing and health insurance. Different business scenarios were compared. The model presented in this book is the result of this undertaking. It proposes three strategies for developing a large cost-sharing capacity that covers at least 10 million members. The economy of scale boosts businesses constructed with lower prices to obtain many clients. However, affordability is a relative concept that needs to be applied in the income context. In business, a low price is far from enough. The quality of a product or service is equally or even more important. Quality in health insurance means many things, but an essential parameter is the benefits package of the healthcare services covered. Usually, the benefits correlate to the premium. That’s why for a low premium, low coverage is offered in term of benefits, exclusions, and deductibles. The idea of the model is to say, “Let us focusing on a limited number of expensive healthcare services, as the prevalence is usually low and cost sharing should work.” For 10 million of the population, the lower premium is calculated at a $1 dollar premium a month for developing countries, $1 a week for newly industrialized countries, and $1 a day for developed countries. The proposed attractive benefits include major surgeries, complicated birth deliveries, and cancer treatment. The services include medical consultations, diagnostic exams (laboratory, imagery, etc.), and drugs. To make the model more attractive and sustainable, the quality and efficiency of healthcare services and the efficiency of the health insurance administration were added. The inclusion of quality and efficiency is an innovation in health insurance businesses. By balancing only the proposed premium and benefits, the business is profitable in all development levels and economies of countries. This means that the addition of quality and efficiency should increase the profitability and allow the expansion of members’ benefits. The model is proposed as a profitable social business that aims to attract investments for the reduction or prevention of the impoverishment of low-income populations due to expensive healthcare services.