Private health insurance funds/schemes
What are they?
Private insurance schemes offer health insurance coverage to beneficiaries by pooling risk across a large population. Patients are required to pay premiums.
How is it applicable to hepatitis?
There is potential for pre-existing private insurance companies to integrate hepatitis coverage into their package of services, though there needs to be a strong actuarial argument for companies to do this.
Advantages:
- These schemes reduce the financial risk to all stakeholders
- They can increase the predictability of health care expenditures for individuals
- They increase the demand for health products and services
Challenges:
- The additional costs of including hepatitis in an insurance package may make it unaffordable for some people
- In countries with fragmented insurance markets it will require additional effort to implement this across the board
- In some countries many private health insurance companies do not cover pre-existing conditions, such as hepatitis
Case study
Rwanda has mandated private health insurance funds to include hepatitis in their benefits package.
Micro-insurance
What is it?
Micro-health-insurance is specifically offered to low-income clients by either a for-profit or non-profit institution in return for a regular premium payment by clients equal to the cost of the risk. Micro-insurance products are offered by microfinance banks as an optional or mandatory purchase for savings and loan clients.
How is it applicable to hepatitis?
Micro-insurance could be used for hepatitis C treatment. There are currently no insurance products specific to hepatitis as they are traditionally used for general healthcare and not to treat pre-existing conditions.
Advantages:
- There is the potential to build upon pre-existing insurance products
- These institutions have experience working with low-income clients
Challenges:
- Microfinance banks or other organisations offering micro-insurance products are not always efficiently linked to private and public healthcare facilities
- Organisations are typically small and would need significant technical assistance and capital to scale up
Hepatitis-specific insurance funds
What are they?
This financing mechanism sees private insurance companies offer a special insurance coverage for hepatitis illnesses only.
Advantages:
- With low prevalence rates and increasingly lower cost of treatment, this could be an inexpensive form of insurance when at scale
- It spreads the risk so patients can afford treatment when they need it
Challenges:
- This option is likely only feasible if a third party, such as an employer, is willing to pay or in very high prevalence settings where the client believes they are at very high risk of transmission
- People need to be able to afford insurance
Rotating savings and credit associations (ROSCA)
What are they?
This is where a group of individuals make regular cyclical contributions to a fund, which is then given as a lump sum to a different member at each meeting. These are widely implemented across developing countries but not specifically in healthcare.
How is it applicable to hepatitis?
This financing option could be set up by individuals specifically to fund hepatitis diagnosis or treatment. As the payment is given as one lump sum it may be more applicable to hepatitis C as treatment is for a short duration only.
Advantages:
- It is a sustainable option which increases access to treatment with patients’ owns funds
- Simple and transparent model
Challenges:
- In some countries the cost of HCV treatment may be prohibitively high for the ROSCA model
- Difficult to implement on a large scale
- Only provides timely access on a large scale
Personal Loans and micro-loans
What are they?
Personal loans and micro-loans are known as “unsecured” debt as they are not backed by collateral, such as a home or car. A micro-loan is a small loan typically made to low-income borrowers who may lack collateral, steady employment and a credit history. They have a fixed repayment term and often carry a fixed interest rate.
How is it applicable to hepatitis?
A personal loan or micro-loan could be taken to finance any out of pocket expenditure for hepatitis diagnosis and treatment. As it is a lump sum that requires payment over a fixed term this may be more suitable for hepatitis C treatment.
Advantages:
- Increase access for those on lower incomes or without credit histories
Challenges:
- The relatively high cost of treatment in some countries may deter lenders
- Interest rates on personal loans can be higher than those that are backed by collateral, such as a mortgage