Our approach
The Health Insurance Fund programs strengthen the supply of healthcare delivery by introducing a financing mechanism based on pre-paid health insurance. The demand for insurance is stimulated by subsidizing part of the premiums.
Our innovative approach applies a unique combination of characteristics.
Private sector insurance companies
Private sector insurance companies are contracted to provide customized basic health insurance to selected low-income groups of beneficiaries. Contracts with these companies are output-based. This means that payments are related to the enrollment of beneficiaries, delivery of services, and to medical, administrative and financial quality improvements.
Network of private and public clinics
The insurance companies contract a network of private and public healthcare providers where the beneficiaries can obtain their medical services. Prices and profit margins of the insurers are contractually fixed and controlled. The beneficiaries themselves must always contribute to the premium, whereby the contributions are expected to increase over time. The insurance benefit package includes primary and limited secondary health care, including HIV/AIDS treatment and medication.
Improving quality standards
Funding by the Health Insurance Fund is also used to improve the quality of care by training staff, installing equipment and introducing standards. Quality is pursued by strictly enforcing medical, administrative and financial quality standards and performance through continuous monitoring and evaluation and independent external audits.
Independent operational research
In addition, independent socio-economic and bio-medical operational research is carried out by external organizations to measure the effectiveness and impact of the schemes. This research is carried out by the Center for Poverty-related Communicable Diseases (CPCD) of the Academic Medical Center (AMC) of the University of Amsterdam and the Amsterdam Institute for International Development.
Guaranteed income
And by paying the premiums up front, healthcare providers have a guaranteed income, which allows them to expand and improve the quality of their services and to attract investments.
All programs are implemented through collaborations between the public and private sector. It is the first time that this approach is applied in Sub-Saharan Africa.
This innovative approach lays the foundations for a more transparent and sustainable healthcare economy. It will result in increased access to good quality health care, delivered by qualified African medical staff in upgraded clinics and hospitals with sufficient beds and available medication.