Summary (English)

Healing Fields Foundation is a non profit society based in Hyderabad, India. Healing Fields has developed an innovative linked scheme involving several players: a private insurance company, 19 NGOs, a network of 39 hospitals and a service integrator (namely Healing fields). The objective is to provide social protection coverage including a health component and a personal accident component to the informal economy and rural workers. The project started in 2005 and was supported by USAID. In 2007 the scheme was covering 22 415 people.

Healing Fields plays several roles:

1) HF designs the benefit package

2) HF develops the network of hospitals and negotiates with them a discounted rate for the treatment of selected illnesses using Diagnostic Related Groups (DRGs) (75% deduction) and a cash less payment system (when a patient arrives at the hospital he/she only disburses 25% of the treatment cost as co-payment). HF facilitates the hospitalization and claims process with facilitators that provide assistance to the patients at the hospital level.

3) HF has developed a network of NGO partners that promote the product, facilitate communication and awareness raising among the communities, enrol members, collect the premiums and membership forms.

4) HF invests a tremendous amount of time in providing the NGO's and members with health care and prevention education. HF has also reduced some public health risks through claims analysis (e.g. Typhoid cases).

5) HF contracted with a private insurance company and endorses several functions (marketing and sales, management of enrolment and renewals, maintenance of health profiles for each member, claims management).

Within this innovative linked scheme, interesting and replicable ideas have been introduced such as:

1) Nurse manned dispensaries.In one of the tribal areas where the nearest network hospital is about 60Km away from the hamlets, the partner NGO runs the dispensary with nurses. A list of 9 diseases can be treated at this level and the nurses refer the patients to the partner hospital for complicated cases. The creation of the dispensary has increased accessibility of care to the community and helped in reducing the cost of care.

2) Saheli concept.Members from the community are given an intensive training on the product, policy and health education. They then communicate on the product across their hamlets and receive a fee of Rs.10 for every enrolment. The Saheli concept helps with accessibility and overcoming communication barriers in these remote tribal areas.

3) Prevention of epidemics through claims management.Monitoring of claims helped to identify 4 typhoid cases from the same geographical area. Healing field's medical management team immediately notified the local public health officials who closed down the water source. This prevented further infections.

4) A strong "Client servicing".In each network hospital a facilitator accompanies patients in consultation with a doctor, handles the pre-authorization process and sends all relevant information and documents to facilitate the claims processing.Member feedback is also captured through post hospitalization visits (on the 3rd day and on the 10th day after the patient is discharged from the hospital) and through two types of surveys (a patient satisfaction survey and a post insurance survey).

However Healing Fields faces several challenges that need to be overcome in the coming years:

1) Cost of administration is very high and it will be necessary to find ways of reducing the cost of delivering of the programme.

2) Renewal rates (15%) are very low with great differences between NGOs (rates vary from 0% to 71%).