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世界银行:普惠金融如何推动国民健康与福祉

其他国际资讯

世界银行:普惠金融如何推动国民健康与福祉

艾萨克和莫尼卡夫妇是肯尼亚财务日记研究项目的参与者,他们的经历反映了健康问题给低收入家庭造成的困境。莫尼卡生下第三个孩子后不久就病倒了。没过多长时间,这对夫妇就为就诊和买药而花掉了所有积蓄,而她的病情依然没有得到明确诊断。最后莫尼卡被诊断出喉部肿瘤,需要手术。他们没筹到手术所需的2.3万先令(227美元),因此莫尼卡很快就去世了。具有讽刺意味的是,莫尼卡死后,朋友和家人为其丧葬费用捐助的资金超过了3.3万先令(326美元)。此后艾萨克的境况日益恶化:他也出现了健康问题,后来变得无家可归。

世界上有很多人都和艾萨克和莫尼卡一样——他们无法获得良好的医疗服务,因为疾病导致家庭陷入贫困。联合国可持续发展目标3就是要实现全民医疗覆盖,使类似上面这种故事有个更好的结局。普惠金融有助于提高国民的健康与福祉,为实现这一目标发挥重要作用。

普惠金融与全民医疗覆盖

如果艾萨克和莫尼卡有医疗保险和/或其他金融服务,莫尼卡是不是可能活下来呢?艾萨克是否就不会变得无家可归?证据显示,这些服务会给他们带来更好的健康结果,避免陷入贫困。国际劳工组织影响保险项目的研究表明医疗保险的确有很大作用:它可以改善医疗服务获取,降低病人自付费用,使患者家庭不必采用会给他们带来沉重负担的应对方法,并帮助他们避免焦虑。

医疗卫生服务筹资是一项非常复杂的工作,多数国家都是依靠多种资金来源的结合。尽管多项研究显示市场化的综合微型医疗保险本身不具可行性,但简单的微型医疗保险产品与社会医疗保险制度相结合却可以带来很大好处,对后者提供的基础保障形成有益补充。

实现医疗服务全民覆盖的一大挑战是如何将医疗保障延伸到在非正规部门就业的劳动者。这种延伸就是普惠金融界所说的“产品发放”,公共保险界所说的“扩大参保”。说法不同,但指的是同一件事。例如在菲律宾,政府的医疗保险项目PhilHealth是通过多种机构来分销,包括全国最大的微型金融机构CARD在内。在资源有限的国家,公共保险体系应当考虑与金融机构建立伙伴关系,以充分利用它们的资源和基础设施。

储蓄、信贷和保险

属于普惠金融范畴的其他服务也可以帮助低收入家庭应对健康方面的冲击。例如,布基纳法索信用社网络(RCPB)提供一种自愿医疗储蓄产品:客户可以每月在一个医疗专用账户中存入最低1美元,当账户余额达到20美元时,客户就有资格申请医疗贷款。通过这个储蓄与贷款相结合的产品,RCPB客户可以获得用于基本医疗支出的资金,从而避免造成病情延误。

但只靠储蓄和贷款将难以应对灾难性事件——这应当通过保险来解决,最好是“可持续发展目标”中所阐述的那种全民医疗保险制度。储蓄、贷款和保险三者结合,可以形成抗击贫困的强大武器。人们可以建立医疗储蓄账户,同时还可以利用医疗贷款,来支付共付额、就医交通、药品或其他医疗保险不涵盖的自付费用。但不幸的是,这三个元素有效结合的例子少之又少。这是一个需要开展大量创新和实验的领域。

增值服务与民众福祉

可持续发展目标3谈论的不仅是健康,还包括了福祉。穷人的生活压力很大,充满风险和不确定性;如果出一点差错,后果就可能很严重。在一些关键时刻,他们也不一定能获得关于医疗健康问题决策的良好建议。改变这种状况的一个方法是在上述“保险-储蓄-贷款”三结合的基础上再加上一些增值服务,如Sema Doc提供的医生上门服务等。这类服务对那些生活在农村偏远地区的人尤其有益,因为他们前往诊所的旅行成本可能比医疗费用都高。移动医疗(mHealth)解决方案使人们可以从更大的医疗专家网络获得服务,这有助于填补当前医疗服务体系的空白,改善服务获取和服务质量。

的确,将医疗保险与药品折扣、短信提示和免费电话等增值服务相结合,不仅可以扩大服务的影响,也有助于使保险产品更具吸引力。这样,医疗保险客户即使没有要报销的医疗费用,也仍可以享受这些额外服务,从而更能体会到保险产品的价值。

普惠金融与基本社会保护

普惠金融在帮助艾萨克和莫尼卡这样的家庭避免健康冲击的灾难性后果方面可以发挥很大作用,但如果没有基本的社会医疗保险,普惠金融也就难有成效。全面医疗服务需要大量资金,因此,为了实现医疗服务全民覆盖,各国必须投资于社会医疗保险制度。国际劳工组织在基本社会保护领域的工作呼吁各国提供这种最低医疗保险。然而,基本医疗服务从其定义来说就不是全面的医疗服务。社会医疗保险可以承担预期医疗费用的很大一部分,而共付额和/或社会保险不保的部分可以通过创新金融产品加以补充,以缓解医疗困境带来的财务风险。

为实现医疗服务全民覆盖,就要使穷人既能获得医疗服务,也能获得金融服务。在当今数字技术日新月异的形势下,普惠金融和健康议程之间出现了越来越多的交叉可能性,人们也可以找到更多整合公共部门和私营部门资源的新途径。可以与微型金融机构、移动网络运营商和金融行业其他机构合作,通过将保险延伸到就业于非正规经济部门的劳动者以及用简单保险产品和增值服务来补充社会保险制度等方法,扩大基本社会保护。政府对国家医疗体系的投资会给经济带来巨大的正面效应;而通过普惠金融的支持,改善民众健康和福祉将成为更容易实现的目标。

The health plight of low-income households is illustrated by Isaac and Monicah, participants in the Kenya Financial Diaries study. Shortly after delivering her third baby, Monicah fell ill. It was not long before the couple had exhausted their funds on medicine and inconclusive diagnostics. Eventually Monicah was diagnosed with a throat tumor that required surgery. Isaac and Monicah were unable to raise the 23,000 KES (US$227) needed to pay for the surgery; Monicah soon died. Ironically, funds from friends and family worth more than that – 33,000 KES (US$326) – then flooded in to help pay for funeral expenses. Things for Isaac deteriorated; he too developed health problems, and he became homeless.

There are many Isaacs and Monicahs in the world, where inadequate access to quality care drives families into poverty. The UN’s Sustainable Development Goal (SDG) 3 strives to ensure happier endings with the ultimate goal being universal health coverage. To achieve this goal, financial inclusion can and should play a critical role in boosting a nation’s health and well-being.

Financial Inclusion and the Path to UHC

If Isaac and Monicah had health insurance and/or other financial services, would Monicah have possibly survived? Would Isaac have avoided becoming homeless? Evidence suggests that they would have possibly had better health outcomes and averted poverty. Research by the ILO’s Impact Insurance Facility shows that health insurance has impact: it helps improve access to healthcare, lowers out-of-pocket expenses, helps families avoid relying on burdensome coping strategies and provides peace of mind.

Funding for healthcare is complex, coming from a patchwork of sources in most countries. While studies show that comprehensive, market-based health microinsurance is not viable on its own, simple health microinsurance products can be particularly beneficial in tandem with social health insurance schemes, to supplement the basic package available.

One of the great challenges in achieving universal health coverage is the extension of benefits to workers in the informal economy. This extension is what one would call “product distribution” in the financial inclusion world and “expanding enrollment” in public insurance. Different language, same thing. For example, in the Philippines, the government’s health insurance program, PhilHealth, is distributed by a range of organizations, including CARD, the largest microfinance institution in the country. In countries with limited resources, public schemes should investigate partnerships with financial institutions to leverage resources and infrastructure.

Savings and Credit, and Insurance

Other services under the financial inclusion banner can also enable low-income households to cope with health shocks. For example, Reseau des Caisses Populaires du Burkina Faso (RCPB), a credit union network, offers a voluntary health savings product. Clients deposit a minimum of US$1 per month into an account that can be used only for health expenses. When the account has a balance of $20, clients are eligible for a health loan. With this savings and credit combo, RCPB clients have access to the funds needed to address basic health expenses before they become serious.

But with savings and credit alone, it is difficult to cope with catastrophic losses, which really should be covered by insurance, ideally through a universal health coverage scheme as stipulated by the SDGs. Together savings, credit, and insurance can be a powerful poverty fighting triad. A health savings account could be set up alongside a loan to pay for co-payments, transport to hospitals, medicine or other out-of-pocket expenses not covered by the insurance mechanism. Unfortunately, there are few examples (if any) where the three elements are combined effectively. This is an area that warrants significant innovation and experimentation.

Value-Added Services and Well-Being

SDG 3 talks not only of good health, but also well-being. The poor lead stressful lives plagued with risk and uncertainty; when things go wrong, the consequences are severe. At critical times, advice to make wise health decisions may not be available. One approach is to include value-added services, such as the call-a-doctor service provided though Sema Doc, to insurance-savings-loans combinations. Such services are particular beneficial for those in rural areas for whom travel to clinics might be more expensive than the cost of care. Access to a wider network of medical expertise through mHealth solutions can start to fill in the current pixilated picture of healthcare provision, improving access and quality.

Indeed, combining insurance with value-added services, such as pharmaceutical discounts, SMS tips and toll-free numbers is important not only to enhance impact, but also to bolster the attractiveness of the insurance product. In this way, policyholders who do not make a claim can still avail of the additional services and therefore are more likely to appreciate the value of the product.

Financial Inclusion and the Social Protection Floor

Financial inclusion can go a long way toward helping families such as Isaac and Monicah’s avoid the catastrophic consequences of health shocks, but it will not be effective unless there is a basic level of publicly funded healthcare. Comprehensive healthcare funding is expensive, thus to reach the aspiration of universal health coverage, it is imperative that countries invest in their social health insurance schemes. The ILO’s work on social protection floors lobbies for such minimum health coverage. The base level of care will not, however, by definition, be fully comprehensive. While social health insurance can cover a substantial tranche of expected healthcare costs, the copays and/or balance can be supplemented through innovative financial products that relieve financial risk during times of hardship.

To achieve universal health coverage, the poor need access to both financial and health services. Given today’s digital advances, there are more opportunities than ever for financial inclusion and health agendas to intersect, and to find smarter ways of combining public and private sector resources. Microfinance institutions, mobile network operators, and other financial sector players can be engaged to extend social protection floors by distributing coverage to workers in the informal economy, and supplementing the benefits with simple insurance products and value-added services. Public investment in national health has tremendous positive economic side effects; with a boost from financial inclusion, good health and wellness become more achievable.


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