Integrated Health Insurance for the Urban Working poor

This case study conducts a community-based retrospective analysis of primary, secondary, and tertiary care utilization over a 12-month period by 5000 urban slum dwellers in the context of an integrated health insurance plan. The plan was introduced by Naya Jeevan, a social enterprise in Sultanabad (an urban slum in Karachi) during 2013. The study compares projected versus actual utilization costs of 5000 lives enrolled in the plan and seeks to identify groups with specific characteristics/risk factors that may predict trends in healthcare utilization. It also analyzes cost drivers within Sultanabad community health plan. The study covers following sections in detail:

• Health microinsurance model (HMI) adopted by Naya Jeevan;
• Features of the customized integrated health plan adopted for Sultanabad;
• Client-focused value-added services that the organization provides in Sultanabad with a focus on access to discounted primary care, 24/7 mobile phone access to Naya Jeevan medical doctors, customized group orientation sessions, annual medical screenings, and workshops;
• Overview of clinical operations, insurance distribution, member enrollment, beneficiary utilization, and selection of insurance underwriters;
• Results of the research with a focus on annual clinic utilization, claims summary, annual cost per insured member, and secondary and tertiary health care expenditures;
• Recommendations for optimal pricing and increasing the efficiency of the program.