The Value of Claim Analysis in Health Microinsurance: Learnings from Three South Asian Cases

This case study attempts to demonstrate that analyzing claims data equips health microinsurance (HMI) practitioners with valuable insights to improve client value and viability of HMI programs. It performs a comparative analysis of three South Asian HMI programs run by VimoSEWA, Uplift Mutuals, and Naya Jeevan. The study suggests that a better understanding of the drivers of claims, including the cause of claim, can enable HMI providers to identify areas for product and process improvements, leading to improved client value and provider viability. It also provides basic recommendations to enable HMI practitioners unlock the potential of claims analysis. These recommendations include:

• Define, assign, and communicate responsibilities for gathering, monitoring, and interpreting claims data;
• Identify key data elements and a process for data collection and analysis;
• Support data consolidation and segmentation with unique identifiers, standard definitions, codes, and use software;
• Carry out training and monitoring activities;
• Identify the key drivers and claim patterns over time;
• Monitor turnaround time and rejection rates from client’s perspective;
• Identify variation in treatment, service use, and charges among clients and health-care providers;
• Use claims data to optimize product design and calculate accurate premiums;
• Analyze and disseminate data with a view to improving the health system.