The model of “One Dollar Health Insurance” is to offer the lowest possible health insurance premium to those with a low income focusing only on covering a limited number of expensive healthcare risks (strategic purchasing) and the highest financing value of healthcare services. It is a social business model based on the postulation that “I need insurance to rescue me when I’m sick and when my revenue is not able to do so.” This is theoretically the usual concept and objective of all social protection and health insurance schemes, but the reality is different. The classic benefits package of healthcare services includes the “essential package of healthcare services” that requires a high premium that is unaffordable to those with a low income. This is why many types of private health insurance essentially have the employed middle class subsidized by the employer and a high income or rich people. In countries where social security with a health or medical scheme exists (national compulsory pool) or in the case of the United States’ Affordable Care Act, those with a low-income receive cross subsidies from a high income or government tax subsidies. Few countries have social protection systems providing coverage of financial healthcare risks to those with a low income, especially those in informal sectors of the economy.
The ACA has faced resistance for using tax subsidies. How can we ensure the low-income population is covered when taxes subsidies are not possible? How can private insurance become a protective product for low-income populations and obtain business profit as well? These are questions that this book addresses through financial estimations and quality and efficiency tools. The model contained in this book is constructed for 10 million of the population. It is estimated that $1 a month in developing countries, $1 a week in newly industrialized countries, and $1 a day in developed countries should finance a limited number of expensive, unaffordable healthcare services. These healthcare services include major surgery, complicated birth deliveries (cesarean sections and other procedures), and cancer treatment. The covered services are medical consultations, diagnostic exams (laboratory, imagery, etc.), and drugs. To make the model more attractive and sustainable, the quality and efficiency of healthcare services and the efficiency of health insurance administration were added. The inclusion of quality and efficiency is an innovation in health insurance businesses. By balancing the proposed premium and benefits, the business is profitable in all levels of development and economy of countries. Adding quality and efficiency should increase profitability and allows the expansion of members’ benefits.
The following are the three pillars of the model: (i) a large economy of scale for strong cost sharing that enables business profit and enough protection; (ii) financing a limited number of unaffordable healthcare risks to be attractive; and (iii) value financing in terms of the quality and efficiency of healthcare services.
The model is proposed as a profitable social business that aims to attract investments for reducing or preventing the impoverishment of the low-income population caused by expensive healthcare.
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