At Shamseya we are seeking the gradual implementation of a deep, community-rooted, dynamic system that accounts for the scarce resources and available infrastructure, is custom-designed and managed by communities, possesses the flexibility to adapt to each communities’ preferences and needs, insures choice of providers, guarantees work sustainability, pushes towards accountability to patients and quality improvement. A system that operates with the highest degree of independence from the government, uses market dynamics in pushing for better service delivery whilst being directly regulated, monitored and partly subsidized by the state and that still benefits from nation-wide risk-pooling and cost-sharing mechanisms.
It is a system that is designed to complement any nation wide healthcare system but also, to work alone in case of inefficiency of the state solution.
The proposed structure can be shortly described as follows:
Multiple, communities’ designed / funded / managed, government supported / regulated, selective, non-profit, income-measured, risk-distributed, preferred providers micro-insurance with a layer of overlying, proportionate, non-profit, mandatory, national, social reinsurance scheme.
The following diagram graphically illustrates the roadmap for the functioning of this system.
Graphical representation of the highlights of the dynamics of the proposed healthcare system structure and the roles of its major components
■ Building blocks
The proposed healthcare system rests on a number of important building blocks, namely:
1) Preferred-Provider Networks and Health Cooperatives (health co-ops)
5) The role of the Market and the social sectors
Sources:
E. Morelli, G.A. Onnis, W.L. Ammann, C. Sutter (Eds), Micro insurance – An Innovative tool for risk and disaster management, Global Risk Form GRF Davos, Davos, 2010
The Ottawa Charter: Health promotion, 1st International conference on Health promotion, Ottawa, World Health Organization,1986
D. Dror, C. Jacquier, Micro-insurance: Extending health insurance to the excluded, International Social Security Review, 2001, P. 15
The Bamako Initiative, Women’s and children’s health through funding and management of essential drugs at community level, World Health Organization, 1986
J.F. Outreville, The health insurance sector: Market segmentation & international trade in health services, 1998, P. 111-124