Third Party Payment Mechanisms in Health Microinsurance

  • Date Posted: November 15, 2011
  • Authors: Pascale Le Roy, Jeanna Holtz
  • Organizations: ILO Microinsurance Innovation Facility
  • Document Types: Evaluation
  • Donor Type: Multilateral Organization

Some health microinsurance (HMI) schemes require that patients pay cash at the time of receiving health care services, and then seek reimbursement from the insurer at a later date. For low-income households, this can be a severe financial barrier. One common way to alleviate this barrier is to set up a third-party payment (TPP) mechanism with selected health care providers. A TPP mechanism is a model for claims payment in which insured patients are not required to pay the entire cost of health services covered by the HMI scheme at the time the services are rendered. This paper draws on the experience of various health microinsurance schemes and presents the pros and cons of using a TPP mechanism. It also presents key issues to address when establishing and managing TPP mechanisms, as well as tips and solutions collected from case studies and experts` interviews.