Tibetan Medicare System
Structured Technical Assistance
Project Title:Setting up a holistic Tibetan Medicare System (TMCS) for the Tibetan population in India and Nepal
PROJECT CATEGORY:Structured Technical Assistance
OBJECTIVE:
The long-term objective of this project is to leverage the financial gains of a risk-pooling mechanisms tailored on natural and institutional households (including monasteries and schools) among the Tibetan community in exile, ad hoc micro-insurance business processes and the coordination of public and private providers of secondary and tertiary healthcare. The reformed Tibetan health care system (in exile) should not only provide appropriate finance and risk management mechanisms for catastrophic health expenses of destitute Tibetan refugees, but also provide a high-impact, sustainable and responsive holistic health care coverage to the entire Tibetan population exiled in India and Nepal.
BACKGROUND:
Since its establishment in December 1981, the Department of Health (DoH) has worked as the apex body within the Central Tibetan Administration (CTA) to manage and finance health care for the over 115,000 Tibetans in exile in India, Nepal and Bhutan.
One of the major objectives of the DoH is to provide adequate, equitable and holistic primary health care services to all Tibetan refugees through a primary health care system, integrated with the major traditional Tibetan systems of medicine. In addition to its core primary & secondary health care facilities, the DoH also bears the costs associated with catastrophic tertiary care for the sections of Tibetan population who are either classified as below the poverty line (BPL) or cases referred by the various Tibetan settlements in India, Nepal and Bhutan.
However, due to changing international funding situation, the on-going DoH Tibetan health programme is faced with critical budgetary constraints in providing the above services in a sustainable manner.
The lack of internal resources and the uncertainty linked to inconsistent external funding has put in jeopardy the programme and its need for longer term financial sustainability. Currently, the DoH spends annually around Rs 7,153,000 INR out of which over 40% is being spend on primary and secondary medical treatment and 10% on catastrophic coverage. The overwhelming majority of the population does not yet receive secondary treatment coverage. To face these needs the DoH needs to set up a sustainable mechanism to raise or pool funds for 8 million INR a year. This amount represents a uniquely competitive investment given the size of the population which would be covered and benefit under the proposed scheme.
PROJECT CONCEPT:
The MIA has offered to adapt its inclusive risk-pooling model to the needs of the Tibetan communities and the vision and organisation of the DoH's health care system. The project will see the MIA support and assist the DoH/CTA to study, scope and design the features and processes needed to set-up a sustainable mixed private-public health financing system, including household-based health insurance and long-term sustainability mechanisms like reinsurance. The MIA will also conduct training sessions of MoH/CTA cadres and will be involved in monitoring the implementation. A third independent party will be in charge of rigorous mid-term monitoring and end-line impact and evaluation assessment.
PARTNERS:
The project is a collaboration between the MIA (Delhi, India), as technical service provider, and the Department of Health of the Central Tibetan Administration (Dharamshala, Himachal Pradesh, India), as implementing institution and owner of the planned scheme.
FUNDING:
The MoH/CTA has been funding the initial stages of the project through direct and indirect financial contributions. MIA and the DoH/CTA are currently calling for financial support internationally from donors and development agencies focused on public health, microinsurance, refugee issues, and the Tibetan cause.
DURATION:2009-2011
COUNTRY:India, Nepal
LOCATION:
The MoH/CTA is based in Dharamshala, Himachal Pradesh, India.
The initial survey was administered in a sample of locations where Tibetan Communities are settled:
- Bylakuppe (Karnataka)
- Dharamshala (Himachal Pradesh)
- Dickyiling (Himachal Pradesh)
- Mandi Miao (Arunachal Pradesh)
- Gantok (Ladakh)
The scheme will be implemented in all Tibetan settlements across India and Nepal, with a view to expanding it to the Tibetan communities based in Bhutan.
CONTACT:Siddharth Srivasta, Researcher, siddharth@mia.org.in
PROGRESS:
The MIA has conducted the first round of training (ToT) of MoH/CTA staff to carry out a feasibility survey in 7 locations.
A study has been completed and includes the analysis of the findings of the surveys, setting the base for the planning and roll-out fo the household insurance scheme.
