Faculty of Commerce

Faculty of Commerce: Department of Risk Management and Insurance
Name : Zibusiso Thabani ChirawuStudent Number: P0127869X
Supervisor : Mr TinarwoFACTORS AFFECTING UPTAKE OF MICRO INSURANCE BY CIVIL SERVANTS IN ZIMBABWE: A CASE OF HEALTH MICRO INSURANCE PRODUCTS IN BULAWAYO
CHAPTER TWO
LITERATURE REVIEW
This chapter establishes the base for the research by literature that other researchers have discovered in their various studies on the subject. The researcher will formulate a working definition of micro-insurance basing on the various existing definitions, and then identify the benefits of micro-insurance to various stakeholders. The section will go on to look at the demand and supply issues of micro-insurance and finally the regulatory framework of micro-insurance in selected jurisdictions. This section will identify the situation on the ground in various countries that are implementing micro-insurance and will provide a base upon which to lay our own micro-insurance framework in Zimbabwe.

Theoretical foundations
The slow growth in health micro-insurance can be explained by the customer perceived value theory. Customer perceived value is the difference between the prospective customer’s evaluation of all benefits and all the costs of an offering and the perceived alternatives. CPV = what customer gets (benefits) – what he gives (costs). Total customer benefit is the perceived monetary value of the bundle of economic, functional and psychological benefits customers expect from a given market offering because of the products, services, personnel, and image involved. Total customer cost is the perceived bundle of costs customers expect to incur in evaluating, obtaining, using, and disposing of the given market offering, including monetary, time, energy, and psychological costs (Kotler and Armstrong, 2010, p.161). The authors explain that creating loyal customers is at the heart of every business because the only value that an organization will ever create is the value that comes from present and future customers. They propose an adoption of the modern customer oriented organization chart as opposed to the tradition organization chart.
Kotler and Armstrong(2010) explain that the traditional organization chart is a pyramid with the president at the top, management at the middle, frontline people and customers at the bottom while the modern customer oriented organization chart is inverted placing customers at the top, followed by frontline people who meet customers then middle managers who support the front line people and at the base is the top management whose job is to hire and support middle managers.

Health micro-insurance companies have largely operated the traditional organization chart. This means that customer perceived value has remained very low hence affecting the growth of health micro-insurance both in Zimbabwe and other developing countries, (Kaguma, 2011). Creating loyal customers is at the heart of every business. Businesses succeed by getting, keeping and growing customers. Customers are more educated and informed than ever and they need to feel they are getting value for their investment, (Kotler and Armstrong, 2010).
DEMOGRAPHIC PROFILES OF VARIOUS HEALTH MICRO-INSURANCE USERS IN ZIMBABWE.

Micro-insurance policyholders may be individuals, households, groups, or whole communities. They may be found in rural, urban or sub-urban areas. Many but not all policyholders work in informal sector (David, 2008).

Micro-insurance reaches out to a very varied and broad clientele. This target clientele can range from people below the poverty line to people to low or emerging middle classes who lack effective access to risk protection and remain vulnerable without insurance coverage or other means of protection against risk (David, 2008). The target clientele of a particular micro-insurance programme is often determined by the characteristics, goals, and existing operations of the insurer, delivery channel, and other stakeholders involved:
Microfinance institutions involved in micro-insurance typically insure their existing clients (most commonly borrowers, but also savers) and the family members of those clients.

Private mutual insurance organisations (former mutual health organisations) may exclusively insure their members, who may be defined narrowly or broadly.

Private or public insurers often target a group that can be reached through an existing delivery channel or aggregator:
Clients of microfinance institutions or the MFIs themselves;
Women’s associations;
Trade unions, social and popular organisations; 
Funeral providers;
Self-help groups (mutual-assistance groups of 10 to 20 individuals);
Groups receiving government cash transfers or other benefits.

Less commonly, micro-insurance is marketed to individual clients:
Retail points-of-sale;
Remittance providers, pawnshops, providers of utilities and other service providers
THE VARIOUS MICRO INSURANCE PRODUCTS THAT ARE AVAILABLE ON THE ZIMBABWEAN MARKET
Churchill (2003) defines micro-insurance as the protection of the low-income people against specific perils in exchange for regular premium payments proportionate to the likelihood and cost of the risk involved. While concurring with Churchill, Ahsan (2009) goes further to say micro insurance can be viewed as “a financial arrangement designed to protect low-income people against specific perils in exchange for regular premium payments proportionate to the likelihood and cost of risk involved”.

The definition clearly spells out that micro-insurance is similar to all other forms of insurance except for the clearly defined target market, the poor. Churchill adds on to say the definition of poor differs or varies by country but micro-insurance is for persons ignored by mainstream commercial and social insurance schemes especially those working in the informal sector.

The International Association of Insurance Supervisors (IAIS) and Consulting Group to Assist the Poor (CGAP) (2007) define micro insurance as ‘insurance that is accessed by low income population, provided by a variety of different entities, but run in accordance with generally accepted insurance practices. Importantly this means that the risk insured under a micro insurance policy is managed based on insurance principles and funded by premiums. The micro insurance activity itself should fall within the purview of the relevant domestic insurance regulator or supervisor or any other competent body under the national laws of any jurisdiction.’ IAIS is mainly concerned with the regulation of insurance activities, of which micro insurance is one of them.

Churchill (2003) goes on to say “Micro insurance has no relationship with the size of the risk carrier; these come in all sizes and include AIG Uganda and the Delta Life in Bangladesh. It also does not refer to the scope of the risk as perceived by clients; to the households the risks are by no means micro.”
Micro insurance has the following characteristics:
Transactions are low cost ( and reflect members’ willingness to pay)
Clients are essentially low-net-worth individuals and households (but not necessarily uniformly poor)
Communities are involved in the important phases of the process (such as package design and rationing of benefits)
The essential role of the network of micro insurance units is to enhance risk management of the members of the entire pool of micro insurance units over and above what each can do as a stand-alone entity (Ahsan (2009)).

According to McCord and Cohen (2003) micro insurance is a system of protecting poor people against specific shocks using risk pooling for regular affordable premiums proportionate to the likelihood and costs of the risk involved. They add on to say, ‘appropriate delivery mechanisms, procedures, premiums and the coverage define micro insurance.’
Ahmed (2007) clearly states that micro insurance is designed to be appropriate for the poor in relation to cost, terms, conditions and coverage and provides a more efficient alternative to relying on credit and savings products to manage the impact of risks. All the definitions rule out the misconception that micro insurance is charity, it involves costs and risk-pooling, clients must make regular premium payments which are in turn proportionate to the likelihood and cost of risk. Ahmed (2007) further states that micro insurance is a valuable mechanism that reduces the vulnerability of the poor while offering insurers and their agents the potential to expand their markets to low-income households.

Benefits of Micro insurance
Roth (2010) noted that micro insurance gives insurers access to a large and more diversified pool of risk and allows them to get a foot in the door of developing markets. The insurers have a sense that today’s low-income client will be tomorrow’s middle income client.

Micro insurance promises to benefit all stakeholders in a number of ways as noted from various sources. Ahmed (2007) noted that from the commercial perspective micro insurance is an additional product and, if properly managed, is profitable. It is from this realization that some large global insurance companies like AIG, Swiss Re and Munich Re have ventured into micro insurance and are at the forefront of micro insurance research and innovation. According to Lloyds (2009) the potential market for insurance in developing economies is estimated to be between 1.5 and 3 billion policies. There is significant demand for a range of insurance products from health and life, agricultural and health insurance, to catastrophe cover.

The benefit from micro-insurance to commercial insurers is not only the profits. Lloyds (2009) goes on to identify more benefits from micro insurance that can accrue to commercial insurers which are, diversification, reputational benefits, a laboratory for innovation, market intelligence and first mover advantages.

Health micro-insurance
Before jumping into the topic of sustainability it is important to establish what constitutes HMI. People have differing views on what constitutes “true” HMI. Some believe a product must be comprehensive in nature to be considered HMI, and would not view a product with limited benefits as true health coverage. For the purposes of this study, HMI is viewed across a spectrum of products that range from limited coverage hospital cash products to comprehensive health-care products. The four main HMI product categories: (1) hospital cash, (2) inpatient-only, (3) outpatient and maternity, and (4) comprehensive (hospital cash + inpatient + outpatient and maternity) health care.

Health micro-insurance – referred by different names such as community-based health insurance, micro-health insurance, mutual health insurance, community-based health financing, community health insurance etc -is a form of micro-insurance in which resources are pooled to mitigate health risks and cover health care services in full or in part. Health micro-insurance schemes are more complex in nature compared to life insurance schemes, as they provide services towards specific risks or illnesses and involve the role a health care provider, whether independent of or in partnership with the scheme.  The scheme can be provided by government, a private insurance company, an NGO or a CBO (Aiyar, 2010).

Health micro insurance is important for the poor because health risks are often identified by the poor as the greatest and costliest risks among all other natural, social, economic etc risks faced by them. Health problems not only impact expenditure of the household, but also reduce the productivity and lessen the opportunity for growth.  Long-term illnesses have serious implications on the poor, leading to other unhealthy social conditions such as alcoholism, domestic violence or psychological complications. The poor are considered to be more vulnerable to illnesses and epidemics than the rich as the former usually live in unhygienic conditions, they have low-levels of health awareness and fail to take up preventive measures. According to Devadson (2010) in the ACCORD Community Health Insurance: Increasing Access to Hospital Care, the poor become further impoverished in the process of seeking health services.  Nearly 40% of hospitalised patients sell assets or borrow money to afford treatment and an average of 24% fall further down the poverty trap in this process. One of the reasons for lack of a proper health-seeking behaviour within the poor community is the expensive medical treatment especially at private health clinics in addition to the bad facilities available at public health centres. Smith and Chamberlain (2010) say there is a close relationship between the health conditions of the people and the economic growth of the country in which they live.  It becomes necessary for the government to ensure affordable services for the poor to improve and maintain their health well-being. Some of these factors prove that health micro insurance is critical to reduce poverty and improve household conditions in poor and developing countries.

Health micro insurance can be defined as a type of insurance where accessibility to essential health services is made available to individuals and families, who are unable to afford formal health insurance schemes, through affordable premiums and low prices for health services. Aiyar (2010) Health risks such as illness, accident or injury, which require households to incur medical treatment costs, are some of the most common concerns to low-income households. Risk pooling over a large number of people through health insurance schemes can provide at least partial protection against these health risks at an annual cost that is within the household budget. HMI schemes use the principles of insurance to fund a tangible service like health care. They must be designed with risk pooling mechanisms to harness private funds for health care financing. The large rural informal workforce in some Asian countries like India and Bangladesh makes it difficult to offer work-based social insurance and therefore health insurance provision should be incorporated within the framework of an overall national health plan and treated as a social security program. For example successive Bangladeshi governments have failed to incorporate it due to misplaced priorities, poor planning and scarcity of resources. The poor cannot access the private health care system because of high costs. Before embarking upon the provision of a complicated service like health care, HMI providers need to consider six critical areas: 1) institutional mission, 2) institutional capacity, 3) marketing and client education, 4) product design and controls, 5) claims management and 6) financial performance.
FACTORS WHICH AFFECT THE UPTAKE OF HEALTH MICRO-INSURANCE PRODUCTS IN ZIMBABWE
Insurance is a contract between the policy owner and the insurer, where the insurer agrees to pay a sum of money upon the occurrence of the insured individual. Health micro-insurance therefore is a contract between an insured (insurance policy holder) and an insurer (insurance company), where the insurer promises to pay a designated beneficiary a sum of money (the “benefits”) upon the death of the insured person (Asfaw and Jutting, 2007).
Depending on the contract, other events such as terminal illness or critical illness may also trigger payment. In return, the policy owner agrees to pay a stipulated amount called a premium at regular intervals or in lump sums, (KPMG, 2004). There may be designs in some countries where bills and death expenses plus catering for after funeral expenses should be included in Policy Premium. As with most insurance policies, health micro-insurance is a contract between the insurer and the policy owner whereby a benefit is paid to the designated beneficiaries if an insured event occurs which is covered by the policy. The value for the policy holder is derived, not from an actual claim event, rather it is the value derived from the ‘peace of mind’ experienced by the policyholder, due to the negating of adverse financial consequences caused by the death of the life assured (Yaari, 2009).

Uptake of health micro-insurance
Uptake of health micro-insurance is the ratio of Gross Direct Premiums to Gross Domestic Product (GDP). This currently stands at just about 1.3% in most African countries, which is very low. Currently, work is being done by insurance companies in the area of micro insurance. Health micro-insurance providers can build customer involvement and loyalty; establish competitive differentiation; and increase referral value by applying various initiatives, (Asfaw and Jutting, 2007).
Insurers have under-invested in technologies at a time when customer expectations regarding service and delivery are higher than ever. There are numerous opportunities for insurers to collect and analyze customer information to improve the range and quality of products offered; to refine pricing strategies; and to develop an effective array of distribution channels (Aiyar, 2010).
Technologies including business intelligence, descriptive and predictive analytics, and data mining can help health micro-insurers improve both their decisions regarding new products and their levels of customer service. At the next level, analytics can help life insurers identify customers who are in danger of making a full or partial switch to another insurer, and can identify appropriate actions to head off such decisions.
The widespread use of social media provides another opportunity for life insurers to increase their understanding of what customers want (Aiyar, 2010). Ultimately, health micro-insurance providers must develop social media strategies and policies that coordinate brand positioning, product offerings and distribution channels to capitalize on social media’s power to reach and engage both existing and prospective customers.
According to Bester (2009) adoption of loyalty programs is lower in health micro-insurance than other financial industry players. Players in the retail industry among others have demonstrated that loyalty programs may be a worthwhile area for health micro-insurance providers to explore to improve customer retention. Health micro-insurers could provide discounts for a customer who buys health micro-insurance policy from the same company. Health micro-insurers have not perfected their ability to approach the right customer with the right product offering. For instance, younger customers (say in the 35 to 45 age bracket) are often interested in single-premium health micro-insurance products that build value quickly if there is claim for 10 to 20 years. Other customers may want to purchase only the simplest and cheapest of health micro-insurance policies. Older customers with substantial assets may have complex needs involving health micro-insurance.
According to Berry, Hoyt and Wende (2010) many health micro-insurers, lack the customer profiling capabilities necessary to quickly match products with high-potential customers. Agents and customers both waste time because the first face-to-face meeting is devoted to establishing the customer’s needs, when a simple interactive “app” designed for a tablet computer or smart phone could ask the same 20 or so questions that the agent might otherwise ask in the first meeting, which should be devoted to addressing the customer’s real needs.

Health micro-insurers are highly reliant upon their product development and policy administration systems, but many of these are unable to support the demands of an aggressive program of product segmentation, new product development and robust distribution channels. In terms of systems, few health micro-insurers have in place what they will need to build customer loyalty and grow sales. They need an integrated architecture that encompasses policy administration and claims, but that also supports multi-channel distribution through social media monitoring, customer relationship management, data collection and advanced analytics.

Conceptual framework on uptake
KPMG (2004) report, contends that several variables that influence the successful uptake of health micro-insurance. These variables are largely divided into independent variables and dependent variable and independent variable is typically the variable representing the value being manipulated or changed and the dependent variable is the observed result of the independent variable being manipulated.
First, the sales force serves as a critical link between a company and its customers. In many cases it serves both the seller and the buyer. First the sales force presents the company to the potential customers (Asfaw and Jutting, 2007). They find and develop new customers and communicate information about their company’s products and services. They sell these products by approaching prospects, presenting their products, tackling objections, negotiating prices and policy terms and then closing the sale. In addition, sales people provide customer service and carry out informal market intelligence research. Sales people represent customers to the company acting as „champions ” of the customers? interests and managing the buyer- seller relationship (Kotler, 2000).
The sales force can be structured along several lines. The Territorial sales force structure shows each sales person assigned to an exclusive geographical area and selling the company?s full line of products or services to all customers in that territory. This responsibility is given to super sales people who have intrinsic motivation, disciplined working style, ability to close a sale and ability to build relationships with customers. Under the Product sales structure, sales people sell along product lines, with different teams selling different products. Customer sales force structure comprises of a sales force organization under which sales people specialize in selling only to certain customers or industries. The Complex sales force structure is used when a company sells a wide variety of products to many types of customers over a broad geographical area. It often comprises of several types of sales force Structures. A good sales structure can mean the difference between success and failure (Hawes, 1993). At the heart of any successful sales force operation is the recruitment and selection of a good sales people. In a typical sales force, the top 20 percent of the salespeople might bring in 80 percent of the total sales.
Most micro-insurance companies will prefer recruiting married sales people aged above 30 years with at least a mean grade of C in KSCE (AKI, 2008). Married sales people are believed to have family responsibilities which will make them work hard while salespeople of 30 years and above are said to be more focused in their work. Training the sales people is very costly and every insurance company will try to retain their workforce. Most companies provide continuing sales training via seminars, sales meeting and the web throughout the sales person’s career (Jobber, 2000).
Secondly, the product itself can be defined as a bundle of physical and psychological attributes capable of providing buyer satisfaction. These attributes can be reinforced and differentiated by sales people to create and sustain a competitive advantage. It followers that product knowledge, benefits, usage and performance is essential to a salesperson. Detailed product knowledge is a necessary prerequisite and a major factor in effective selling (Donaldson, 2009). Third and equally important is the ability to develop and maintain customer relationship. (Green, 1976), maintains that the role of the sales person has moved away from the traditional aggressive and persuasive selling to a new role of relationship managers. The specific tasks may vary but can include providing technical information, delivery of information, handling complains and providing other aspects as appropriate (Kohli, 1993). Skills are a combination of factors (personality and knowledge) which can be used to practice the job more effectively. Sales people need combination of communication skills, matching skills and persuasive skills. The selling characteristics and skills required will be those which best match the role to be performed and the tasks which must be undertaken (Kohli, 1993). Understanding the communication process and the ability to appreciate the importance matching the benefits of sellers to the needs of buyers are necessary skills. Thus the uptake of micro-insurance is affected by the Agent’s personal profile, like age, gender, marital status, educational level and skills. The second set of factors influencing uptake of health micro-insurance products are the Agent’s personal selling methods, eg advertising, publicity, sales promotions, direct marketing. Thirdly there are the target clientele’s personal profile factors like age bracket, , buyer attitude, marital status, terms of employment.
THE PRESENT REGULATORY FRAMEWORK IN RELATION TO MICRO INSURANCE DEVELOPMENT
Regulation of any market can either promote or impede its development, thus affecting social welfare. Insurance regulation has been in existence for nearly as long as has the formal insurance market, dating back at least to the 1575 establishment of the Office of Assurances in Great Britain to “coordinate and begin to control the writing of insurance” (Daykin & Cresswell, 2001). While regulatory efforts develop and change over time and across jurisdictions, regulation in the insurance sector generally falls into three categories: pricing, solvency, and market the latter including product licensing and marketing, claims handling, market access, and underwriting. As seems true for any regulated industry, debate over the appropriateness of governmental requirements is extensive and varied. Among economists, general agreement exists that the most socially beneficial industry regulations are those that assist in encouraging competitive markets.
Such markets will not address issues associated with unequal wealth and income distribution or other societal concerns; yet the belief is that by encouraging competitive markets, private industry can perform its best for society. Other societal concerns can and should be addressed through non-private mechanisms, such as by NGOs and governmental programs, which are transparent and overt, limiting market distortions.

Within the insurance context, research suggests that the market demonstrates the key attributes of a competitive market, with many buyers and sellers, and reasonably open entry and exit; that is, concern over monopoly power is unwarranted. Joskow’s (1973) seminal work set the foundation for such consideration within the insurance markets, and generally has been supported over the years (see Klein, 2012 for a discussion). Within the academic literature on insurance regulation, most authors conclude that regulation is most appropriate when market failures exist, and these most often are found in situations involving asymmetric information (see Klein, 2012).
Market failures in insurance tend to arise due to greater levels of information and power held by insurance carriers relative to consumers. These situations are most common in the personal-insurance lines of business, which is where micro insurance is focused. Insurers in particular have greater levels of information and power regarding the riskiness of their portfolio, leading regulators to focus on solvency concerns. Other concerns arise out of the insurer’s control over contract wording and enforcement, which the consumer may not have the capability to understand or refute, directing attention to sales and claims adjusting practices.
Product design and pricing
In most countries where specific micro insurance regulation exists, specific regulations have been implemented regarding product design and pricing. Both India and the Philippines, for example, require that micro insurance policies be easily understood and bear a specific obligatory micro insurance logo. The Brazil regulations also require simple terminology that is easily understood by the insured. Taiwan includes these same types of requirements and also limits the term of coverage to no longer than one year and no more than one peril covered per policy (see Taiwan Insurance Bureau, 2009). Restricting the number of perils covered under one policy makes sense when it comes to reducing product complexity to account for low levels of financial literacy of the target population. It also is appropriate when data availability is limited, restricting the ability to analyze underlying risks as well as dependency among risks (see, e.g., Biener, 2013). Single-peril policies, however, limit the opportunity to experience efficiencies of bundling together coverages for several causes of loss. Furthermore, the policyholder is not particularly concerned with the precise peril that causes loss, just that loss occurs. If the target population is likely to need and want coverage for more than a single peril, it may be wise to devise a method to permit these broader contracts.
Rate restrictions similarly have the potential to dampen market opportunities for the target population. While insurance premiums are subject to some form of regulatory intervention in most areas around the globe, such restrictions tend to yield undesired outcomes, even when done with the best of intentions. Research on the US market consistently finds perverse effects of pricing restrictions, such as the reduced coverage availability in the US auto market (see Weiss, Tennyson, & Regan, 2010; Harrington, 1990). Similarly, rate restrictions in voluntary private health insurance markets intended to increase access to health insurance for high-risk individuals (e.g., with chronic diseases) sometimes lead to the exclusion of those risks from health coverage due to the insurers’ anticipation of losses from coverages for high-risk types (Van de Ven et al., 2000).
The micro insurance market also has been subject to pricing restrictions and distortions, either through upper limits placed on premiums or through the use of direct premium subsidies. Premium subsidies may have positive short-term effects by increasing demand and reaching underserved populations; however, long-term incentives and willingness to pay might be detrimentally affected, leading to higher aggregated costs to society as a whole.18 These market interventions often result in higher premiums as well. When governments and, by extension, their populations believe that access to a product or service ought to be increased, methods that increase resources rather than reduce prices tend to be most effective. Hudon and Traca (2011), for instance, identify improved efficiencies for MFIs that receive “smart subsidies,” which are those that are definitive, time-designated, and limited. Furthermore, the subsidies are most effective when they go to the lending institution rather than the consumer
Chapter summary
Chapter two covered the demographic profile of health micro-insurance users, factors affecting uptake of health micro-insurance and the regulatory framework. the next chapter will cover research methodology.

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