Digitisation facilitating inclusive insurance
Session 15: Leveraging mobile and digital solutions for inclusive health insurance in low- and middle-income countries
The rise of mobile technology in Africa could transform health insurance – but what impact has the pandemic had? Day four of the ICII started with a deep dive into tech solutions for inclusive health insurance, facilitated by Kwasi Boahene, Director of Advocacy and Partnerships at the PharmAccess Group in Ghana.
From the World Bank’s point of view, said Olumide Okunola, Senior Health Specialist in Nigeria, universal health coverage (UHC) has to be front and centre of health service reforms. “The concept of universality provides policymakers and stakeholders the means to move forward, but the pace of progress has been stalled over the last 12 months,” he said. “There have been severe fiscal contractions, but now is not the time to stop spending – indeed this is the time to increase spending on human capital including health. Public financing is key to UHC.”
The COVID-19 crisis has provided a unique opportunity to advocate for UHC, but much more needs to be done to leverage additional revenues as well as general taxation to fund state-provided healthcare. “There is now a resurgence towards pro-health taxes,” he added. “Covid has shone a light on the health sector in terms of financing, and this is the time for countries to get additional revenues. There is a cardinal role for public financing and general revenues – without that, the hopes of attaining universality will be a mirage indeed.”
Lydia Dsane-Selby, CEO of Ghana’s National Health Insurance Authority, said that going digital has been a huge game-changer. “When we started the scheme we gave people laminated cards, but since then we have developed a national biometric database,” she explained. “One of the key advantages for us has been portability – people can access healthcare from anywhere in the country, and you can renew your membership via a mobile phone app. 80-90% of renewals were done on mobile phones within two years of the launch.”
Ghana has the biggest public healthcare system in Sub-Saharan Africa, and another big advantage of going digital is gathering data. “Data fed back into the health sector has big implications for how it is run,” she said. “Non-communicable diseases (NCDs) such as diabetes and hypertension are a big issue for us. The information fed back to us could change the way we handle NCDs.”
Public healthcare is run at the sub-national level in Nigeria, explained Olubunmi Jetawo-Winter, Executive Secretary of the Kwara State Health Insurance Agency, which was launched in 2018 but not fully implemented until 2020, when a change of state government created greater political will. The agency runs on two principles – it must be affordable and accessible without breaking the bank – and includes a digital enrolment and admin platform, supported by a call centre. “We knew from the outset we wanted to operate on a digital platform, but we also knew there were limitations, because of literacy and poverty. Not everyone has a phone, so they can register through an agent if they want.”
“The programme was a scaling up of the previous community-based health insurance scheme,” she said. “The new administration promoted health in its policies, which gave us leverage to get funding for implementation. But we still needed to lobby hard to get health insurance as a priority. We had to attach a prominent face – the First Lady became an ambassador for health insurance in the state.”
Netherlands-based tech giant Philips has pledged to improve the lives of 2.5 billion people around the world by 2030, including 400,000 in Access to Care (ATC) countries with below-average access to healthcare. “Why are we interested in insurance?” asked Ties Kroezen, Venture Leader for Connected Primary Care Solutions. “Insurance can improve quality and reduce the cost of care. We want to move from an input-based to an outcome-based payment model of value-based care. The challenge is how to get people enrolled into healthcare systems and to keep healthcare affordable. One of the biggest barriers is that there is simply not enough money in the system in ATC countries.”
Philips helps impact investors ensure they are going to get a return for their money. “Many ATCs rely on donor funding, but there is a financing gap. Private sector health insurance can ensure efficiency and quality of care, so Philips tests different models to make sure they are financially sustainable and to make them bankable. Philips itself invests in impact schemes – we are on the verge of investing in two impact investment funds focused on primary health in two African countries,” he added.
Development agencies try to take a holistic approach to health finance, explained Kelvin Massingham, Director of Risk and Resilience at FSD Africa, a specialist development agency working to build and strengthen financial markets. “We’re not primarily thinking about insurance but about health finance. We need financial resilience to health shocks and quality outcomes for patients.” However, there are a number of “intractable challenges”, including a fragmented finance landscape, money being spent but not translating into better outcomes, “catastrophic” expenditure on preventable health conditions (particularly in maternal health), and a lack of data. “It’s a complex problem and there’s no silver bullet,” he concluded. “You have to take as holistic an approach as possible. It’s not just about making public schemes more efficient, but creating an enabling environment for public-private partnerships to improve access.”
Session 16: Digital health
Did the digitalisation of health coverage improve access, efficiency and outcomes during the pandemic, asked session facilitator Denis Garand, President of Denis Garand and Associates. Data from the Philippines would seem to suggest so – Dante Portula, Senior Finance Adviser at GIZ said that one telemedicine scheme had attracted 15,000 sign-ups and that 500 people had actually used the platform, especially for online consultation. “People are afraid to use hospitals and clinics for preventive healthcare,” he said.
However, the service was not without its challenges, which included overcoming reluctance by patients – especially those less digitally savvy – to using a new, online service; data privacy concerns; finding a company to develop the app in a very short timeframe; poor internet connection in some areas; and overcoming cultural resistance to change. Key lessons included allowing enough time for development; providing content for onboarding; focusing on data privacy; and having a backup solution!
Michal Matul, Head of VAS, Consumer Insights and Training at AXA Emerging Customers, said low-income consumers often forego check-ups and treatment, leading to “very bad and tragic health outcomes” – hence the importance of telemedicine. “Spending a day in the hospital means loss of revenue. Regular check-ups are rare. Most low-income people have a hard time funding healthcare,” he said.
AXA offers a digital window to mass healthcare, with 15 schemes in nine countries reaching 1.8 million customers – 0.32 million of them enrolled. Michal highlighted three schemes which create value for just USD 0.30 per month, per user: Alodokter in Indonesia which involves cross-selling insurance to telemedicine customers; AIS in Thailand, a freemium product for telco members to access a Covid clinic via the app; and an MFI scheme in Egypt with unlimited tele-consultations for insured borrowers and their families. The widely differing usage rates of these products show that if you include something extra in an online scheme, it will be more used. But if you ask people to download yet another app, it’s a hard sell. The key takeaway? Create access and secure retention.
A hybrid approach of mixing low-touch (SMS) with high-touch (call centre) models proved successful when it came to offering ‘save-to-insure’ health insurance to mobile health wallet savers, said Saurabh Sharma, Director, Emerging Consumers at Britam Kenya. Britam partners with M-TIBA, a mobile-based health wallet platform, to offer product variants with USD 1,000 or USD 2,000 cover. Digital and tele-sales were used for distribution, targeting 2.4 million customers. Key lessons so far indicate that health wallet savers are more likely to take up insurance.
Session 17: The value of human touch in the wake of digital distribution: Insights from Brazil, Indonesia, and Ghana
Linnea Kreibohm, Senior Policy Officer at BMZ, set the scene for this discussion by highlighting the importance of innovation, digitalisation and technology to reach clients and reduce friction across the insurance value chain. “Technology is a game-changer for inclusive insurance,” she told moderator Matthias Range, Head of Unit Risk Finance and Insurance at GIZ. “But we also need to be aware that limited human touch might cause low insurance awareness and limited trust in insurance providers. We need to find the perfect balance between digitalisation and human touch tools to reach sustainability.”
Finding the right balance was a recurring theme. Desmond Mall, Customer Experience Product Manager at BIMA, took us through a typical SAGABI customer journey experience. SAGABI (Strategic Alliance GIZ, Allianz, BIMA) is a public-private-partnership (PPP) which aims to enable underserved consumers to access simple and affordable mobile-delivered insurance and health services. The scheme combines both digital and human touch points, including experience centres, an agent app, digital onboarding and health programmes, teledoctor services, fast claims pay-outs and personalised digital communication. “Digital communication, executed well, can add another level of humanisation to the customer experience,” said Desmond.
Edson Calheiros, CEO of Oxxy Seguradora, in Brazil, described Roboerta, a “human touch with digital experience”. Roboerta is the “resident” of a mobile site accessible by mobile phone, desktop or tablet. The purchase of insurance products is made via a friendly chatbot talking with audiences in a language they understand and are comfortable with. Sales are completed in three minutes, and the policy issued in seconds. “Roboerta humanises and simplifies our work, guiding people to buy the right insurance products with a 24/7 human touch, using popular language to bring people closer to microinsurance,” said Edson. The main objective is to allow customers to feel their family is protected, and also that they have access to benefits they would not have without insurance.”
From Indonesia, Felicia Kawilarang, VP of Marketing at Halodoc, talked us through some of the challenges to delivering healthcare in a country which has only 3.8 doctors per 10,000 inhabitants. “This was one of the main drivers which led to the creation of Halodoc,” said Felicia. “It is very hard for people to get to hospitals, there is unequal healthcare access across the country, and there is no integrated online and offline information to keep medical records.” Halodoc’s mission is to simplify access to healthcare through technology, which it does by offering services including chat with a doctor, COVID-19 testing and vaccination, hospital visits, a health store and health-related news and features. The platform, which currently has around 20 million active monthly users offering access to 20,000 doctors and 7,600 hospitals, also offers digital cashless out-patient services.
From a totally digital experience to the human touch in providing health insurance for drivers at the ride-hailing app Gojek. Marco Japutra, Head of Health Business Development at Allianz Life in Indonesia, explained the role of human interaction in a mostly digital journey. As gig-economy workers, Gojek drivers are not part of an insurance programme and they have limited understanding of insurance. Since most of them get paid day-to-day and are extremely mobile, the prospect of waiting four hours to see a doctor is a major challenge to seeking healthcare.
The solution? An affordable, simple healthcare product with a premium of about USD 0.17 per day. “The human touch is needed for a successful customer onboarding,” said Marco. “It helps to generate enthusiasm between the drivers. Human connection is key.”
Session 18: InsurTech for inclusive insurance
For the final session of Day Four, attention turned to InsurTech providers. As facilitator Lisa Morgan, Technical Specialist at the ILO pointed out, we tend to overestimate the effect of technology in the short run and underestimate the effect in the long run. “Technology can be a game-changer for inclusive insurance, but it imposes some challenges, such as in inclusion of women,” she noted.
Dimitrios Velmachos, Venture Partner/Advisor at Equintis, provided an overview of the opportunities and trends in InsurTech, including the fourth industrial revolution, connectivity, and a data-driven world. “Covid has accelerated the process of digitalisation. There’s more investment, usage and trust. Technology is now interconnected with financial services, and financial services with technology.,” he said. “However, technology is not a silver bullet and competition by itself cannot make the difference.”
InsurTechs, he said, are trying to disrupt every aspect of the value chain: underwriting, claims, and distribution. Digital technology is becoming easier and cheaper, with out-of-the box simple technology to create digital wallets integrated with insurance – which in turn makes insurance affordable and easy. And Dimitrios had a word of advice for InsurTech entrepreneurs: “Focus on the problem you are trying to solve. Understand it really well. Try to leverage digital capabilities, but understand that there are limitations.”
“Imagine if farmers participated in the profits. Blockchain technology will make it possible for non-traditional capital investors to invest in insurance. It is about handling assets. Farmers can invest and participate in the profits that are made.” This was the vision of Michiel Berende, Chief Inclusivity Officer at Etherisc, who showcased a fully automated, end-to-end solution to process Acre Bima Pima insurance products. “The best case for blockchain is in parametric insurance. Insurance was unaffordable and not trusted by farmers, especially due to long waiting periods for pay-outs. Because of the automation the platform makes possible, it reduces cost, increases speed of transaction and transparency.” Agreements and contracts can be converted to codes called "smart contracts" which automatically execute functions previously performed by an individual, explained Michiel. “The main challenge was to find an organisation willing to dive into the project,” he added. “Risk aversion is in the DNA of insurers.”
Risk aversion certainly isn’t an issue for Nhi Huynh, Manager (Platforms & Acquisitions) at Allianz X. “Allianz X invests in front runners. We are set up to identify, invest in, and work with high-performing entrants. We want to develop the next generation of mobile insurance. Our aim is to reach as many customers as possible.”
Risk-taking innovation was also key when Asher Hasan founded his groundbreaking telemedicine docTHERs platform in Pakistan. The emphasis is on a high-quality, high touch continuity of care experience: doctors “navigate and curate patients from A to Z.” “The business model is based on delivering digital health and finance services to the informal sector,” said Asher. “Programmes are financed by a corporate partner and intermediary.” There are four components to the initiative: a focus on the excluded; gender inclusivity; preventive care; and training for healthcare professionals based on customer feedback.
“Technology is not a silver bullet, but it is a huge democratiser,” he noted. “It enables families to participate in the mainstream economy, living more dignified, empowered and inclusive lives.”