With many parts of the world still grappling with the fall-out from the COVID-19 crisis, it’s too early to say whether heightened awareness of the alarming ease with which the pandemic spread will result in a long-term uptick in health insurance policies. What is clear, however – as highlighted in the 2021 Landscape of Microinsurance report – is that both consumers and insurers are rethinking their approach to health coverage.
“The report shows the huge impact COVID-19 has had on insurers and low-income communities as the pandemic has heightened awareness of the risk of not being insured, driving up significant demand for health insurance,” said MiN Executive Director Katharine Pulvermacher, launching the Landscape at the recent International Conference on Inclusive Insurance (ICII). “This shift presents the biggest opportunity for the sector in decades.”
In some regions, including Africa and Emerging Asia, health microinsurance has overtaken life and credit life as the largest product line. “Whilst for many years, life insurance has been the starter product for insurance providers moving into the inclusive insurance market, we can see this has now been taken over by health policies in many countries, presenting a huge opportunity for insurers looking to enter the sector,” noted Pulvermacher.
“The coronavirus crisis has made us more aware of how vulnerable we are to unforeseen events. As a result, in the new social context the insurance industry and InsurTechs have been driven to strengthen their customer focus, digitisation, health insurance and microinsurance, with innovation at the fore,” notes a recent report from BBVA. However health insurance – ranging from simple hospi-cash cover to more sophisticated products incorporating technology and value-added services like telemedicine, screening and diagnostic patient monitoring – is increasingly seen as only one in a suite of tools for preventing and managing health risks.
In Africa – the engine of growth for inclusive health insurance – holistic approaches to managing health risks came under the spotlight at the ICII, where there were calls for greater investment in universal health coverage (UHC) in the wake of the pandemic. “The concept of universality provides policymakers and stakeholders with the means to move forward, but the pace of progress has been stalled over the last 12 months,” said Olumide Okunola, Senior Health Specialist with the World Bank in Nigeria. “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.”
One country that has invested heavily is Ghana, which has the biggest public healthcare system in sub-Saharan Africa. One of the drivers was digitalisation, explained Lydia Dsane-Selby, CEO of Ghana’s National Health Insurance Authority. “Going digital was a game-changer. People can access healthcare from anywhere in the country, and you can renew your membership via a mobile phone app. Data fed back into the health sector has big implications for how it is run.”
Going digital was also a priority in Nigeria when it came to implementing public health reform. “We knew from the outset we wanted to operate on a digital platform,” explained Olubunmi Jetawo-Winter, Executive Secretary of the Kwara State Health Insurance Agency. “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.”
If one company can be said to exemplify an innovative, digitally-driven, holistic approach to health risk management, it’s Philips. Over the past decade the Dutch-based tech giant, better known for household appliances and audio-visual equipment, has radically reinvented itself as a ‘Connected Care’ provider. “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.” He noted that one of the biggest barriers is lack of investment in developing countries’ health services. “Many rely on donor funding, but there is a financing gap. Private sector health insurance can ensure efficiency and quality of care.”
Digital health microinsurance may be slower to take off outside Africa, but there are still encouraging signs of progress. Participants at the ICII also heard from Dante Portula, Senior Finance Adviser at GIZ in the Philippines, who highlighted one telemedicine scheme which had attracted 15,000 sign-ups and 500 users during the pandemic. “People are afraid to use hospitals and clinics for preventive healthcare,” he said, while noting challenges including lack of digital awareness, data privacy concerns and poor internet connection in some areas.
“Most low-income people have a hard time funding healthcare. Spending a day in the hospital means loss of revenue, meaning regular check-ups are rare, leading to tragic health outcomes” noted Michal Matul, Head of VAS, Consumer Insights and Training at AXA Emerging Customers, currently running 15 schemes in 9 countries reaching 1.8 million customers, and offering cover for as little as USD 0.30 a month. For example, Alodokter – the most used mobile and app-based Indonesian healthcare platform – combines telemedicine, insurance, e-pharmacy and health information services. The boom in online healthcare in Indonesia, driven by COVID-19, has seen Alodokter’s monthly user base climb 50% to around 27 million.
A rival service, Halodoc, reported app downloads up by 300% in 2020, offering services including chat with a doctor, COVID-19 testing and vaccination, hospital visits, a health store, health-related news and features and digital cashless outpatient services. VP of Marketing Felicia Kawilarang explained that one of the main drivers behind the move to online health services was the lack of doctors – just 3.8 per 10,000 inhabitants. “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,” she said.
Numerous studies have shown that women in developing countries have been hit harder by the pandemic than other groups, particularly when it comes to impacts on health and income. Among the recommendations following the publication of a UN Policy Brief in December 2020 were that the UN could help developing countries provide women with health insurance packages. Others have suggested targeting women-headed households with additional assistance, including the management of health risks.
DoctHERs, an innovative digital health risk management service in Pakistan connecting female doctors to millions of underserved women patients in real-time, aims to overcome socio-cultural barriers which restrict women to their homes, allowing them access to quality healthcare. As Founder Asher Hasan explained at the ICII, DoctHERs goes way beyond telemedicine, encompassing financial inclusion, inclusive insurance, access to quality healthcare and promoting women’s participation in the workplace, especially in rural areas. Asher’s vision is to reduce the neonatal, maternal, and medical mortality rate by 50% in the target community using video consultations and community midwife-assisted telehealth services. “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.”
It goes without saying that treatment is important. But preventative healthcare through education, lifestyle changes, economic empowerment and development opportunities will, in the long run, have the greatest impact. Insurance schemes which recognise and reward individual and family efforts to keep healthy are one approach. Ultimately, however, investment in UHC will reap the greatest rewards. As the authors of the 2018 (and therefore pre-COVID-19) study An Ounce of Prevention is Worth a Pound of Cure - Universal Health Coverage to Strengthen Health Security presciently noted, “Weak health systems in low-income and middle-income countries require bolstering to deal with future epidemics and to promote health. By investing in health, human development is also supported; active participation in economic development is promoted, and catastrophic risks avoided.”