In her article “m-Health: Remote access,” Milliman consultant Lisa Morgan discusses how mobile technologies, specifically telehealth services, are being used around the globe, from their incorporation into health microinsurance schemes in sub-Saharan Africa to rural health clinics in California, increasing provider reach.
Here is an excerpt:
There are many examples of telehealth in HMI [health microinsurance] schemes (typically telephone contact with a nurse or doctor).
‘Dial-a-doctor’ programmes are already reaching millions of members of large HMI schemes, as shown in Tables 1 and 2 (below). Unsurprisingly, tech-savvy youngsters under 40 have proved to be the earliest adopters.
…m-Health not only increases efficiency but has huge potential to change health-seeking behaviour. This in turn could translate to significant savings for entire healthcare systems. With recent experience in Africa, Jonathan Govender of Bupa sees shifting customers’ behaviour towards trusting mobile interactions as a key challenge. In the UK, Vitality has just launched its new app, ‘Vitality GP’. Time will tell whether we are ready for video chats with our doctors in the UK rather than face-to-face visits. Available to all members, the Vitality app provides direct access to a private GP from home or anywhere, video consultations within 48 hours, calls to doctors 24/7, direct referrals to consultants and delivery of written prescriptions.
…m-Health is increasing provider reach, effectiveness and productivity as much as it enables consumers to move to the centre of the healthcare universe and to receive care more naturally in daily life, whether in emerging or developed markets.
As this relatively young technology matures, generates more insightful data, and comes to be better understood, it may help propel provider and insurance transactions beyond the zero-sum logic that has historically limited options for patients.
Health insurance models vary from country to country. As highlighted in our first series of articles on international health markets, governments often dictate the role of private and public health insurance within any country. Milliman has produced a new series of blogs focused on the medical underwriting and risk adjustment practices of eight countries: Australia, Ghana, Ireland, New Zealand, Saudi Arabia, South Africa, Spain, and United Arab Emirates. This is the fifth article in our series.
South Africa’s health system consists of a large public sector and a smaller but fast-growing private sector—these two sectors are essentially disconnected and exist in parallel. There are also a few non-government not-for-profit organizations that are considered part of the system. These three sectors form the national health system under the stewardship of the Minister of Health.
The public health system is a tax-funded system that provides free primary healthcare to all citizens. At hospital level, payment for services is means tested—in 2011, anyone with an annual income over ZAR36,000 (about US$4,000) has to pay partly and those with annual incomes over ZAR72,000 (about US$8,000) must pay in full. The model is based on a referral basis for escalating a patient through the levels of care. The entry point is a community nurse who may seek guidance from a general practitioner.
The Atlantic reported last month about an unconventional aid organization in Pakistan that appears to be overcoming some of the barriers to traditional aid programs:
So while USAID is very good at quickly mobilizing assistance to disaster-afflicted communities, it carries a lot of political baggage — so much so in places like Pakistan that the U.S might be better off in the long run by downsizing USAID’s direct activities there and working through alternative programs.
One good model might be the Rural Support Programmes Network. A sprawling collection of local NGOs, the RSPN was founded by the Agha Khan Network in 1982, and has since become its own, separate program. While the stats about its reach are impressive — reaching millions of the poorest homes across a vast swath of Pakistan — what’s especially fascinating about RSPN are its methods.
Put simply, RSPN has a different focus than normal aid programs. They emphasize the development of institutions first, and only after that institution is established do they worry about its output or performance. The NGO also heavily invests in the smallest scale of the community, from conceptualization to execution, hiring mostly locals to administer projects. Lastly, they have extraordinarily long project timelines — sometimes as long as 15 years from start to finish.
RSPN’s activities might be of interest to readers of this blog because they run a significant health microinsurance program:
But the most interesting project RSPN has done in rural Pakistan is a collaborative micro-healthcare insurance system. For very little money — $3.50 a year in some cases — poor people can get access to basic medical care (especially maternity care) and assistance if they face hospitalization.
The earthquake in Haiti has called attention to the role that micro-finance can play in developing countries, especially following a catastrophe. The largest microinsurer in Haiti was in a position to respond more quickly than many traditional financial entities, a story reported in Newsweek last month:
Hollywood couldn’t have done it better. Late in the afternoon on Jan. 22, an armored car packed with $2 million in cash rolled out of J.P. Morgan Chase headquarters in downtown Miami, headed to the Homestead Air Force Base. Thirty-four bricks of bank notes packed into ordinary office supply boxes were loaded onto a C-17 transport plane redeployed from Langley, Va., and dispatched to Haiti, lighting up switchboards at the United Nations, the U.S. State Department, the Federal Reserve, and military rescue bases in Port-au-Prince.
Before dawn the next day, the stash was on a helicopter bound for 34 branches of microlender Fonkoze. While Port-au-Prince’s nine commercial banks were in a shambles and Western Union was paralyzed, half of Fonkoze’s 42 agencies were up and running in four days, and all but two of the rest within a week. The amounts were trifling: no more than a few dollars per client. But for tens of thousands of desperate Haitians, the nimble infusion of cash amid the chaos and ruin literally meant survival. For the legions of aid bureaucrats, charities, civic groups, and emergency organizations struggling to get a grip on the Western hemisphere’s worst natural disaster in memory, Fonkoze’s nationwide client base of 200,000 depositors (50,000 of whom are also borrowers) was a ready-made lifeline. Could microcredit be the new Red Cross?