Financial Inclusion for Universal Health Coverage Summit 2022
ACCESS Health International Southeast Asia co-hosted the Financial Inclusion for Universal Health Coverage Summit on October 18, 2022 with the Institute of Insurance and Risk Management, Hyderabad. The summit was attended by start-up founders, central and state government representatives, insurance companies, industry, academicians, development sector partners and experts. The summit brought together a diverse set of stakeholders and actors from various sectors including health, finance, and technology.
The summit achieved its goal of engaging stakeholders to brainstorm and echo ideas that pave the way to innovation, development, and distribution of digital financial services that help achieve financial inclusion, better health, and ultimately, universal health coverage for the people of India. The stakeholders engaged through two empowering panel discussions on innovation and distribution of digital financial services for health respectively. Panellists for the event included experts from both public and private sector. The summit also included insightful presentations on fintech landscape and opportunities in India based on the report by ACCESS Health International Southeast Asia and on the application of e-RUPI by National Payments Corporation of India (NPCI).
The summit discussed numerous ideas and approaches on a variety of topics including health financing, financial inclusion, digital transformation, and primary healthcare. It sets the stage for ACCESS Health International Southeast Asia’s upcoming initiatives and activities in India and beyond on integration of digital financial services and health.
Key insights from the discussion:
India’s journey to achieve universal health coverage and better health for all
The summit began with Insurance Regulatory and Development Authority of India (IRDAI) calling to identify synergies between stakeholders to collaborate and create a 360-dimensional change in India’s health ecosystem. IRDAI expressed strong optimism for meaningful outputs from the summit while, emphasizing the learnings from the lessons learnt during the COVID-19 pandemic management in India, especially with health service delivery and financing. Mention of some of the critical issues, such as: lack of knowledge and understanding of the health financing needs, innovative practices for vulnerable populations, reduce the pain points in the health and financing ecosystem, identify synergies and collaboratively work to bridge the gaps between sectors and the system that hamper the collaboration between private and public systems of the country in the area of health service delivery and financing set the stage for rest of the day.
NITI Aayog laid the foundation of the summit by pointing out nature and capacity of public sector initiatives under Ayushman Bharat including the Pradhan Mantri Jan Arogya Yojana (PM-JAY), the social health insurance for the lower income populations, Health and Wellness Centers (AB-HWCs), the primary-level healthcare initiative, National Digital Health Mission (ABDM), the digital health ecosystem initiative, and the Health Infrastructure Mission (ABHIM), the public healthcare infrastructure development initiative by the Government of India. Shedding light on the challenges and pain points, NITI Aayog expressed the difficulties in development of a model which is sustainable, affordable and can address all the challenges regarding distribution, volume and outsourcing for improved private sector collaboration. Laying down government’s priority to prevent families going into poverty due to medical expenses, NITI Aayog expressed the need for private sector to closely work with PM-JAY and ABDM while leveraging fintech, which has been a game changer in terms of financial access for people.
Opportunities for Fintech in India’s healthcare ecosystem:
Echoing the objective of universal health coverage, ACCESS Health International Southeast Asia began with a presentation on fintech for health and pathways for UHC through financial inclusion and technology. Nourishing the summit with comprehensive and articulated insights, the presentation provided various forms of digital financial services that have been conceptualized and available. Drawing on the work done in Bangladesh, Vietnam, Malaysia, Indonesia, Nepal, China, and India, the presentation showcased the impact of integration between digital platforms and traditional financial services through use of digital wallet, digital ID, and analytics. Focusing on India, the presentation delivered the role of community level care and the complementary nature of digital financial services to PM-JAY and other public programs in health through the lens of affordability and accessibility for lower and lower-middle income populations. The presentation further contextualized the use of digital financial services through personas representing lower and lower-middle income people incurring medical expenses. ACCESS Health International Southeast Asia shared their vision to bring together public sector and the private sector with innovative startups and companies that are looking to make a difference to the people.
Delving further into India’s health and fintech ecosystem, the second presentation from ACCESS Health International Southeast shared the recently published report to showcase opportunities and challenges for digital financial services in the country. The presentation provided a comprehensive profile of India in terms of the health systems, fintech and health-tech startup landscape, and numerous initiatives created by the public and private sectors including Unified Payments Interface (UPI), e-RUPI, Unified Health Interface (UHI), Jan Dhan Yojana, digital wallets and applications. The presentation provided data-driven insights through enabling factors and a quantitative index that showcased the potential and scope for digital financial services in health. The presentation further shed light on 24 opportunities conceptualized by the authors and detailed the country-specific solution for India that is elaborated in the report. The presentation concluded with elaboration on the India solution that built upon the foundations of UHI and UPI to create a fintech-enabled interoperable health ecosystem that can be leveraged by the government, healthcare providers, hospitals, and most importantly reduce the out-of-pocket expenditure for the lower and lower middle-income populations. These presentation set the context and provided the participants with a window into the wide and impactful scope for digital financial services in healthcare.
Development of affordable innovations in digital financial services for health:
The first panel discussion at the summit was focused on deliberating private-sector led development innovative and affordable digital financial services for healthcare needs of the lower and lower middle-income populations. The panel included representation from fintech and health-tech startups including Clinikk, Navia Life Care, and DigiSparsh along with TPAs and insurance companies such as MediAssist and Aditya Birla Insurance.
The panel discussion began with discussion on the impact of COVID-19 where Navia Life Care mentioned how the pandemic created a positive behavioral change among health providers as adoption of telemedicine, Electronic Health Records (EHR), and broadly digital technologies became a norm. DigiSparsh further added from their experience of being a COVID-era startup that they witnessed a behaviour change among care seekers including patients even at the rural level. The behaviour change comprised of increase in people’s affinity to receive services such as diagnostics, pharmacy and consultations at their doorstep or in the neighborhood. The virtual channels of health seeking opportunities help patients not incur out-of-pocket expenditure from travel to urban or semi-urban facilities. Providing examples of an innovative solution, DigiSparsh elaborated on how they are able to provide zero percent interest loans to people in need of health loans. DigiSparsh also envisage to bundle healthcare lending with insurance for patients to achieve health coverage, thereby minimizing the need for another loan in the future. Discussing the considerations while designing insurance and financial services products for people, Aditya Birla Insurance stressed on the importance of primary healthcare and the role of regular outpatient services. Aditya Birla Insurance further elaborated on the need to eliminate informality in the health sector through well-defined primary care practices especially for services such as cancer screenings. This would further help bring in innovative approaches to pricing and risk pooling from the insurers. The panel further discussed the role of digital platforms in helping deliver the wellness and preventive care while also providing the insurance industry with and massive scale potential.
Clinikk healthcare pointed out that leveraging these platforms effectively through various payer models with both pharma and insurance companies, bundling of outpatient services and creating a product for the general population or the missing middle is a challenging task. MediAssist showcased Employee State Insurance Company insurance as a potential model that can cover the missing middle population. The panel including private sector and startups engaged in an interactive dialogue with the audience which included experts from the government, regulatory bodies, public sector insurance companies, and the development sector. The exchange highlighted key issues affecting the collaboration between the public and private sector especially through the lens of price structures and inclusion of private hospitals. The key takeaway from the exchange included the imperative need for stakeholders to put together a price structure for products that can be adopted by the masses and will also support the private sector. The discussion also highlighted the importance of data to test and explore innovations in niche areas such as non-communicable disease management and behavior change for target segments such as young populations and the elderly. The discussion noted that the development partners and think tanks can play a critical role in not just research but also, in partnership building and problem solving to bundle the solutions to provide integrated health services.
Clinikk further elaborated on the impactful role played by integrated health services which bring together inpatient health coverage with outpatient services supported by protocol-based care which is technology-driven. Protocol-based care is also in line with the Ayushman Bharat Digital Mission (ABDM) which aims to build an AI-powered protocol engine for healthcare delivery in the future. Such models can be beneficial to patients with chronic illnesses and noncommunicable diseases along with the general population looking to lead better health. Using subscription-based models for delivery of these integrated health services can make it affordable and accessible for all.
The last segment of the panel discussion included a comprehensive exchange between the audience and the panelists around adherence to protocol-based care and implementation of managed care models. The discussion resulted in government representatives setting up clear requirements from the private sector to help reduce the out-of-pocket-expenditure through innovative models. The participants of the summit all concurred on the need to create multiple financial options for the patients while working with the government to keep the health services affordable.
Distribution and scale of finance and technology solutions:
The second panel discussion at the summit discussed the large-scale distribution of innovative and affordable healthtech and fintech solutions that cater to the lower and lower middle-income populations. The panel included representation from potential distributors and experts playing a key role in the ecosystem including WhatsApp, Jio Health, and Mr. Sachin Aggarwal, a digital health expert.
The panel discussion began with Jio Health emphasizing the need to reimagine healthcare from the perspective of self-use and leveraging the existing infrastructure and functions. Jio Health stressed on the importance of finances and health coming together to create accessible and affordable solutions which are data-driven. WhatsApp elaborated on the importance of taking a solution to the consumer for services and products that make healthcare more affordable and accessible for them. Accessibility and empowering consumers with the needed information about healthcare services can be further reinforced through use of existing, popular platforms such as WhatsApp as delivery vehicles. Mr. Sachin shed light on the association between financial services, telecom services and potential for massive scale. Mr. Sachin discussed the fragmented nature of pilots in the ecosystem and the lack of scalable solutions due to the missing role of government and private aggregators from these pilots.
Speaking on the role of WhatsApp in overcoming the barriers for achieving scale, the scale of WhatsApp was attributed to the evolution of services that was led by consumers. WhatsApp also mentioned how engagement is driven through adaption, simplification, and access which can be further improved by breaking down the literacy barriers to technology and finances. Health insurance is a push product and leveraging big data, engagement, and literacy to help consumers realize the value of health insurance through platforms such as WhatsApp would drive scale. Jio Health further added that ensuring well-being and a healthy population would be beneficial for everyone in the ecosystem. While discussing wellbeing and healthy behavior as a possible distribution channel, Jio Health noted the importance of personalizing and customizing the experience for the users. WhatsApp and Jio Health both concurred and noted that digital distribution platforms will play a crucial role to facilitate and ensure quality patient journeys both from a user experience and accessibility perspective.
Discussing on the potential scale for insurance products in the country, Mr. Sachin pointed the role of government and various ecosystem players who could help reduce and subsidize costs, especially through diagnostics and medicines. The panel together envisaged and discussed the development of a platform which can act as a rewarding platform for improvement to health. The platform can be further strengthened by bringing together insurance and financial rewards as outcomes for healthy behavior. WhatsApp further added that the organic growth of WhatsApp has helped them learn that affordable and organically grown financial services such as insurance and investment management can reach people, even in rural areas, through digital platforms. The key to leveraging digital platforms is to reduce the cost of the products by reduction in operational costs of running the product or service itself.
The panel discussion concluded that ecosystem partners and startups that work on care centres, medicine delivery, managed care models, protocol-based care and others, need to work together with government, funders and institutional partners to serve people while ensuring the business potential for the private sector.