|ACCESS Health hosted the fourth session in the virtual Fintech for Health Special Interest Group (SIG) series on January 122022. The Fintech for Health team in India continues to engage fintech and healthtech players to share knowledge, dialogue with each other, and catalyze the creation of new partnerships and models to support health financing for low- and moderate-income populations. ACCESS Health, with support from MetLife Foundation, created the Fintech for Health platform for innovative solutions that enable low- to moderate-income people in Asia to pay for and access high quality care using digital financial services and a financial inclusion approach.
Twenty-five representatives from leading health tech, fintech, payment banks, and insurance companies participated in the fourth session. The objective of the fourth session was to showcase digital savings and health wallet, innovative health financing solutions that can be offered using technology. Discussions spotlighted two of the financing solutions applicable to healthcare on a health wallet by MILVIK BIMA and a digital health savings account with a health risk score by Fedo.
BIMA Health Wallet – A Monthly Subscription Model
BIMAis a global firm which focuses on serving ~ 2 billion people in the global emerging middle class. Typically, traditional insurance products do not cater or focus to this segment of the population, a consumer base that frequently uses smartphones and mobile wallets. The majority of this population doesn’t have health insurance, and in the event of a healthcare need, people either go to a nearby chemist, who is like a proxy to a doctor, or in an adverse event, seek loans, pawn gold, or end up in debt. BIMA is present in South Asia (Sri Lanka, Bangladesh, and Pakistan), Southeast Asia (Indonesia, Malaysia, Philippines, and Cambodia) and Sub Saharan Africa (Ghana and Tanzania). It offers health insurance protection to families who do not have access to healthcare through its flexible and affordable digital health subscription, both offline and online.
A bundled subscription model, through a cashless health wallet platform accessible through both smart and a feature phone, was launched in the last quarter of 2020offering health insuranceto cover outpatient and inpatient services, primary and specialist care via telemedicine, pharmacy, lab tests and home health kits to its subscribers.The product is channeled through various mobile walletsfor payments, provides easy signup mediums, health data management from the medical consultations, and allows beneficiaries to visualize health benefits associated with their subscription. This health walletprovideshealth points for timely subscription payments and enrolling in health programs to improve health seeking behavior that can be used as discounts, since there’s an open API; the platform allows non-governmental organizations and governments to make partial payment for health programs, allows peer-to-peer health points transferto support another friend or family member and integrated with multiple payment channels.
The discussion highlighted that a traditional insurance setup, the premiums are charged annually and for a middle-income beneficiary to pay for a big chunk of amount at one time can be a limitation from buying a policy. A cashless health wallet with a monthly subscription can come in handy to address the segment which doesn’t have a steady income but can also avail cashless healthcare for outpatient, inpatient services, pharmacy and lab tests etc. BIMA accounts for any defaults in subscription payments in its monthly premium.
FEDO: A Digital Health Savings Account (HSA) with a Health Risk Score
The rising cost of healthcare, especially during the Covid-19 pandemic, has impacted millions of families in the country. While health insurance plans provide respite to some extent, individuals and families end up spending a large chunk of their health budget on pre- and post-hospitalization expenses. Health insurance products in the market may not answer most of the needs identified for the low- and moderate-income segment, especially which can also promote preventive care; and provide access to affordable and quality healthcare.
FEDO, a Bengaluru-based startup, came with a solution to this problem with the launch of aHSA. FEDO presented their product on digital health savings with an enabled health risk score to predict and plan health expenses. The HSA is powered by robust AI algorithms that can predict an individual’s health risks and possible medical expenses. At the heart of FEDO’s algorithms lies the FEDO Score which is a credit score for health, like a CIBIL or a FICO Score in the financial world.The HSA in combination with FEDO Score and deep tech analytics platform lays the foundation for a holistic healthcare ecosystem from an individual’s perspective. The core objective of the platform is to enable customers to manage healthcare expenses using a combination of services such as HSA, insurance, wellness, and disease management programs.FEDO provides the individuals with a financial platform -HSA, with a right assortment of health/life insurance along with an individual’s savings which can be offered depending on the health status of the individual and his/her family members.Along with this, the savings will provide better interest rates than the normal savings account. It will give an individual the freedom to choose the amount of money that can be kept aside for healthcare costs. It also gives the control over how that money is spent depending upon quality and costs.Medical emergencies break the financial and emotional backbone of a household. With HSA, the households can manage the unexpected medical emergencies and the healthcare costs associated with it more effectively and independently. The entire process is digital and accessible via a mobile application and internet banking. There are pre-approved loan offers. Also, an array of easy credit card management services is offered for a seamless experience.
FEDO provides recommendations on a combination of healthcare financing options including a boutique of insurance products that will ensure minimal out of pocket expenses for an individual’s course of life. There will be no minimum amount. The amount will be based on the certain parameters present on the case like health status of the individual, FEDO Score, CIBIL Score etc.FEDO Score is a holistic indicator of future health risks. It is created on the principle that the first step in managing or preventing lifestyle diseases in an individual is the detection of the propensity of such a disease.
What these models mean for financial protection in India:
In India, with the low penetration of health and life insurance which mostly focuses on in-patient healthcare expenses, a person spends three times the hospitalization expenses for pre and post hospitalization expenses which is usually not covered by insurance. Sixty-two percent of the total health expenditure in India is paid out-of-pocket as compared to the world average of just 18.2%. There is a large gap between the financial needs of an individual related to health and the current healthcare finance needs are catered by unorganized money lenders and gold loans in the market. Studies have highlighted that more than 55 million families went bankrupt in 2020 due to medical expenses. Although the insurance sector is working towards bridging the gap, the change is not drastic. This Special Interest Group fourth session dug deeper into the potential use of Fintech for Health models and how these can expand to unreached populations. Overall, the session highlighted:
Have more to add to the conversation? Read more about the Fintech for Health program here. If you have questions, or would like to work with us, please email us here.
Please see blog post on the next Special Interest Group Series Launched in India here
Authors: Sireesha Perabathina, Senior Consultant at ACCESS Health International
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