ACCESS Health hosted its sixth session in the virtual Fintech for Health Special Interest Group (SIG) series on March 30, 2022. The Fintech for Health team in India continues to engage fintech and healthtech players to share knowledge, have dialogue with each other, and catalyze the creation of new partnerships and models to support health financing for low- and moderate-income populations. With support from MetLife Foundation, ACCESS Health 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.

ACCESS Health and Pfizer launched a white paper on “Strengthening Universal Health Coverage in Asia: Opportunities for Innovation in Private Health Insurance,” focused on India alongside four other markets in the region (Malaysia, Indonesia, Thailand, Vietnam). In this paper, we put forth different private health insurance innovation models and recommend an ecosystem approach of diverse stakeholders – insurers, digital companies, pharmaceuticals, non-profits and government players – coming together for the development and deployment of private health insurance for the masses to cover high quality healthcare that is often out of reach for the majority of people. You can find our full paper here.

In the sixth session, thirty representatives from leading healthtech, fintech, payment banks, non-profit organizations, insurance companies, and pharmaceutical companies participated. The objective of the sixth session was to describe the landscape of innovative insurance models that are helping to bring affordable insurance to the masses. These models are powered by digital advances and innovative partnerships between traditional insurers, fintech, health tech pharmaceuticals, nonprofit organizations, and other entities. This multistakeholder approach entail partnerships along the insurance value chain. The session focused on significant opportunities in India for an ecosystem of private and public actors to reinforce Ayushman Bharat-PMJAY goals by incentivizing the private insurance innovations to bring greater financial protection to the masses.

Insurance innovations trends and opportunities in India
Health Insurance is a powerful mechanism of financial protection. While many governments have tapped into public mechanisms for health insurance (termed social insurance), private insurance remains largely undertapped as a health financing mechanism for the masses. Launched in 2018, the Ayushman Bharat program comprises of two components that collectively underpins India’s continuum of care approach to Universal Health Coverage (UHC), namely establishment of health and wellness centers (HWCs) and a social insurance scheme for the poor, the Pradhan Mantri Jan Arogya Yojana (PMJAY).

  • The health and wellness centers provide free comprehensive primary healthcare to all Indians, with an emphasis on a community-based approach.
  • PMJAY aims to provide health protection cover to a subset of Indians who are deemed to be the most vulnerable to financial risk from catastrophic health episodes.
  • PMJAY aims to reach some 500 million beneficiaries who form the poorest 40% of the Indian population.
  • India has ~50% uninsured population with only 12% covered through private sector insurance.
While significant progress has been made, countries face three fundamental health policy challenges: achieving UHC requires a balanced approach across the three dimensions (financial protection, services and population); countries are facing strained UHC budgets with significant deficits; and the growing tide of noncommunicable diseases threatens to overwhelm health systems. There can be three approaches of innovative models of Private Health Insurance to support the achievement and sustainability of UHC:

A multistakeholder approach anchored around PHI will provide the structure and design to reinforce UHC system goals and stability. An ecosystem approach is needed to not only design the insurance, but to ensure its uptake through a few policy enablers which can be pilot testing of the insurance or regulatory sandboxes.

  • Models to sustain UHC were showcased: This included (1) Singapore’s Integrated Shield Plan a supplemental Insurance. The Integrated Shield Plan (IP) builds on the mandatory state insurance, MediShield Life to provide supplemental coverage. The Integrated Shield Plan gives consumers the option to buy supplemental or “top-up” insurance that is more affordable than traditional private health insurance packages. Consumers can access a wider range of health services without having to incur large OOP payments. (2) China Million RMB Insurance by Zhong An, a mass insurance. China’s Million RMB Insurance encompasses 4 key features that enable it to fill the gap between state insurance and high-end medical policies: High sum insured while keeping premiums low; High deductibles; Coverage is above basic medical insurance and using technology.
  • Models to address NCD burden were showcased: (1) Yaoshenbao Anti-cancer Special Drug Security Plan a specialty drug insurance. While several markets (like China) have National Reimbursement Drug List (NRDL), many innovative drugs are not covered posing a heavy economic burden on patients. Having specialty drug insurance with low premiums allows patients access to expensive drugs that are necessary for treatment for major disease and have no alternatives. Four companies collaborated to form the insurance product with Value-added services instead of compensation for expense and convenient enrollment. (2) FWD Insurance (multi-market) a disease specific insurance. While the case study showed details from the cancer insurance plan that FWD offers in Singapore, the company also offers similar products in Malaysia (FWD Care Direct), Vietnam (FWD Cancer Care), Hong Kong (CANsurance), Thailand (Cancer Fighter Health Insurance) and Indonesia (FWD Cancer Protection). Disease specific insurances provide reimbursement or lump-sum payout upon diagnosis or treatment, thus offering financial protection where high medical bills, inability to work and loss of income are probable. They offer value-added services tailored to needs and enables convenient distribution of insurance plan on online channels
  • Models to reinforce prevention were showcased: (1) Prudential Pulse (multi-market) provides prevention and wellness benefits. Prudential Pulse is a free mobile application available to users in 13 markets in Asia (Cambodia, China, Hong Kong, India, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Taiwan, Thailand, Vietnam) and in Africa. Such models empower users with technology and by keeping clients healthy in turns helps prevent large claims related to the onset of a condition and resulting medical intervention. (2) MSIG-S’pore Cancer Society Partnership, for integrated education and awareness. MSIG and Singapore Cancer Society (SCS) have entered a long-term collaboration of 3-years to advance public awareness on cancer risks. The model engages policyholders on proactive health management with the aim to minimize risk of disease and prevent disease progression and complements existing insurance plans. (3) Malaysia’s MSIG Gluco Safeguard, ensures biomonitoring to incentivize healthy behavior. The MSIG Gluco SafeGuard insurance provides comprehensive coverage for the wide variety of illnesses and treatments similar to normal health insurance plans, but with additional protection and assurance for diabetic patients through incorporating biomonitoring. This model enables, peace of mind to patients with pre-existing disease, additional protection and assurance; and promotes autonomous health management.
    The discussion highlighted some of the key challenges with the current state of insurance product design which do not provide outpatient insurance plans as issues of fraud and abuse are very real. There is need to collaborate with companies who have managed fraud and authentication in finance and UPI well or used biometrics and apply their experience into healthcare.
There’s a disconnect between what’s recommended by the government in their recent Niti Ayog report for missing middle on various options offered for the missing middle including expanding private voluntary insurance through commercial insurers and its suggested implementation process and plan.

Process discussion needs to happen by bringing in different stakeholders, technology companies, policymakers before we go with PMJAY as supplemental plan. A pilot testing of model in the private setting through collaboration would be ideal. The “How To” of implementation needs to be figured. The process discussions need to focus on the product design to offer macro level solutions so they can aggregate and address risk.

In India, private health insurance covers approximately 12% of the population, and 66% of all health expenditures. Healthcare in India is plagued by challenges around Access, Affordability and Quality. Sixty three percent of the Indian population has to spend Out-Of-Pocket (OOP) to access healthcare services. The increasing cost of quality healthcare combined with greater need and demand for health with increasing incomes, higher life expectancy, and epidemiological transition towards non-communicable diseases have made health coverage imperative. In the absence of a low-cost health insurance product, the missing middle remains uncovered. There is significant opportunity for an ecosystem of private and public actors to reinforce Ayushman Bharat-PMJAY goals in India by incentivizing the private insurance innovations to bring greater financial protection to the masses.

There are innovative on-demand and/or subscription-based health insurance solutions in the market which aim at breaking affordability, access and awareness gaps. However, the success of these new-age models is yet to be established as market friction remains and the need for intermediaries continues. For UHC to be successful and sustainable, new approaches are needed to support national insurance programs. Private health insurance is important, but underutilized. The opportunity is significant where uptake of private health insurance is still low, digital use and penetration is high, and government policies are supportive of innovation. The government needs to improve consumer trust and confidence in health insurance through stronger regulatory mechanisms and most importantly, be supportive of customizable innovations to cater to the mass population.

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.

Authors: Sireesha Perabathina, Senior Consultant at ACCESS Health International For more information contact [email protected]