Emerging Innovation of

Health Care Delivery in Developing Countries

ZheeChong Koh - Product Actuary, Medical Insurance

Swiss Re Services India Private Limited

Examples of health care challenges in developed

countries: over-diagnosis, lack of R&C tariff,
exclusions of high risk patients, and access to
wellness programs

In developing countries, challenges around

having access to basic medical care are far more
serious.

Key Objectives of Session

To understand the unique challenges that developing countries
face in delivering health care
To study the outcome of various emerging innovations seen,
and to understand key success factors
To replicate these models in a larger scale, and to explore
potential health care delivery model which will further increase
health care penetration in developing markets
Note: will focus on models with some extent of voluntary
enrollment and/or contribution
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In India, 56% (680M people) of the population

fall short of "Empowerment Line", and can't
afford private medical insurance

National Sample Survey Office survey, 68th round; McKinsey Global Institute analysis

Challenges Developing Markets

Cost of health care
Unaffordable
Rely on government subsidy

Availability of coverage
Low coverage, limited
procedures
Lack of primary care

Distribution
Lack of awareness
High cost of outreach

Operational challenges:
Ineffective enrollment process
Underwriting challenges

Health care supply

Lack of hospitals, doctors and
medical practitioners
Substandard quality of
healthcare facilities, and
healthcare providers

Claims management
challenges
Pre-existing conditions
exclude or include?

Frauds and abuses

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Challenges Developing Markets

Private insurers have little appetite for or experience in health insurance for the
mass market 1:
Lack of reliable data for accurate pricing and product development
Acquisition cost out of proportion to the small premiums
Inability to access reinsurance at reasonable rates
Costly and complex administration, sales and education
Poor service quality by health providers and high cost of management

1: http://www.microensure.com/products-health.asp

Emerging Innovations

Distribution increasing awareness, increasing outreach

PMJJBY, PMSBY India

Background:
18 million new bank
accounts in one week
190 million accounts as
of Oct, 2015
110 million enrollment
under PMJJBY +
PMSBY
Success Factors:
Financial inclusion +
insurance coverage
Heavy promotion by
government
Easy enrollment
process
Low premium level

Mobile Insurance Cover E Africa

Background:
Handles the
insurance
partnerships and
claims
administration

Provides technical
interface, agency
force to register
users, and other
supporting functions

Microfinanc
e Specialist

Mobile
Technology

Various tiers of life and

hospitalization coverage
Premium paid via deduction from
the customers airtime balance
Mobile money used for claim
payments (much quicker)
600K families covered in Tanzania

Provides the
subscriber base
Markets the
product

Other projects: Bangladesh, India,

Kenya Ghana
Key Success Factors:
Establish strategic partnerships

Mobile
Provider
https://www.hfgproject.org/wp-content/uploads/2014/05/Mobile-Money-CaseStudy_MicroEnsure.pdf

Training sales agents about

health product and mobile money
Design payment mechanisms for
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users.

Emerging Innovations

Access to Comprehensive Health Care Primary Health, Vision Cover

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SughaVazhvu Thanjavur, India

Comprehensive primary care model at decentralised levels in Thanjavur district
Detailed Mapping and
Enrolment

Risk Assessments

Defining the catchment

of a Primary Care
Centre

Defining services of a
Primary Care Centre

Profiles and roles of

primary health care
staff

Training and capacity

building

Treatment Protocols

Health Management
Information System
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Reference: http://www.brookings.edu/research/reports2/2015/04/india-diabetes-care-management-rural-mcclellan

Aravind Eye Care Madurai, India

Carry out high quality

process at low cost

Follow the idea of

reproducibility

High productivity due

to process innovation,
driven by close
analysis of value
adding time

Economically self
sustaining model
revenue from paying
patients > cost to
majority

India = quarter of worlds

blind, major cause is
cataract.
Treated 29M patients +
performed 3.6M eye
surgeries, avg 2K
surgeries/year
Worlds largest and most
productive eye-care service
Complication rate is half of
that in UK NHS

Three horizon strategy

concept

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Reference: www.wileyeurope.com/college/tidd

Emerging Innovations

Technology - as enabler for improved accessibility

and availability of health care supply

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Portable Ultrasound rural China

Leveraging on existing technology / infrastructure
Laptop with special software becomes portable ultrasound
Developed by General Electric, costs 15% of GEs high-end ultrasounds
Performance is compromised but still very useful for rural clinics
Also useful in developed countries for emergencies
Made possible by empowerment of a local team
Commercially and strategically makes sense for companies like GE to do
this reverse innovation, not just for profits but also for survival

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Reference: http://internetmedicine.com/vscan/

Odon Device Development Phase

Empowering medical practitioners through equipment
A prolonged 2nd stage of labour is a major killer of women in the developing world and
yet the three tools available for assisting delivery (forceps, vacuum extraction and
Caesarean section) often arent available in low-resource countries
Odon - A device to assist delivery during labour with complications
Low cost, simple device that can be used by midwives without doctor supervision
Safer for both mother and baby
Could help to reduce Caesarian births in developed countries
Currently being tested in WHO-sponsored clinical trials, with positive results

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Reference: http://couldhavebeenbetter.com/odon-device.html#.ViL67P7ouM8

So what have we learned? How

can we create a sustainable
health care model to increase
penetration in developing
countries?
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Sustainable Health Care Model

VOLUNTARY
Banks,
MFIs,
Utilities
Cos,
Telcos

Insurance
Company
(risk
taker)

Preventive
Services,
including
Screening

Primary Care

APL,
middle
class with
no govt.
subsidy

Prem Pmt

Secondary +
Tertiary Care

(1) Primary Care Group + Hospitals, (2) Provider group including PCPs

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Key Success Factors/Challenges

Marketing and awareness
Distribution: Cost effective, vast reach, simple enrollment, efficient payment
Provider network: needs to be restricted and with tariff rates
Tiered network with differential co-payment or premium contribution
Good hospitals <> expensive hospitals
Primary care:
Capitation model (rate needs to be sustainable)
Quality and access control (including treatment protocol)
Upskilling of medical practitioners
Secondary & Tertiary care:
Outcome based provider payment?
Single provider group?
Reliable and low cost Health Management Information System
Premium level needs to be affordable
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Of all the forms of inequality, injustice in

healthcare is the most shocking and
inhumane.
- Martin Luther King Jr.

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Thank You