5 Disruptive Innovations in Health Insurance You Should know About

32% of the total healthcare expenditure worldwide comes from OOP payments and over a 100 million people are pushed into poverty each year because of these OOP payments.

The need for health insurance is more acute today than ever. The World Health Organization (WHO) push for universal health coverage (UHC) and unsustainable government contributions to healthcare expenditures mean the private insurance industry needs to fill the void.

While major world economies have near 100% public insurance coverage however in the developing world majority of the world’s population is yet to be covered. China, India, Brazil, Russia, and Mexico, with high out-of-pocket (OOP) and high private spends on healthcare.

Given the very nature of the different markets, the developed ones emphasise on cost reduction of the insurance, while the others concentrate on increasing coverage. Several models of innovations exist in different regions of the world for health insurance and adjunct sectors, and yet some areas remain unaddressed from an innovation point of view.

Health Insurance Innovations

Voluntary Dengue Fever Insurance – To improve awareness and affordability in Indonesia

 Although an illness such as Dengue fever can cost up to 3.5 million Rupiah for hospitalisation for 5 days, people in Indonesia are reluctant to pay monthly premiums for incidental accidents or illnesses. Besides, many believed the claims processing was very difficult and complex.

The innovation approach has been more operational focused on reducing costs and improving awareness.

Insurance voucher cards were introduced with a premium of USD 4 (coverage of $150). These cards can be picked up at super markets, convenient stores, post offices etc. Vouchers scratched to reveal PIN, which is used to enter covered persons’ information using text messaging.

Vouchers are for single disease treatment to keep costs low and cell phone based claims process makes claims easy and real time

Telehealth + Microinsurance Product – Improving Insurance Coverage in Kenya

Kenya has 1 doctor for 100,000 people—a serious healthcare access issue. To leverage telehealth to solve this issue, Cannon Assurance, a private insurance firm, in association with Safaricom, a communications provider and Hello Doctor, an international mHealth solutions provider launched Sema Doc, the membership to which comes loaded with microinsurance.

For a low membership fee of KSh 300 per month, members get access to a health savings account, hospitalization cash benefit of up to KSH 5,000 and medical loans of up to KSH 10,000

Mobile Microinsurance – Catering to the low-income group’s health insurance needs in Tanzania

Only 18% of Tanzanians are covered by health insurance, mostly employer-based. High, unaffordable insurance premiums are cited to be a major reason for such low coverage rates.

BimaAFYA is a unique micro-health insurance product that has proven to be the most affordable solution available to Tanzanians. It is backed by a completely mobile-based platform.

With a technology back-bone, BimaAFYA has a completely paperless process from registration to claims, allowing it to eliminate 99% of the administrative costs and provide insurance cover at extremely cheap premiums beginning at $1 (TZS 2,700).

Health Products Marketplace – Health payer to e-commerce participant in the UK

Health insurance is the only business that makes (saves) money by making people healthier—fitness apps, wearables or social networks, or even e-Commerce websites do not.

Realizing this, AXA PPP Healthcare started an eCommerce platform, MyActive+, to sell discounted health technology and other wellbeing products and services.

The rationale behind the platform is to enable customers to take charge of their health and health decisions and drive healthy behaviors. The platform offers 6,000+ health products including beauty, diet and nutrition, sports & fitness, independent living (mobility) as well as fitness courses

Order fulfillment is the responsibility of suppliers, with whom preferential discounts are negotiated for members. AXA’s goal is to improve the health of its member base and bundle free health coaching with its products. Pricing is not competitive when compared to Amazon or other platforms.

Behavioral analysis helps categorize users into segments to decide which products and incentives would most likely tempt an individual.

Simplifying Insurance – Improving coverage, reaching mass markets in India, the Philippines and Ghana

MicroEnsure, an insurance intermediary, partners with telecommunications companies and other local distribution partners. It provides simplified health insurance products to mass customer bases, a majority of which tend to be new to insurance.

Simplification –

  • Enrolment through SMS and USSD Codes
  • Claim Evidence through WhatsApp images
  • Premiums and reimbursements through mobile money

Operation Models

  • India – Hospital insurance for rural (poor) households of 5 states—premiums of about $5/year per person
  • The Philippines – Hospicash provides cash payout for each day of hospitalization, premium $4/year per person
  • Ghana – Credit Health (microfinance bank) partnership, pays borrower’s loan installment when hospitalized; cost $0.25/month


Sapan Agarwal | sapan.agarwal@frost.com | +603 6204 5830

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