Telemedicine and telehealth services are helping to provide ‘medical inclusion’ in the form of easier and cheaper access to health services for many people around the world. This has undoubtedly created a new landscape for participating members to offer unconventional and innovative medical services, and an evolving regulatory framework to keep specified patient safety parameters in check. How can insurers leverage this opportunity and help to broaden the service, and what risks do they need to consider? Generali Asia’s Dr Hak Hong Soo reports.
The term telehealth includes the use of a broad range of technologies and services to provide patient care at a distance and improve the healthcare delivery system. It can refer to remote non-clinical services provided via electronic communication, such as healthcare training, provider communications and continuing medical education, in addition to clinical services. It is different from telemedicine because it refers to a broader scope of remote healthcare services.
Telemedicine, on the other hand, is a subset of telehealth that refers solely to the provision of healthcare services and education over a distance using telecommunications technology.
Growth in Asia
Once considered expensive and unconventional, the growth of affordable technology has made TTS an increasingly attractive option for doctors and patients throughout the world and is gaining popularity in Asia.
According to a report by Frost and Sullivan, the telehealth market in Asia-Pacific is predicted to reach $1.79bn by 2020, with an annual growth rate of 12%. Looking across the region, China has been rolling out a telemedicine programme to bring skilled expertise to rural areas, especially hard to reach places due to its mountainous terrain. In 2013, China’s National Health and Family Planning Commission set up a telemedicine network and, when fully deployed and functional, it will be the largest in the world.
Japan, Singapore and South Korea‘s fast-growing ageing populations have urged their respective governments to look at implementing TTS to reduce the cost of care to monitor the elderly and minimise the need for hospital stays.
Opportunities for insurers
An increasing number of TTS platform vendors have emerged providing a collaboration opportunity for insurers to support the growth of telemedicine, so patients are covered when they use the service. Insurers could also leverage telemedicine as a virtual cost-efficient general practitioner gatekeeper, where insured patients would undergo a teleconsultation for referral to a specialist or hospitalisation.
Generali has offered telemedicine services in the Philippines since 2017 and the utilisation, quality and cost-savings have been favourable. We do see potential and benefits in telemedicine, and there is sound strategic value to do more in this space.
Regulatory landscape
Many countries in Asia have recognised the potential for TTS and have developed frameworks for governance that are evolving as demand increases. For example, in 2015 Japan’s ministry of health removed several regulatory barriers against TTS. Last year, both Singapore and Thailand’s ministries of health established regulatory sandboxes for TTS so it will eventually become a licensed healthcare service. While Vietnam’s ministry of health issued new regulations to protect users of TTS by ensuring the service can only take place by proper specialists in licensed facilities.
Risk implications
While these services are transforming the delivery of healthcare, insurers need to be aware of the potential risks and implications in order to apply the appropriate TTS practice and underwriting principles.
Due to the virtual nature of the consultation there is an increase in the risk of negligent and missed diagnosis which can also be impacted by poor technical connection. Data privacy and security issues on patient health information transmitted digitally and the unauthorised use of such information can present a risk element.
Their cross-border nature can raise credibility issues on the transmission of documents and reports across different time zones, and there are also complexities around the role of national health insurance programmes and traditional insurance providers. For example, if a radiologist from Thailand is analysing imaging tests for a patient in Australia, will the patient be able to claim any of the cost through Medicare?
While one of the attractive benefits of TTS is its ability to provide specialist care to people who would otherwise not have access, it raises the important notion of providers exceeding the scope of practice. For example, could some of the services be delegated to a mid-level provider rather than a specialist?
These risks must be addressed to ensure the delivery of TTS is of a high quality and hence over time, the service will be subject to the country’s health regulatory framework.
Looking ahead
TTS is certainly a cost-effective and efficient way to deliver vital healthcare to patients who cannot travel, or who live in remote areas and it has enormous potential in Asia due to the region’s increasing wealth, ageing population and geographical spread.
As the number of service applications increase it will present a challenge for regulators in most countries to define what is and what is not covered or allowed under TTS. For insurers who have incorporated, or are considering incorporating, TTS services into their product offerings, it is essential they have a solid understanding of its future direction in order to develop the appropriate health service strategy and underwriting principles for this rapidly growing area of healthcare. A
Dr Hak Hong Soo is Generali Asia’s head of regional health.