ITIC APAC 2023 | Assistance challenges and solutions, part 2: Provider network management

Second to speak was Debbie Tong, General Manager of Business Development at Matilda International Hospital, Hong Kong, and she started by saying why it’s important that hospitals work as part of a network. She said that there are 13 private hospitals in Hong Kong, and that not all of them work very closely with assistance companies. Ninety nine per cent of medical claims are from in-patients. But that in-patient care is where patients find they can’t afford the costs. Tong showed the payer distribution for a ‘normal’ year (2018) and pointed out that almost 50 per cent of the hospital bills were paid for by insurance companies. Since then there have been protests in Hong Kong, meaning far fewer people visiting HK, plus the pandemic happened.

Tong went on to talk about the reasons for joining the network, and said that getting direct referrals from insurance companies is a big reason; they also get recognised on a global status as being a centre of excellence, and the hospital gets secure payment for services from insurance companies. They can also keep up to date with international practices, so that they know what the international insurance companies are looking for. She said they can also build trust and develop their branding.

Tong said there are three important criteria for a good network hospital – clinical, financial and services. Clinical aspects would include whether the hospital is a centre of excellence, what the facilities are like, if they have good specialists, if they are accredited, and how transparent their outcomes are.

Financial aspects include items such as direct billing, their payment terms, cost estimation, price transparency and special rates.

Service aspects include network contact points, customer service, the location, language ability and service values.

Next to speak was Dr Attapoom Susupaus, Assistant Hospital Director at the Bangkok Heart Hospital, and he started his session by sharing one of his cases. A 79-year-old British man who lived with his wife in Thailand presented at Buriram hospital with difficulty breathing and a serious heart condition. Less than 5 per cent of the population in that area can communicate in English. It was very difficult for the patient because of the language barrier. At the hospital they were told that as his condition was so serious, he would have to be transferred. The man’s daughter in the UK contacted the insurance company and assistance company, and then the Bangkok Heart Hospital was contacted, because most hospitals in Thailand don’t have a channel to work with assistance companies.

They accepted the transfer of the patient and later gave him the heart treatment he needed. In this case the family were important. Between the patient and the healthcare provider was the assistance company. It’s important to have good communication between the hospital and assistance provider, Susupaus said. He agreed with earlier comments that doctors don’t want to spend too much time on forms and documents – they want to be providing healthcare. Sometimes, he said, the assistance companies are not as aware how ill the patients are as they should be.

He then used another example of a 66-year-old Cambodian woman who was admitted to his hospital. She had a serious lung condition. The local insurance company didn’t know where to send her, so they contacted the international insurance company. She was transferred to the Bangkok Heart Hospital, but even after three weeks of treatment she was not improving. They discussed with the assistance company the billing concerns and whether she should have a lung transplant or palliative care. The family opted for palliative care and had her repatriated to Cambodia.

Finally, Susupaus outlined, from their perspective, how hospitals can workeffectively with insurance companies. He said it is important that they understand the insurance system; be transparent with patients; communicate effectively with insurance companies; use technology to their advantage; and focus on outcomes, not incentives. He added that networking is important with hotels, embassies, and airlines.

Dr Carl Luckhoff, Medical Doctor at the nib Group, was last to present.He started by asking if Australian providers are too reliant on reciprocal health. He said that Australians have free access to healthcare in Italy, Malta, and several other European countries. For insurers this is convenient, but he said that insurers are perhaps over-reliant on these agreements. He asked if these arrangements are still fitting the needs of customers, especially because of what they are seeing in the international travel market.

After the pandemic, health systems across the world are being challenged by delayed and deferred care, he said. Elective surgery had been put on hold, and now health systems are struggling to catch up on cases. Luckhoff went on to say that there are also changes in the epidemiology of diseases and that there is a big rise in viral infections. All these aspects have a disproportional impact on lower socio-economic and minority groups, he added.

Travellers can add to these numbers of patients. Not only because of the sheer numbers of people travelling, but because older people are travelling much more. The younger demographic have not changed their expenditure on travel, but for over 65s it has risen to more than double inflation. Because of the age bracket gap the reciprocal agreements need to be looked at again due to these changes, he suggested.

Luckhoff went on to look at ‘on the ground’ assistance company partners. Every country has a nuanced health system, he said, with varied administrative processes. Culturally, people have different expectations of hospitals, adding that there are also language barriers, expectations from patients and family, and shared decision-making differences.

He said that patients and family are often overwhelmed when ill abroad. Sometimes healthcare providers push the families aside. When abroad, patients are inclined to follow instructions they are given, plus they have a limited understanding of the insurance product they have.

Luckhoff said assistance companies can really help with all of these complexities. They can build rapport, help with overcoming language and cultural barriers, offer reassurance and help to navigate local customs.

Luckhoff questioned whether assistance companies are relying on healthcare provider networks that no longer function. He said many healthcare providers have had to pivot and that many businesses have adapted and amalgamated.

He finished by saying relationships are the magic ingredient and the most reliable way of navigating through complexities.