In the Middle East and Africa (MEA) region, healthcare costs are rising, regulatory ‎frameworks are evolving, and the number of remote workers and expatriates is growing. ‎According to estimates, the health insurance market in the Middle East and North Africa ‎‎(MENA) will grow at a compound annual growth rate (CAGR) of 6.78%, reaching ‎US$25.64 billion by 2030. In the Gulf Cooperation Council (GCC) countries, healthcare ‎expenditure is predicted to reach $135.5 billion by 2027. Disparities in healthcare ‎across the region are pushing forward a preference for private care. ‎

For example, in the United Arab Emirates (UAE), digital health is thriving and the country ‎was ranked 19th in the 2022 World Index of Healthcare Innovation. However, in stark ‎contrast to this, there are countries where healthcare supplies are dwindling, and the ‎situation is worse still for countries in conflict, where hospitals have been destroyed ‎and health systems are barely functioning.

The MEA region presents diverse healthcare landscapes, from world-class facilities in the UAE and Saudi Arabia to underserved rural areas in Sub-Saharan Africa

“The MEA region presents diverse healthcare ‎landscapes, from world-class facilities in the UAE and Saudi Arabia to underserved rural ‎areas in Sub-Saharan Africa,” stated Eugenia Guskova, Head of Network at AP ‎Companies Global Solutions. Demand for private healthcare is driven largely by ‎expatriates and wealthy locals, and effective international private medical insurance ‎‎(IPMI) is essential to meet the needs of the employees of multinational companies. ‎

Meeting demand

ITIJ asked Amber Musson-Thorp, Group Commercial Director – MEA at Lifecare ‎International, about the specific benefits and coverage options that are most in demand ‎among expatriates and corporate clients in the Middle East. “We are definitely seeing ‎demand for strong maternity benefits, and access to support for IVF is also common. ‎Wellness, and a desired annual check-up, is more common than I’ve seen in Europe. ‎Vitamin deficiencies can be common here, particularly vitamin D, ironically enough – so ‎we see that these benefits are being tailored by IPMI providers to fall in line with local ‎demands,” she stated. ‎

Guskova shed light on contrasting demands: “In the GCC, high-net-worth individuals ‎expect VIP medical services and access to internationally accredited hospitals, while in ‎African markets, affordability and emergency evacuation capabilities are priorities. ‎We’ve also seen a growing demand for digital healthcare solutions, and the rising ‎prevalence of lifestyle diseases, such as diabetes and hypertension, in the MEA region ‎has also driven demand for chronic disease management programmes.” ‎

Indeed, according to 2019 research, the MENA region had the highest global prevalence ‎of diabetes, necessitating a robust approach to managing this disease. ‎

Customisation is crucial

To meet such a diverse array of needs, customisation is key to ensuring customers ‎receive appropriate healthcare coverage in line with their specific circumstances and ‎are, ultimately, satisfied. This also helps ensure that policies are compliant with local ‎regulations and reflect the healthcare standards and expectations in different countries. ‎

Guskova commented that she has spotted a trend towards this. “We have noticed that ‎bringing a tailored approach to IPMI policies is essential. The benefits and limits must ‎be customised to suit the unique needs of expatriates, high-net-worth individuals and ‎remote workers in this region,” she explained. “Telemedicine services have become ‎critical in regions where healthcare infrastructure is limited or distant.”

She said that AP ‎Companies’ on-the-ground presence in key MEA countries facilitates the provision of ‎localised services: “Our localised approach includes aligning healthcare solutions with ‎local customs, such as gender-sensitive medical services in conservative societies. ‎This enables us to offer localised solutions tailored to regional healthcare standards ‎and regulatory frameworks.”‎

Musson-Thorp reported that customising IPMI policies is becoming increasingly difficult ‎across the Middle East in particular. “The largest brands have become rigid in their ‎decision-making and there is a lack of desire to tailor policies in the IPMI space (bar one ‎or two),” she said. “We see that tier two offshore insurers and managing general agents ‎‎(MGAs) are more agile and more interested in finding a solution to cover all company ‎designations, but this is effectively non-admitted business. In some locations that’s ‎okay, but [it] will not work in others.” ‎

For the worker population, Musson-Thorp asserted, it is very location dependent. ‎‎“Worker populations that are based offshore and in remote locations are easily insured, ‎but the network is the key here and, in some places like Algeria, getting to the closest ‎hospital can take many hours by road, and some form of evacuation will need to be ‎readily available,” she outlined. “In Qatar, HMC (Hamad Medical Corporation) is ‎available and the worker population will not be insured at all; they will usually have a ‎‎$25-a-year health card which serves as access to the state healthcare system, whereas ‎in the UAE and Kingdom of Saudi Arabia (KSA), they will be required to have an ‎insurance policy, and for low-salary-level workers, the average premium is around 600–‎‎1,000 dirham ($160–$270). This is why IPMI players don’t want to compete in this ‎space.” ‎
Indeed, for IPMI providers who offer comprehensive, high-end plans for expatriates and ‎high-income individuals, the low-cost mandatory segment in the UAE and KSA is not ‎profitable for them.‎

Navigating region-specific challenges

For insurers providing international health coverage in MEA, there are challenges to ‎circumvent, such as navigating local regulations and healthcare infrastructure. ‎

William Cooper, Marketing Director at William Russell, spoke with ITIJ about this: ‎‎“Across most of the MEA, we offer our standard offshore IPMI product. Obviously, the ‎UAE is different and is quite prescriptive on the benefits a product must include. Therein ‎lies the biggest challenge. One of the main issues is the prohibition on excluding pre-‎existing medical conditions, which turns the concept of insurance (i.e. managing risk) ‎on its head,” he stated. ‎

In African markets, affordability and emergency evacuation capabilities are priorities

‎“Unlike our offshore product, our telemedicine and virtual medical services are central ‎to our product in the UAE. However, much like other insurance providers are ‎experiencing, the demand for such services by brokers is not matched by utilisation by ‎our members. Also key to customer experience in MEA is the use of third-party ‎administrators, who – through their networks of hospitals and clinics – manage the ‎members’ experience of private healthcare. As with the pre-existing medical condition ‎requirements, outsourcing such an important part of the insurance experience to a third ‎party is contrary to the William Russell ethos. But it is necessary in many countries in ‎MEA,” he said.‎

Guskova also highlighted the challenges faced by insurance providers. “Hurdles include ‎regulatory complexity, varying healthcare standards and provider availability. MEA ‎countries each have distinct regulatory frameworks, with stringent licensing ‎requirements in the GCC, evolving insurance mandates in Egypt and Nigeria, and ‎fragmented healthcare systems in Sub-Saharan Africa. AP Companies mitigates these ‎challenges by leveraging its deep expertise in local compliance, ensuring seamless ‎navigation of MEA’s diverse regulatory environments, licensing requirements, and ‎mandatory insurance frameworks.” ‎

Guskova said that these difficulties can be overcome through the use of advanced cost ‎control measures and fraud prevention strategies. “AP Companies implements ‎automated systems that prevent overbilling and fraud, enhancing financial ‎sustainability,” she highlighted. “Additionally, by continuously expanding its provider ‎network and forming strategic partnerships with accredited hospitals and clinics, AP ‎Companies guarantees access to high-quality, cost-effective medical care for ‎policyholders across the region. We also ensure compliance with region-specific ‎requirements, such as Saudi Arabia’s CCHI regulations and the DHA’s mandatory ‎insurance policies in Dubai.”‎

Musson-Thorp said that although the MEA region is an ever-changing landscape when it ‎comes to regulation, the biggest challenges now are centred around sustainability, cost ‎management and managing fraud waste and abuse. ‎

‎“In markets like the UAE, where the regulation has been around for some time, we are ‎beginning to see regulatory measures being introduced to protect the industry. But in ‎other territories such as Oman and Qatar, where the insurance concept is still not fully ‎understood, the biggest challenge is the market competition, which is driving ‎underfunding and tightening of the guidelines for approvals,” she said. “Even data isn’t ‎regulated, which also causes issues with sustainable pricing – and the cost of treatment ‎in the Middle East is high anyway due to many factors, including the standard of the ‎facilities, overtreatment of patients and the pure availability of the healthcare itself.”‎

Enhancing accessibility

Telemedicine is critical for allowing people in remote areas to access medical care, and ‎the integration of these services into IPMI has been crucial to enhancing accessibility. ‎The use of telemedicine in the MEA region is rising, with the telehealth market projected ‎to exceed $22.2 billion by 2030. ‎

The benefits and limits must be customised to suit the unique needs of expatriates, high-net-worth individuals and remote workers

‎“Virtual consultations are particularly impactful in countries with underdeveloped ‎healthcare infrastructure, such as Sudan and Somalia, where telemedicine bridges the ‎gap between patients and specialists,” highlighted Guskova. Indeed, research from ‎‎2023 found that digital health solutions have the potential to help address health needs ‎in fragile and conflict-affected areas in the MENA region. ‎

Musson-Thorp said that telehealth is recognised in the UAE but is still a fairly new ‎concept in some countries, such as Qatar. “However, I know that governments will be ‎utilising telehealth and other innovative healthtech available to improve population ‎health management across the entire region. Digital transformation is one of the biggest ‎focus areas,” she underlined. ‎

Flexible and customised IPMI policies are key to meeting the needs of the MEA region’s ‎diverse demographic. Healthcare provision and customer satisfaction can be elevated ‎with the use of telemedicine and, to ensure ongoing success, IPMI providers and third-‎party administrators (TPAs) must continue to provide access to customised, efficient ‎and accessible healthcare solutions. ‎