ITIC Americas: Cost containment - are local prices realistic and accessible for international payers?

Dr Ivan Dario Ortiz, Former Vice Minister, Public Health & Health Services

Dr Ortiz’s presentation gave an overview of the provision of healthcare in Colombia, before moving on to how insurers can further strengthen the quality of care on offer to national and international patients.

Advances in health tourism in Colombia was the first topic he addressed, showing how much money was earned, and how many procedures were performed, in 2019. Some of the factors that make the country attractive for international patients include the broad spectrum of healthcare services on offer, with relatively low costs, high quality of physicians, a strong accreditation system and quality hospitals. Addressing the make-up of Colombia’s healthcare system, Dr Ortiz explained that it is a mixed public-private system, with many more private facilities than public. Private hospitals, he said, have a problem with increasing levels of debt from insurers: “Dominant positions that arise from integration models can distort the system,” he explained, “making it difficult for insurers to enter the market and negotiate fees.”

Regarding the accreditation system, Dr Ortiz told attendees that it is an internationally recognised national system, and both public and private facilities can be accredited, which is further driving development in quality of care provided in both the public and private healthcare sectors.

Dr Ortiz highlighted several key ways in which payers can drive the level of healthcare quality upwards

There are also challenges that the healthcare system has to overcome, though, the main one being that there is a wide variation in terms of quality of care – for insurers, they must choose carefully which hospitals they are going to work with and add to their networks. The World Bank found that while there have been ‘outstanding improvements’ in healthcare in Colombia, quality remains a challenge. Dr Ivan pointed to five specific hospitals that he recommended international insurers add to their network that are leading the field in terms of outcomes, meeting patient expectations and financial stability.

Addressing the question ‘how can insurers help to improve quality’?, Dr Ortiz highlighted several key ways in which payers can drive the level of healthcare quality upwards.

• Identify and contract with high quality accredited hospitals
• Ensure all healthcare providers measure and report quality indicators
• Ensure adequate information that will empower patients and the international healthcare community
• Place the patient in the centre of the relationship between insurers and providers
• Make arrangements by healthcare value, rather than by volume and utilisation rates.

Yanni Jota, Sales Vice President, Aetna International Health Services

Yanni’s presentation focused on how Covid-19 affected the delivery and cost of international patient care, looking specifically at the fact that Covid has been a disruptor and driver of development in the healthcare sector.

The challenges for insurers have been different in 2020 and 2021 as the pandemic evolved and its different phases moved the focus … what all the challenges had in common was that they put pressure on insurers, increasing costs and services simultaneously

Covid-19 as a disruptor meant that the whole world had to stop – for every industry and for individuals, who are much more aware of their health and health needs. From an insurance company perspective, Covid’s impact resulted in changes to policy wording, with unpredictable length of stays for patients, and an increase in chronic conditions that were not necessarily being managed appropriately due to lockdowns and the pressure on healthcare providers. The challenges for insurers have been different in 2020 and 2021 as the pandemic evolved and its different phases moved the focus – from the introduction of telemedicine services and treatment costs, to vaccine administration costs, the rescheduling of elective care, and an increasing propensity to cover the cost of treatment for Covid-19. However, what all the challenges had in common was that they put pressure on insurers, increasing costs and services simultaneously. “We have seen a substantial increase in costs of treatment,” confirmed Yanni.

Covid, however, has also been a catalyst, she explained. Telehealth visits increased more than 150 per cent in 2020, with services ranging from outpatient visits to mental health support. “Telehealth investments hit an all-time high of $4.2 billion in the first quarter of 2021, which was nearly double the $2.2 billion raised in the same quarter of 2020,” she added. Mental health telehealth support is expected to drive utilisation of the services provided by insurers.

Dra Brenda Herrera, Chief Medical Officer, Med One Assistance

Dra Herrera addressed the issues that insurers face in building medical networks in the region, identifying the top challenges as being:

• Service differentiation
• Wide variations in costs with each country in Latin America
• Service quality being unpredictable
• Ensuring the healthcare professionals with which insurers and assistance companies contract are internationally certified.

the highest quality service insurers will receive from their healthcare partners will always be based on the clarity of insurance company’s policy wording

“It’s now more important than ever to work with local partners,” she told the audience. They can ensure quality and value for insurance payers because they are going to be able to direct the patient towards the correct hospitals – not just the ones that serve tourists – cost effectiveness, value, and payments in local currencies, all of which can help contain rising medical costs. Also vital is having a solid guarantee of payment – the highest quality service insurers will receive from their healthcare partners will always be based on the clarity of insurance company’s policy wording – no hospital likes the policies that simply give a coverage limit and then when the bill is submitted, the exclusions are then highlighted as a reason to limit the cost of the claim.