INTERNATIONAL MEDICAL ASSISTANCE AND LINGERING CHALLENGES

International Medical Assistance is a concept that was designed to ensure that health policy holders of any international health insurance companies are able to use their policy cards across the world with little or no difficulties. This was the idea and thinking of health insurance providers that gave room to International medical assistance program.

Though the concept has strived and performed optimally well in some countries of the world but difficulties are still being faced in proper administration, non availability of standard healthcare facilities, poor access to very fast medicare at the time of critical need, these and many more are the issues still hindering the smooth and efficient administration of international medical assistance services across the world.  

There is an urgent need to critically review processes in ensuring enrolees get good value for their money and the healthcare facilities are also rightly motivated and incentivised through timely clearance of all Guaranty of Payments (GOP) if in use and in some cases have serviceable credit lines. At the moment, the risk is currently being shifted to the enrolees who most times are not granted access to medicare either because their health insurers are not known in that part of the world they find themselves in and even in some cases they have no enough funds with them to pay off the medical bills which will be duly refunded anyway. When such cases occur, one begins to wonder if it would not have been better to have your funds to yourself and be self accountable for all health challenges and eventual outcomes within a fiscal year.

My questions are:

·         Are there ways to do these better than we are currently doing?

·         Can we collate all questions and challenges reported to a round table and identify better ways of improving on the existing services and processes?

·         Can we fully take up the risk, instead of virtually sharing it with the policy holders?

·         Are there international trade barriers that currently impede the smooth administration of international medical assistance? Can they be identified and reviewed?

·         The state it is now, can our products really win and sustain subscribers confidence? If no, then the time for review has come.

·         Are existing frauds within all levels of implementation stages also factors to be considered? If yes, can we profile the countries of high prevalence and work out ways round it?

·         Is there the urgent need to tag-on with the local health insurance companies in ensuring a face is attached to the management of subscribers in such country of treatment?

I have become rather worried over these issues of late mostly the ones i have seen in Lagos Nigeria under the international medical assistance platform. Maybe we should even define health insurance in the right context; it could just be the missing clue to fix this whole confusion.

Health insurance has been defined as the insurance against the risk of incurring medical expenses among individuals. Or

The insurance that compensates the insured for the expenses or loss incurred for medical reasons, as through illness or hospitalization.

The statement common to the two definitions are “incurring medical expenses” and if health insurance must act in line with this definition, it means there must be that capacity and capability to absorb or manage the health risks of the subscribers within the period of the validity of their health policy. We need more people into this pool and the only way to make this happen is to ensure a high level of trust and confidence exists between the insured, the insurer and the treating facility. The interface must be strong, cordial and mutually of measurable benefit to all parties concerned.

There are a whole lot of distrust which currently exist amongst this circle of stakeholders which have greatly imparted negatively business relationships and quality of care delivery. We understand the huge fraudulent practices and gross dishonesty on the part of the subscribers also which has a huge cost effect on the finances of the international medical assistance company. Most of these false policy claims arise from falsification of medical bills, falsification of admission that never existed, claims of known costly treatment that were never done. There could not have been such claims if there was no connivance with a health facility or a treating Doctor that issued both the false medical report and the acclaimed medical bill which the policy holders always claim they have paid for with valid receipts to support such claims. This has created a level of distrust with the relationship chain; investigations and excessive scrutiny are now in place to verify claims even when they are genuine. Is this practice what we can do away with? Yes, we can.

We do not need to play in every market, let us play in markets where we can have a level of control for our products or where we can have responsible persons or organisations duly representing our interest in effectively managing our subscribers. The International Medical Assistance companies should defractionalise and close up the market with strong capacity building and development which makes them form a strong mass through a collection of several insurers having a cover under one umbrella and trading in that name in countries where they have no comparative advantage. This we see already happening among the International Assistance Group (IAG), other smaller companies registered under them use their names in countries where they have strong controls. This is all to the benefit of the subscriber.

We have had to investigate a number of cases, case-manage so many other cases and even sometimes we had to place a local Guaranty of Payments (GOPs) in place on personal recognition for the sake of the subscribing patients who needs medicare at such times. We still feel these are not all enough, there is the need to have a face to your international medical assistance policy having an in-country representative who will at all times be available to help sort you out. When this happens, we can have international health policies and travel to Ukraine, India, Bangladesh, Morocco, Australia, China, Venezuela, Sweden and of course Nigeria without having any difficulty in accessing quality medical care based on trust, equity and fair play on the part of all stakeholders within the wheels of best global practices.

There is also the need to understand infrastructural gap which still exist in most countries and there are times mails are sent about a patient sent to healthcare providers and they at the hospitals at that moment do not have a functional internet services, these and many more creates a number of breeches in trying to run a smooth and hitch-free processes.

One of the things our company has done of late is to be able to position properly for the International Medical Assistance companies in ensuring we cater for all requests sent to us seamlessly by closely interfacing properly with all notable hospitals across the country and riding on the wings of such relationships to ensure nothing is left to chance.

We have become very involved through our Medical team in:

·         Case management

·         Bills verification and negotiation

·         Admissions confirmation

·         Treatment review and confirmation

·         Case bookings

·         GOP placements

·         Third party hospitals management

·         Local and international medical evacuations

These have greatly become very crucial units within our growing SBUs. We will keep innovating changes and ensuring what ought to be done are rightly done to create requisite value for not just the patient alone but the healthcare facilities and ultimately the International Medical Assistance community.

We just wanted to share our market experience, opportunities and the daunting challenges. Kindly read through and leave a comment.

ehi@ohsm.com.ng