The global health insurance market has been experiencing a declining growth rate in recent years; from 9% in 2014-2015 to 6-7% in subsequent years. The 2019 Forbes report that pointed this out also attributes this decline partly to the low adoption of digital solutions in this sector. But those very same solutions can transform the market.
Already with futuristic technologies like clinical grade personal health sensors, at-home genome sequencing kits and artificial intelligence, healthcare is receiving a much-needed overhaul that democratises access to quality care. The health insurance industry could also ride on those same waves of disruption to make the market relevant again in the digital health age.
But as these solutions make the landscape more data-focused, new issues about privacy and whether the new insurance systems the technologies help create will be used to discriminate against patients. We contemplate these aspects and more in this article exploring the influence of digital health on health insurance.
1. Healthcare is becoming globalised and so is health insurance
Digital health enables healthcare to be truly globalised, allowing patients to have access to quality digital health services wherever they are (save for some shipping restrictions), even if the companies behind those services are headquartered in different countries or continents. Take for example U.K.-based Atlas Biomed. It ships its at-home microbiome testing kits to patients in other countries.
The same is possible with whole genome sequencing kits from Dante Labs in Italy or Fitbit, headquartered in the U.S., and its fitness trackers. Patients can adopt these devices and services and bring the data to their physician, even if the service would otherwise not be available through a local company.
Health insurance is also following a similar path. Global health insurance coverage is particularly enticing for those traveling regularly for work or digital nomads working on the go. Cigna, IMG, and GeoBlue are some of the many providers of such globalised access to health insurance; and some even offer modular packages and home country coverage to best suit patients’ needs.
With more competition in the field, packages could become more interesting for payers who could find even better options from those international insurance companies than what they can find locally. This could further incentivise local competitors to innovate in this space.
2. The divide between socialised medicine and private insurance
Differences in the quality of care available can also be seen between and within types of national healthcare services. Countries with a socialised medical system provide basic healthcare access to everyone; but the cost to maintain such a system leaves little resources to invest in and adopt expensive medical innovations. They would also prove challenging to roll out nationwide as the system as a whole cannot afford them in all institutions. This results in, for example, having a patient checked by an oncologist within days, but that patient won’t receive precision treatment.
In countries with a private insurance system, patients are in a better position to have access to cutting-edge technologies; that is, as long as they are wealthy enough as only the privileged ones with good insurance plans can afford them. Such financial disparities can thus lead to biological consequences. For instance, in such a system, someone wealthy enough can live longer than someone who isn’t as they can purchase a bioprinted liver tissue to “fix” their malfunctioning liver and prolong their lifespan.
If not properly regulated, digital health technologies will only widen such divides.
3. Health insurance is extremely data-based
Health insurance can prove to be a risky business. Investing blindly into people knowing only a few details about their lives and lifestyles might not prove profitable to make fully-informed decisions. Companies can obtain some rudimentary details of patients such as their gender, age and some basic lifestyle details; but without quantifiable and measurable health parameters, the value of the investment remains questionable.
As such, more data could help them make better decisions and this is possible with new technologies like personal health sensors. Some insurance companies already saw the potential in such approaches and put them into practice.
Insurance firm Oscar Health famously incentivised healthy lifestyle by rewarding U.S. customers with Amazon gift cards for achieving their daily goals as measured by Fitbit wearables. In Germany, at least six health insurance companies reimburse mySugr’s digital diabetes solution, which includes an app connected to blood glucose monitors for easier management of patients’ condition; and this covers 15 million lives. In late 2019, the German parliament even passed a new law that covers reimbursement of digital health solutions for patients in statutory health insurance, which nearly 90% of the population is insured by. Such measures can promote the adoption of digital health technologies to assist patients with taking better care of their health with personalised metrics.
4. The choice between privacy or Dr. Big Brother
With such access to personal health metrics, it’s not a question of if insurance companies will use them but how they will use them. The more health data they have on you, the better investments they can make, thus they can provide more appropriate care. For instance, if someone’s genome test indicates a high risk for breast cancer, an insurance company can subsidise more regular mammograms.
The other side of the coin is that this approach leads to a leakage of your privacy and lifestyle choices so that insurance companies can modify your plans and benefits accordingly. They will inevitably not want to pay for the health coverage of those who never take care of their health. For example, if a patient with a high risk of breast cancer is also found to be a heavy smoker, this will increase their chances of developing the condition. The insurance company would be more cautious about offering coverage to such a patient and might even charge more premiums.
In a dystopian scenario, companies will mandate that patients provide access to all of their health data, including those from their personal sensors from smartwatches to sleep monitors. Only then will they decide whether to provide insurance, change patients’ premiums or notify them about changing it based on lifestyle choices. The creation of such a “Dr. Big Brother” should be kept at bay by regulators while striving to keep a balance between maintaining a level of privacy and providing quality and personalised care.
5. A.I. in insurance
We’ve discussed A.I.’s potential in healthcare at length and, even though you might think it’s far-fetched, the technology also has its uses in health insurance. In particular, it can be used to improve health insurance companies’ performance.
According to a McKinsey report, one in ten insurance claims is incorrect and the health insurer can challenge the claim’s amount. However, identifying those claims can be difficult since as many as 70% of claims are flagged as being unusual for review by administrative staff. Such laborious and repetitive tasks can be handled by smart algorithms to filter out the claims for staff review.
Infinx’s A.I.-driven software enables such streamlining of workflows in revenue cycle management for healthcare providers. Similarly, Certifi’s premium billing and payment solution processes are streamlined with the help of an A.I.
Total privacy or equal healthcare?
Today’s healthcare is financially unsustainable; patients don’t have access to the latest innovations and doctors are struggling to provide decent care with the equipment they have. We must upgrade health insurance systems to motivate each of us to live better by making use of emerging technologies. As more and more people turn to wearable sensors to help them live healthier lives, this is starting to happen.
Already some research shows that 55% of patients are willing to share their personal data obtained through tech devices with insurers. That’s how insurance companies can tap into individual health data and turn their risky business into a profitable one while providing quality and personalised care to payers. With such an approach, those health insurance companies that make use of digital health solutions and offer a globalised service will be the ones to thrive in the near future.
But with such developments, we need to avoid the creation of a Dr. Big Brother who watches our every movement, has access to minute details of our lives and thus impacts our personal decisions. We must at all costs avoid a scenario where someone would control what we eat, when we exercise and when we lie down to sleep.
Policy must thus ensure with some regulatory oversight that insurance companies don’t get uncomfortably close to our data about our personal health choices. In a controlled landscape, the option to share one’s health tracker data with their health insurer to promote a healthy lifestyle while having access to personalised care would be a healthy balance.
Written by Dr. Bertalan Meskó & Dr. Pranavsingh Dhunnoo
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