comprehensive health insurance at affordable cost in...

Comprehensive Health Insurance at Affordable Cost in Poland

September 2018

I. Who We Are

II. Overview of the Polish Market

III. What We Bring to Poland

AGENDA

© Future Healthcare 4

WHO WE ARE

Privately held international group established in 2003 with head office in Lisbon, international sales office in Zurich and local offices in Warsaw, Bucharest and Quito Mission: Provide our clients with the best health, life and well-being conditions Medical Network with more than 34.000 health care providers in Portugal and abroad Specialized in health insurance management

BUSINESS PARTNERS


BUSINESS MODEL


I. Who We Are



AGENDA

POLISH POPULATION


Population (Jul 2017) = 38.476.269

Average life expectancy = 77,8 years

Source: 2018 CIA World Fact Book, The Economist Intelligence Unit

Average healthy expectancy = 68,7 years

Population between 25 and 54 years old = 43,5%

Average age: 40,7 years

POLISH ECONOMY


5,01

1,60 1,39

3,28

3,85

2,86

4,60 4,60 4,60

4,20 3,70

0,0

1,0

2,0

3,0

4,0

5,0

2011 2012 2013 2014 2015 2016 2017 2018 2019

Economic Growth (GDP, annual variation in %)

GDP Growth % European Commission (estimate) World Bank (estimate)

Source: World Bank, European Commission

POLISH UNEMPLOYMENT


Source: GUS – Central Statistical Office of Poland

13,4 13,4

11,4 9,7

8,3

4,9 4

6

8

10

12

14

2012 2013 2014 2015 2016 2017

Unemployment Rate (%)

4 054 4 066 4 082

4 281 4 181

4 019 4 055

4 219 4 354

4 221 4 256

4 517

3 800

4 000

4 200

4 400

4 600

Q12015

Q22015

Q32015

Q42015

Q12016

Q22016

Q32016

Q42016

Q12017

Q22017

Q32017

Q42017

Average Gross Wage (PLN)

OECD Health Expenditure in Selected Countries


Source: OECD Health Data

Current Health Expenditure as Share of GDP, All Financing Schemes, All Providers

Health expenditure is growing and will probably continue

to grow

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,02

00

0

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

Switzerland

France

Germany

Sweden

Norway

Austria

Netherlands

Denmark

United Kingdom

Finland

Portugal

Spain

Italy

Hungary

Czech Republic

Poland

HEALTH EXPENDITURE BY FINANCING AGENT


Source: OECD.Stat

28% 29% 30% 29% 29% 30% 30% 31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

20 000

40 000

60 000

80 000

100 000

120 000

140 000

2010 2011 2012 2013 2014 2015 2016 2017

Poland - Current Expenditure on Health - Million Zloty

Total

Government/compulsory schemes

Voluntary schemes/household out-of-pocket payments

% Voluntary schemes/household out-of-pocket payments

OECD Curative and Rehabilitative Care Voluntary and Out-Of-Pocket in Selected Countries


Source: OECD Health Data

1,00 1,06

1,23 1,31

0,00

0,20

0,40

0,60

0,80

1,00

1,20

1,40

1,60

1,80

2013 2014 2015 2016

Latvia Hungary Poland United Kingdom Estonia

Czech Republic Italy Norway Lithuania Switzerland

Denmark Portugal Netherlands Sweden Germany

Ireland Belgium Spain Slovak Republic France

Curative and Rehabilitative Care vs GDP per capita in Selected Countries


Source: OECD Data

PRIVATE HEALTH INSURANCE IN POLAND


Private health insurance is growing in Poland and will probably continue to grow

Source: PIU - Polska Izba Ubezpieczeń (for 2017 only Total is available, Individual and Group were estimated)

Private health insurance is

growing in Poland and will probably continue to grow

Poland - Private Health Insurance Market (2015-2017)

Individual

Policies

Group

PoliciesTotal % Growth

Average

Premium

272 000 1 164 700 1 436 700 337

386 100 1 475 300 1 861 400 29,56% 294

531 259 1 735 241 2 266 500 21,76% 302

Number of Insured Persons

2015

2016

Private Health

Insurance

(All the Market)

2017

I. Who We Are



AGENDA

WHAT WE BRING TO POLAND “COMPREHENSIVE HEALTH INSURANCE AT AFFORDABLE COST”


Health insurance is a hybrid product: risk + consumption

0

1 000

2 000

3 000

4 000

5 000

6 000

7 000

8 000

9 000

10 000

Jan Feb Mar Apr Mai Jun Jul Aug Sep Oct Nov Dec

Example of Utilization History

Insured Person

WHAT WE BRING TO POLAND


Health Insurance has 4 pillars:

Distribution Capital / Risk Medical Network Operations

Insurance Agencies Insurance Online

Agents Multi-Agents

Brokers Banks Others

Insurance Company

+

WHAT WE BRING TO POLAND 1st Pillar: Capital / Risk


Capital / Risk

Insurance Company

+

Annual expenditure limits Comprehensive risk coverage – all specialties Not limited by the kind of medical procedure Few exclusions Utilization moderators Underwriting Reinsurance Competitive premium

WHAT WE BRING TO POLAND 2nd Pillar: Distribution


Distribution

Insurance Agencies Insurance Online

Agents Multi-Agents

Brokers Banks Others

Quick sales process, with tele underwriting Incentives system Sales support hotline Regional sales support teams Internal communication External communication

WHAT WE BRING TO POLAND 3rd Pillar: Operations


Operations

REIMBURSEMENTS CUSTOMER SUPPORT

AUTHORIZATIONS

MEDICAL DEPARTMENT

MEDICAL NETWORK

MANAGEMENT

MEDICAL PROVIDER SUPPORT

CLAIMS PROCESSING AND PAYMENT

CLAIMS AUDIT

COST CONTAINMENT AND FRAUD MANAGEMENT

REPORTING

UTILIZATION IN THE MEDICAL

NETWORK

TELE UNDERWRITING

MEDICAL

PROVIDER

WHAT WE BRING TO POLAND 3rd Pillar: Operations


Operations

Online medical directory Call center Internet reserved area Virtual card Regular communication with the client: • SMS Initial Acceptance of the Risk • Welcome Pack • Statement of Usage • Follow up Call for Booking of Appointments • SMS for Authorization Requests • Comfort call after Surgery • SMS Reimbursement Request • SMS after utilization in the Medical Network

WHAT WE BRING TO POLAND 4th Pillar: Medical Network


Medical Network

Medical network (all specialties, hospitalization + ambulatory) Good ambulatory offering and wide geographic coverage Available capacity in hospitals, but limited activity • 415 private hospitals in all regions (OSSP * includes 174

hospitals) • OSSP hospitals had occupancy rate 55% in 2015 and could

accept 27% more patients with current staffing • Private hospitals represented only 3% of NHF funding in 2015 • New legislation “hospital network” is putting pressure on private

hospitals

* OSSP - Ogólnopolskie Stowarzyszenie Szpitali Prywatnych

WHAT WE BRING TO POLAND In Conclusion


More than 9 billion PLN in health insurance and around 9 million insured persons • Insurance mutualisation effect will expand the number of insured persons

and cover a wide range of health expenses

Appropriate timing in the market

• 22% growth in insured persons from 2016 to 2017

• Economy growing + unemployment dropping = people with higher disposable income

• “Hospital network” legislation

Growth of private healthcare insurance

WHAT WE BRING TO POLAND In Conclusion


New source of funding for private healthcare providers

Clients pay the same independently of the healthcare provider they choose

Operational audits performed by a dedicated medical team

Reduction of client health risk

Payment fee-for-service, max 20 days

Catalyst for developing high quality private healthcare


THANK YOU

Filipe Simões de Almeida [email protected]

Mobile: +351 – 917 276 928

comprehensive health insurance at affordable cost in...

Documents