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30th May 2012
Health Hotline Services in
Emerging Markets
Health Hotline Services in Emerging Markets
Restricted - Confidential Information © GSMA 2012
Outline
1. Executive summary and research scope
2. Value of health hotlines
3. MNO-offered health hotlines
4. Stand-alone health hotlines
5. Summary
6. Appendix: Methodology Overview
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Executive Summary
• Health hotlines (medical call centres) play an important
role particularly in preventative medicine and disease
diagnosis, strengthening over-burdened health facilities
and healthcare service delivery, especially in developing
countries
• MNOs, particularly in developing markets, are increasingly
providing health hotline services with at least 53 now
offering some form of medical information and
consultation service
• Pressure to differentiate and diversify revenue streams are
driving MNOs to launch mHealth services such as health
hotlines
• In markets where health hotlines have yet to be deployed,
adoption barriers need to be removed through strong
collaboration amongst internal and cross-border
stakeholders
• In markets where health hotlines have already been
deployed, endorsements from trusted institutions or
personalities can help improve service awareness and
consideration thereby potentially increasing the
consumers’ adoption of the service
Health Hotline Services in Emerging Markets
Executive summary and research scope
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Pan African mHealth Initiative
Bringing together mobile operators
across Africa with a view to
collaboration to achieve universal
health access
Research & Knowledge
Management
mHealth on MDI
mHealth Tracker
Impact Pathway
Aggregated Health Metrics
Reports on research, lessons
learned & best practices
Advocacy
Convening stakeholders and
catalysing dialogue through:
Mobile Health Summit
Leadership Forum
Mobile Health Live
GSMA Development Fund mHealth Programme Leveraging the ubiquity of mobile to increase health access for underserved people in emerging markets
Health Hotline Services in Emerging Markets
Executive summary and research scope
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Current state of health
Health Hotline Services in Emerging Markets
Executive summary and research scope
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Research Scope This report will provide a global overview of the health hotlines that MNOs offer but will focus on stand-alone
health hotlines – those that primarily provide general medical information and consultative services to consumers
794
637
157 53
0
200
400
600
800
1000
All MNOs MNOs withoutmHealth services
MNOs with mHealthservices
(non-health hotlines)
MNOs with healthhotline services
16 MNOs are offering health
hotline services as well as
other mHealth services
Health Hotline Services in Emerging Markets
Executive summary and research scope
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Value of health hotlines • Health hotline services have important functions in the
prevention, diagnosis and treatment segments of the patient
pathway
• By providing connectivity, MNOs play an important role in
health hotlines operated by the government, healthcare
providers and independent providers
• Many MNOS, however, take a more pro-active role beyond
providing connectivity by launching their own health hotline
services
• As proven in the case of NHS Direct in the UK, health
hotlines can help improve the cost-efficiency in the delivery
of healthcare services while maintaining high consumer
satisfaction
Health Hotline Services in Emerging Markets
Value of health hotlines
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Health Hotline Services in Emerging Markets
Value of health hotlines
Health value chain: health hotline function Health hotlines currently play an important role in the prevention and diagnosis segments of the patient
pathway; it also has some utility for treatment purposes (i.e. medication prescription)
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Types of providers
• Designed to supplement existing
public health facilities to reduce cost
and resources burden Government • Government • NHS Direct, UK • HMRI, India
• Established to supplement
prevention interventions, triage more
effectively, reduce re-admission rates
and ease administrative burden
Healthcare
provider
• HMO / health
insurance
provider
• Aetna’s Informed
Health Line, USA • [None identified]
• Mostly operated by telemedicine
firms; marketed by MNOs to extend
reach of healthcare services
Mobile
Network
Operator
• Patient /
caller
• Medgate (40%-
owned Swisscom
subsidiary),
Switzerland
• Grameenphone
Healthline,
Bangladesh
• Not affiliated with any specific
healthcare provider, MNO or other
group
Independent • Patient /
caller
• Teladoc,
USA
• MeraDoctor,
India
• Medicallhome,
Mexico
Description Who pays? Developed Developing
Deployment Examples
By offering health hotline services, MNOs widen their role beyond providing connectivity in the delivery of
healthcare services
Type of
provider C*
MNO Role
M* B*
*C = Connectivity; M = Marketing; B = Billing (Refer to slide 14 for more information on role of MNOs)
Health Hotline Services in Emerging Markets
Value of health hotlines
9
NHS Direct: value to provider Through NHS Direct, the National Health Services of the UK saves around £213 million annually
Health Hotline Services in Emerging Markets
Value of health hotlines
• A 24x7 nurse advice and health information hotline launched in Oct. 2000
• ‘Online patient decision aids’ also accessible via web app (since Dec. 2010) and
mobile (since May 2011)
• 22,500 calls per day or around 8.2 million calls per year are managed
• Operational efficiency achieved allowing healthcare personnel to focus more on
patients who need more care and on cases that require face-to-face interaction
Source: NHS Direct, UK
Top reasons for calls
• Abdominal pain
• Dental tooth/jaw pain
• Rashes
• Chest pain
• Ingestion of toxic substance
Call Outcomes By avoiding the following, millions
of money are saved:
• 1.1 million Accident &
Emergency attendances
• 1.6 million GP consultations
• 0.5 million other face-to-face
appointments
50%
30%
20%
Self-care
Emergency Referral
Non-emergencyreferral
10
NHS Direct: patient perception Patients are highly satisfied with NHS Direct not only because it avoids them unnecessary trips to
clinics/hospitals but also because of its quality of service
Health Hotline Services in Emerging Markets
Value of health hotlines
Source: NHS Direct, UK based on customer satisfaction research conducted by IFF Research
Quality of advice given
Reassurance provided
Speed
92% were satisfied with the service
Politeness of the staff
Dri
vers
of
sati
sfac
tio
n
88% followed
the advice
provided
77% would
‘most definitely’
recommend the
service again
miniscule
complaint rate
(<1 in 10,000
calls or
0.01%)
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Health Hotline Services in Emerging Markets
MNO-offered health hotlines
MNO-offered health hotlines
• At least 53 MNOs from 30 countries have launched some
form of health hotlines
• MNOs provide the ‘face’ for the health hotline services but
rely on third-party providers that provide the call-routing
solutions and supply of ‘doctor agents’
• Among the five types of health hotlines, stand-alone and
packaged emergency services are the most popular
• Stand-alone services are generally more popular among
countries with large populations, primarily Asian and
African countries which also tend to have limited access to
healthcare resources
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Five types of MNO-offered health hotlines Across all types of health hotlines, MNOs rely on third-party partners who have the expertise and manpower
to answer patients’ medical queries and needs
‘Stand-alone service’
‘Packaged emergency service’
‘Range of expert advice’
‘Health-focused packaged
emergency services’
Types of MNO-offered
health hotlines
‘General info hotline with
medical support’
• Medical information and consultation
• Various emergency services for
medical, roadside, home repair, legal
and laptop/PC repair services support
• Medical information and consultation
but evolved to include legal,
agricultural, education/career advice
• Similar to packaged emergency
services but focuses on medical
emergency services
• General directory/information service
but also provides medical emergency
assistance
Focus
• Telemedicine firms or hospital chains
• Emergency services firms (e.g.
International SOS, American Assist)
• Telemedicine firms or hospital chains
• Legal firms and other domain experts
• Emergency services firms (e.g.
International SOS, American Assist)
• In-house; referrals made to hospital
chain partners
Partner
26
23
2
1
1
No. of
services
launched
Health Hotline Services in Emerging Markets
MNO-offered health hotlines
13
Marketing
Connectivity
Billing
Non-health customer
support
‘Doctor agents’ Tele triage call
routing
solutions
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Value chain: MNO role
Technology
Partner
Knowledge
Partner MNO
Clinic and
Pharmacy
Partners
Patients
Face-to-face
consultation
Prescription
medication
Airtel’s
Mediphone, India
Grameenphone’s
Healthline, Bangladesh
Mobile and Health Regulators
181 million Bharti Airtel
subscribers
37.6 million
Grameenphone
subscribers
Health Hotline Services in Emerging Markets
MNO-offered health hotlines
14
Deployment overview
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Stand-alone services are more popular in Asia and Africa while packaged emergency services are more
popular in Central & Latin America
‘Stand-alone’ ‘Packaged
emergency’ ‘Range of expert
advice’
‘Health-focused
packaged emergency’ ‘General info hotline
with medical support’
Health Hotline Services in Emerging Markets
MNO-offered health hotlines
Mexico
(4 / 4 operators)
El Salvador
(3 / 5 operators
Nicaragua
(2 / 2 operators)
Panama
(2 / 4 operators)
Ecuador
(2 / 3 operators)
Paraguay
(1 / 4 operator)
Uruguay
(1 / 3 operator
Chile
(2 / 4 operators)
Peru
(1 / 3 operator
Colombia
(2 / 5 operators)
Trinidad & Tobago
(1 / 2 operator)
Guatemala
(2 / 4 operators)
France
(1 / 4 operator)
Switzerland
(1 / 4 operator)
Romania
(1 / 4 operator)
Nigeria
(1 / 8 operator)
Kenya
(1 / 4 operator)
South Africa
(2 / 4 operators)
Russia
(1 / 12 operator)
Turkey
(2 / 3 operators)
Morocco
(1 / 3 operator)
UAE
(1 / 2 operator)
China
(1 / 3 operator)
Hong Kong
(1 / 5 operator)
Bangladesh
(5 / 6 operators)
Nepal
(1 / 4 operator)
Pakistan
(3 / 6 operators
India
(5 / 15 operators)
Sri Lanka
(1 / 5 operator)
Afghanistan
(1 / 6 operator)
15
146
84
343
2915
358
141
62
919
25
1115
920
4111
416
1537
12
169452369
19475525571
4798485
32333
15651
201408
2584
796255
1861520
7141159
105229
591698
1064
1,3671,250
178163
152147
11674
67514742
333230
222121181515
887766441
ChinaIndia
PakistanNigeria
BangladeshRussiaMexicoTurkeyFrance
South AfricaColombia
KenyaMorocco
AfghanistanPeru
RomaniaNepal
Sri LankaChile
EcuadorGuatemala
UAESwitzerland
ParaguayHong KongNicaragua
El SalvadorPanamaUrugay
T. & Tobago
Country segmentation
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Health hotlines can supplement existing health facilities especially in emerging countries although stand-
alone services are generally more popular among countries with large populations
Population (in million) Per capita spending
on health (in US$)
Generally larger
population and limited
access to healthcare
resources
Generally smaller
population and better
access to healthcare
resources
Sources: United Nations and WHO
Number of doctors
per 10,000 people
N/A N/A
Health Hotline Services in Emerging Markets
MNO-offered health hotlines
‘Stand-alone’ ‘Packaged
emergency’ ‘Range of expert
advice’
‘Health-focused
packaged emergency’ ‘General info hotline
with medical support’
16
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Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
MNO stand-alone health hotlines
• Of 26 stand-alone health hotlines identified, 23 are deployed
in developing markets
• Some MNOs seem to have discontinued their services most
likely due to low customer adoption
• External organisational factors such as competitive
pressures, government and supplier involvement play a
crucial role in driving MNOs to launch health hotline
services
• By increasing collaboration among stakeholders within a
country and on a regional level, risks in deployment can be
mitigated while improving the chance of operational success
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2004 2005 2006 2007 2008 2009 2010 2011 2012
Bangladesh
Healthlink by
Grameenphone
and TRCL
Nigeria
Tele
Doctor by
MTN
Turkey
7/24 Doctor
Service by
Avea and
Acibadem
Mobile Health
China
Health
navigator
service by
China Mobile
Bangladesh
Through JBMFS the
following offered their
own health hotline
services:
Robi (which
switched to TRCL in
2012)
Bharti Airtel
Citycell
Through Synesis IT
Banglalink launched
Healthlink
Pakistan
uHealth by uFone
Pakistan
TeleDoctor*
by Telenor,
NexSource
and eHealth
Services
Afghanistan
TeleDoctor by MTN
South Africa
MTN Careconnect by
MTN and Sanlam
Kenya
Daktari 1525 by Safaricom
and Call-a-Doc Ltd
Nepal
IOMSmart Healthline by
Smart Cell and Tribhuwan Uni.
Institute of Medicine
UAE
Mobile Doctors
24-7 by du and
Dubai Healthcare
City
Sri Lanka
‘First Aid
Helpline’ by Dialog
and Med1
India
Mediphone by
Airtel and
Religare
Technologies
India
Doctor on Call by
Tata Indicom and
Healthcare Magic
Aircel Apollo
Mobile HealthCare
by Aircel and
Apollo Hospitals
India
Through Healthcare
Magic the following
offered Doc on Call:
Loop Mobile
Reliance
Communications
1 0 3 1 7 1 4 5 2 # of services
launched
Pakistan
TeleDoctor by Mobilink
Turkey
Medline Sağlık Danışma (Health
Advisory) by Vodafone and Medline
Hong Kong
24-hour Advisory Travel and Medical
Hotline by Smartone
Existing services but unverified
when launched
Evolution of MNO stand-alone health hotlines
Still active Subject to verification
Russia
Mobile
Doctor by
MTS
Romania
Health line service
by Comoste and
Total Care Network
Trinidad & Tobago
Medstar by TSTT &
Fonemed
Switzerland
2000: Medgate (40% of
the company acquired by
Swisscom in 2006)
Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
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Besides CSR and a desire to differentiate product offerings, external organisational factors such as strong
domestic competition can lead MNOs to adopt health-related mobile VAS such as stand-alone health hotlines
Population size and economies of scale Competitive markets and pressure to
diversify revenue
India
Country No. of MNO-
offered stand-
alone HH
Population
(2012)
Herfindahl-
Hirschman
Index (2011)*
EBIT Margin of selected MNOs****
(2010, 2011)
Pakistan
Bangladesh
Turkey
China**
Mexico***
Philippines
>3
3
4
2
1
0
0
1.25 billion
178 million
152 million
74million
1.37 billion
116 million
95 million
1355
2218
2891
3936
5018
5364
5557
Idea (8%), Reliance (15%)
Telenor (9%), Mobilink (15%)
Grameenphone (36%), Robi (12%), Banglalink (28%)
Turkcell (21%), Avea (-7%), Vodafone (-9%)
China Mobile (29%), China Unicom (27%)
Nextel (19%), Telcel (40%)
Smart (35%), Globe (37%)
Str
on
g
ado
pti
on
Wea
k
ado
pti
on
Sources: United Nations and Wireless Intelligence
*Herfindahl–Hirschman Index (HHI) is a measure of a certain industry’s market concentration. The Index can range from 0 (where there are many small firms operating) to 10,000 (where there is a monopoly).
** Only deployed in the Inner Mongolia province
*** Telcel only provides connectivity and billing support to MedicallHome and, hence, this service is classified as Independent-provided health hotline
**** Not all operators provide financial information on a country level so even operators that do not offer health hotline services are included in the table for benchmarking purposes
1 2
MNO adoption: drivers
Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
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MNO adoption: drivers Governments should develop a regulatory environment that will incentivise market players, both domestic and
foreign, to invest more in their healthcare industry
Policy and
regulatory
environment that
promotes
investment
Strong supplier
Involvement
• Pakistan: Endorsement from Sindh’s province Ministry of Health of
Telenor’s TeleDoctor
• India:
o Government involvement in development of telemedicine
guidelines & standards
o Discussion on conferring ‘infrastructure status’ on healthcare
industry enabling healthcare players to access low-cost investment
and exemption from payment of various taxes
• India: Apollo Hospitals, Fortis Healthcare and Healthcare Magic
• Bangladesh: Telemedicine Reference Centre Ltd.(TRCL) and Japan
Bangladesh Friendship Medical Services Private Limited (JBFMS)
• Turkey: Acibadem Hospitals Group and Medline Health Group
3
4
Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
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Collaboration among stakeholders within country and on a regional level – key to addressing barriers to
adoption
Consumer preference for face-to-face
consultation • Endorsement (promotion) by credible health authorities
Underserved consumers inability to pay • ‘Freemium’ and/or subsidised services
Medical associations’ inertia and perception that
health hotlines are unethical • Include medical associations and other stakeholders in
planning, trials and commercialisation
Lack of economies of scale
• Appropriate incentives for healthcare workers
• Automation of the “triage” process as much as possible Lack of highly qualified medical practitioners
• Stimulate partnerships to deploy standardised, national
and/or regional health hotlines
Limited government funding and/or subsidies
• Liberalisation of healthcare market: incentivising private
sector through tax and other incentives
• Increase health economic evidence base
MNO risk-aversion (reliance on proven VAS
services like mPesa) and low competitive
pressure
• Risk mitigation through strategic partnership development
• Quantify tangible and intangible value proposition for all
stakeholders
MNO adoption: barriers and solutions
3
4
5
6
7
2
1
Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
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• Does the telemedicine partner have the experience? Does it have enough manpower to manage increases in demand?
• Is there an IVR-component that helps pre-screen calls?
• Did the service undergo user testing [to adopt for various mobile channels]?
• Was the service intuitive/ easy-to use and accessible through a short code?
• Was content/call-routing consistent with government/private healthcare providers’ messaging and does it account for local culture?
• Is enough marketing support provided by the MNO or is the service a haphazard response to a competitor’s launch?
• Is the right campaign content/media used to inform the public of the service?
• Do consumers expect the service to be provided free - as healthcare is expected to be a social benefit provided by the
government?
• Does the campaign highlight who the healthcare provider is if an MNO does not have enough credibility on its own to offer the
service?
• Does the service have the support of government / healthcare providers/ other credible individuals or entities?
• Are the benefits of using the service clearly highlighted in the campaign?
• Is the price of the service affordable relative to the cost of face-to-face consultation?
• Is there a cap to service fee/daily package to avoid patients accumulating a huge bill?
• Does the service have free content that can induce trial of service and strengthen the main health hotline service’s credibility?
• Does the service waive liability upfront making the service provider appear non-committal?
• Are ‘agents’/ doctors knowledgeable about and trained to become more customer-centric?
• Does the service cover the most important health conditions?
• Does the service allow doctors to provide service beyond triage?
• Does the service include referrals to clinics / hospitals / pharmacies?
• Is the service effective? Do the doctors diagnose patients correctly?
• Are there follow-up calls to ensure that patients follow doctors advice/prescription?
• Is there sufficient health information and access to further content to help the consumers / patients?
Service design
and
development
Awareness
Consideration
Trial
Usage
Repeat Usage
Customer/patient adoption: drivers for success
Health Hotline Services in Emerging Markets
MNO stand-alone health hotlines
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Health Hotline Services in Emerging Markets
Summary
Summary • By putting the needs and wants of underserved consumers
– the consumer segment that is more likely to use health
hotlines – at the heart of service design and development,
MNOs can become more successful when launching health
hotline services
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Summary: health hotline success factors
Collaboration • Integration with existing health services / infrastructure
Consumer wants and needs
• Segmenting customers: premium services to subsidise services for
underserved consumers
• Having a ‘freemium component’ that induces trial of service, only
escalating to a paid service upon appropriate triage
• Full consultative approach
Cost to satisfy • Affordability and value for money against a face-to-face service
• Variable pricing but having a cap on how much can be charged
Convenience of acquisition
• 24 x 7 service
• Referral system with potential discount to referral partners
• Using agents for non-prescription medicine distribution
Communication
• Endorsement by government/medical association/celebrity
• Clearly stating value of benefits
• Inducing trial of service
• Reliance on agent network
Taking into consideration underserved consumers’ wants and needs is crucial to the success of any
health hotline service deployment
Health Hotline Services in Emerging Markets
Summary
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Health Hotline Services in Emerging Markets
Appendix
Appendix
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Health Hotline Services in Emerging Markets
Appendix
Methodology Overview GSMA referred to existing publications about health hotlines but also did the following to ensure that we have
covered all health hotlines and other health-related services being offered by MNOs:
Visited each of 794 GSMA full-member operator websites and looked for any mHealth or
health hotline-related services
Used the respective website’s search field, if provided, and used certain search words similar to
the words used below
Used the following example search query to ensure that the MNO’s website is fully explored
•mHealth OR medical OR health OR doctor OR physician OR nurse OR wellness OR fitness OR
prevention OR treatment OR diagnosis OR monitoring OR assistance OR emergency
site:www.[MNO_name].com
To verify the launch date or status of the service (whether it is still active or not), we also
referred to various news, press articles and social media websites
1
2
3
4
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Health Hotline Services in Emerging Markets
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