entry strategy for cognizant- the middle-east healthcare insurance market

© 2008, Cognizant Technology Solutions. All Rights Reserved.The information contained herein is subject to change without notice.

Opportunities in the Middle East-East meets West

Nov 20th , 2007

Author: Abu Isaac

2© 2008, Cognizant Technology Solutions.

Introduction

GCC* governments currently provide the lion’s share of health-care financing—approximately 75 percent.

To lessen the burden, all GCC countries recently passed, or are in the process of passing, sweeping health-care insurance legislation

Demand for private health insurance products has risen significantly since the start of 2007

» Growing at over 21% annually

» Premium growth outstripping major industrialized nations

In Saudi Arabia alone, demand is such that estimates predict that the health insurance sector will be worth more than SR15 billion (USD 4 bn) by 2009.

Abu Dhabi & Dubai passed laws requiring all employers in the Emirate to provide minimum cover for their employees.


Drivers

Cost: Total healthcare spending in GCC countries will rise to about $60 billion by 2025, from almost $12 billion today.

» With most pharmaceuticals, medical equipments and medical service providers imported, healthcare costs are even higher, so insurance is viable, if not critical.

No Tax: These countries don’t have taxes and hence unable to pay for the increasing medical cost

GDP Growth: Healthcare spend is expected to grow significantly in the period between 2006-2015, driven primarily by growth in GDP/ capita

Agreements with a growing number of blue-chip medical companies, such as Cleveland Clinic and John Hopkins Medicine, to set up operations in the GCC region

More insurers, MCOs and TPAs getting into the picture to meet the demand

Saudi Arabia, the largest GCC member taking the first step, many others following suit

Multi-billion dollar healthcare projects like “The Mother of Emirates Healthcare Complex”, “Dubai Healthcare city”, Hamad Medical City” etc

Huge investment in pharmaceuticals and increasing privatization

Population Growth, ageing and increased diseases


Healthcare Demand

Demand for treatment: It is estimated that, over the next 20 years, the demand for healthcare in GCC will rise 240 percent resulting from steep increase in cardiovascular diseases and diabetes related ailments

Demand for hospital beds: By 2025 demand for hospital beds will have more than doubled; the region will require more almost 162,000 beds in all. Saudi Arabia and UAE are expected to register the greatest percentage increase in demand.


GCC Healthcare Market Summary


Players in the Market

MEDNET (TPAs for Aetna in UAE)

Nextcare

CIGNA International

EUROP Assistance

BUPA Middle East

Good Health

Royal & Sun Alliance

Global Health Insurance

Saudi-Indian Insurance Company

SABB Takaful Company

Dubai Healthcare City

John Hopkins International

Saudi German Hospitals

Emaar Healthcare

AXA Insurance Gulf

Qatar Insurance Company

Arabian Scandinavian Insurance Company

Oman Insurance Company

Daman- The National Health Insurance Company

and lots more...

Providers Stats


Saudi Arabia

The Kingdom has made health insurance compulsory for all expatriate workers

Expects the healthcare insurance market to grow at 25% annually

4 million expatriates treated in hospital every year in Saudi Arabia

Health insurance industry is booming with total number of registered people under the national health insurance scheme rose to 2.64 million

A health insurance policy from an approved cooperative health insurer is now a requirement in the granting of Iqamas* and work permit renewals

The Kingdom’s fast-growing pharmaceutical sector is contributing to the good health of insurance company investments

Health insurance law is being implemented in phases

Companies with more than 500 expatriate workers to be covered first

The next phase is to be imposed on companies having 100 workers and more

Finally, coverage will extend to all workers including housemaids

Eventually health insurance would be made mandatory for Saudi citizens

Foreign insurance companies to open their branches in the Kingdom. Includes well-known insurance companies from Britain, Germany, Switzerland, Japan, India, Holland, the United States, Bahrain, Jordan, Lebanon and France

Insurance companies are obliged to float at least 25% of their shares on the Tadawul, the local stock exchange, and meet other regulations

Health insurance premiums, which accounted for about a third of the total market, grew 64% to SAR2.2 billion


UAE- Abu Dhabi

Health insurance to become compulsory in the UAE soon

The United Arab Emirates is divided into seven Emirates having different rulers and rules. The emirates of UAE are

» Abu Dhabi

» Ajman

» Dubai

» Fujairah

» Ras-Al-Khaimah

» Sharjah

» Umm-Al- Quwain

The Abu Dhabi Health Insurance Law

» Begun implementation of its first phase on July 1st 2006

» All local and federal Government, Quasi-Government, and Private Companies with over 1,000 workers to provide Health Insurance to all their employees and their dependents

» Phase II began on January 1st 2007, and will cover all expatriates residing in the capital

» Abu Dhabi Population to soar in the next several years fuelled by trade and tourism


UAE- Dubai

Dubai government in the final stages of implementing comprehensive new health insurance arrangements in the Emirate by 2008

» The plan follows Abu Dhabi's universal health insurance scheme

» Dubai's new health insurance law is expected to take few months to formulate

» The law will enable all in the country to pay insurance EMIs and get health coverage.

Under the plan, all UAE residents can seek treatment at hospitals in the UAE, including private ones, listed by the new federal insurance provider

The goal is to ensure access to healthcare services for all, particularly the middle to lower income level workers such as construction workers

Dubai Healthcare City (Free-Zone) managed to attract high-profile names in healthcare such as Mayo Clinic, Moorfield's Eye Hospital and Harvard Medical School-Dubai Centre

New hospitals coming up are the Bumrungrad Hospital, the Saudi-German Hospital, the Canadian Hospital, the annexure of American Hospital and lot more.

Major international healthcare businesses such as BUPA, MedNet, Swiss Re and InterGlobal have already responded as well as a number of prominent regional insurers such as Arab Orient, Emirates Insurance, Al Khazna and Daman

The Government established the national health insurance company, Daman, early in 2006. By December 2006, Daman reported to have issued approximately 200,000 health cards


The rest of GCC

Bahrain: Recently the Ruling Council approved health insurance plan for expatriates

» Implementing a 5 stage health insurance policy covering citizens in phase II

» Hospitals in Bahrain have direct billing facilities with the several insurance companies like Cumberland Insurance, CIGNA Healthcare, International Health Insurance (IHI)

» Batelco, Bahrain's leading Telecommunications Company, has signed an agreement with Solidarity to provide health insurance coverage for Batelco staff

» Plans to outsource non-core medical services

Qatar: Implementing health insurance in a phased manner

» With the launch of “Qatar Financial Center” in Doha, things have changed

» New private health insurance companies are entering Qatar in a big way

» First step towards privatization with the creation of National Health Authority (NHA) in 2005

» Creating a National Health Database

» “AXA Insurance Gulf” won the healthcare insurance bid for Qatar petroleoum covering 12,000 employees and 23,000 of their dependants

» Healthcare budget in 2006/07 rose 18.2% to QR 3.8bn (USD 1 bn)

Kuwait: Does not have any healthcare insurance plan, but the government is thinking to revamp the entire healthcare delivery and insurance system


Opportunity

For Insurers

Huge market in Saudi Arabia and UAE with expatriates population of 50-60%

Government’s lack of experience in running complex healthcare insurance system is actually an opportunity for international payers

GCC governments often pay big money to insurers for hiring and training locals

Plethora of opportunities if the government adopts appropriate policies and regulations. GCC states are rising to the occasion and are already elevating the private sectors role in healthcare

Opportunity for Cognizant lies in building IT-enabled transparency of Business Process

Helping to build the e-claims model for insurance companies

Can reduce dependence on dollar, increase revenue and diversify geographically

Potential for other verticals in Cognizant

» BFSI- Dubai and Doha competing to become the financial hub of Asia. The market size of Islamic banking solution is $300 billion

» RHML- Booming market for retail, hospitality, manufacturing and logistics

Middle East presence makes it easier to enter European markets

Huge opportunity to enter the “Provider” market as it is wooing big names

from the west


Road Blocks

Takaful* health and life policies are complex

» The main drawback is that the law forbids investments in a wide range of industries –including armaments; and most health and life insurers cannot control where their parent companies invest funds

The current policies and regulations are a roadblock but they are fast changing

Finding talent as people consider a job in the GCC countries as a stepping stone to much greener pastures of Europe or US.

Few people have experience or skills at the point where healthcare and finance intersect.

Very low IT penetration. However the potential for Cognizant is huge.

The GCC expatriate population is traditionally fairly transient, which provides healthcare insurers with specific challenges as policyholders may change more frequently than in other countries.

Different rules in different emirates and GCC countries might confuse the customer as well as the health plans


TCS almost doubling the revenue its makes from GCC every 12 months

Infosys has offices in Sharjah, UAE

Accenture has office in Abu Dhabi and Dubai

Covansys has a good middle east network

IBM has big operations in the middle east with office in Dubai

Wipro has offices in both Saudi Arabia and UAE

Perot Systems, IBM are the Gold sponsors for Arab Health

3iInfotech is penetrating The Middle East market in a big way trying to increase their visibility in this market considerably

Satyam's business growing by around 70% year-on-year in the Middle East alone

What about

Cognizant?

Competitors …a Quick Glance


Appendix- Upcoming Forums for Cognizant

Arab Health- The leading international healthcare exhibition and congress held every time

in Dubai (27th -31st January 2008)

Insurex- Middle East's premier independent insurance conference (8th -9th April 2008)

Healthcare Management Forum- The Middle East conference for healthcare

providers (27th -31st January 2008)

Healthcare Arabia- Launch pad in the Middle East for global healthcare product

manufacturers and service providers (20th – 24th November 2007)

GITEX Technology Week 2008- The leading international IT Trade event for

Enterprise and SMBs for the Middle East, Africa and South Asia. Satyam and Wipro sets up stall here every year.


Market Entry for Cognizant

Joint Venture or an Alliance with the local players like Waseel, Daman etc

Set up our own development center in any of the free zones available all over GCC

Establish a development centre in Egypt targeting Middle East and global businesses

» Smart Village - a 450-acre business park for IT and telecom companies in Cairo

» Cheap Labor available in plenty

Setting up regional offices in GCC with development centers in India itself

» Can leverage on the Kochi development center because of the State’s inherent bond with the GCC countries

especially the Smart City campus built by the Dubai Govt (Possibility )

Acquisition of a local company and integrating it with Cognizant though some GCC

countries don’t allow take-overs