Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
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
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
© Future Healthcare 5
BUSINESS MODEL
© Future Healthcare 6
I. Who We Are
II. Overview of the Polish Market
III. What We Bring to Poland
AGENDA
POLISH POPULATION
© Future Healthcare 8
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
© Future Healthcare 9
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
© Future Healthcare 10
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
© Future Healthcare 11
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
© Future Healthcare 12
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
© Future Healthcare 13
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
© Future Healthcare 14
Source: OECD Data
PRIVATE HEALTH INSURANCE IN POLAND
© Future Healthcare 15
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
II. Overview of the Polish Market
III. What We Bring to Poland
AGENDA
WHAT WE BRING TO POLAND “COMPREHENSIVE HEALTH INSURANCE AT AFFORDABLE COST”
© Future Healthcare 17
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
© Future Healthcare 18
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
© Future Healthcare 19
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
© Future Healthcare 20
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
© Future Healthcare 21
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
© Future Healthcare 22
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
© Future Healthcare 23
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
© Future Healthcare 24
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
© Future Healthcare 25
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
© Future Healthcare 26
THANK YOU
Filipe Simões de Almeida [email protected]
Mobile: +351 – 917 276 928