What did you find?
We realized, during that assessment, that there was actually a fairly robust private health insurance system in place in both countries, but only the corporate elite had access to it. So if you happened to be working for Coca-Cola, or for P&G, or for Unilever, then you were included in the system — otherwise you were excluded from it. Most people in India and Pakistan were not even aware that such a system existed. It works much like it does in the US, where you have access to a network of hospitals. You show your membership or health plan card, and you get treated. The same system was growing and developing in both India and in Pakistan. So we thought, rather than reinventing the wheel, why not just leverage this system but enhance it by adding features that would address the needs of the marginalized?
We started meeting with various health insurance companies and negotiating large group health plans. If we were to enroll 500,000 lives, what is the best price they could give us? Along the way, we realized that we needed to wrap these health insurance plans with services that also met the immediate, tangible needs of the marginalized.
What are some of those needs?
Health insurance in many developing countries tends to be catastrophic in nature — mostly hospital based. Healthcare in the primary, or outpatient setting, is typically unregulated. It’s very difficult for insurance companies to monitor or verify appropriate treatment. So they choose to mitigate their risk by just focusing on inpatient hospital-based care, which is easier to monitor and regulate. Yet the marginalized actually need greater access to primary care — primarily because of the higher-risk, more polluted environments they live and work in. The challenge for us was how to address these needs in a scalable way?
We started providing our members with 24-7 mobile phone access to family doctors, who would also have examined each patient that would help establish titanium round wire a baseline heath assesment to identify latent or hidden disease. After that assessment, we’d basically provide large employer groups with a group risk profile of their worker population, and recommend and deliver customized interventions, interactive preventive health workshops, or health education seminars. If we notice that there’s a group of women working in a factory who perhaps don’t know enough about breast cancer prevention, we’d conduct a workshop on breast cancer screening and self-examination given by one of our doctors.
We also recognized that a lot of poor people feel really intimidated when they walk into a gleaming private hospital with lots of sophisticated medical equipment. It’s unnerving and disorienting for them. Historically, they’ve also been discriminated against in those environments. In order to make them feel more comfortable, our family doctors also serve as liaisons, navigators and patient advocates. They will speak in advance to the hospital’s treating physician, and say, “I’m sending my patient to you; please make sure they get good, quality care.”
If we receive customer complaints or reports of substandard treatment or any kind of social discrimination, the care provider and hospital don’t get reimbursed for that care. This financial penalty creates a kind of a check and balance to make sure that our members don’t face discrimination or get pushed down the list to make way for higher-income patients. Social prejudice was a major concern when we first started enrolling our low-income members, so this is something we remain vigilant about.
That’s a very good question, and this is where I think generation X and Y are playing a huge, catalytic role. What we have seen is that the early adopters of our health plan for the marginalized have been younger, more globally connected entrepreneurs and corporate business people, who tend to be in their 20s and 30s, and understand the benefits of this. I have witnessed more empathy from them than generations that preceded them. The younger generations realize that it’s not only unfair, but that there’s just something intrinsically and morally wrong about this social injustice.
So the millennials and Ys have kept us in business. The good news is that the demographics are shifting rapidly in that direction. Two-thirds of Pakistan is now below the age of 25, so the demographics are increasingly in our favor. We’re optimistic that we’re close to the “tipping point” that Malcolm Gladwell refers to, and on the verge of really taking off in a big way. But it is absolutely true that health insurance for low-income workers remains a big paradigm shift for many employers — both informal employers and formal employers, as well as employers who contract in services. A lot of people circumvent the law — which they also do in the US, by the way — by hiring a contract-based workforce. If you’re a contractee, or you’re part-time, you’re not entitled to benefits. It’s exactly the same in the US.
But in Pakistan, because the cost of that benefit is Titanium Wire suppliers so cheap (only $2 per person per month), we have been able to convince a lot of employers to enroll their part-time or contractual staff into these plans as well. A lot of corporations are doing that it. Two dollars per person per month is a drop in the ocean for many of these large companies.
How does this service directly benefit corporations?
For our corporate clients, insuring employees has proven very valuable, because there have been a multitude of cases we have screened and isolated where client-facing employees could have potentially passed on airborne infectious disease to clients, which would have been a PR fiasco. One particular company came to us as soon as one of their field representatives, who was a contract employee died in a road accident. They suddenly realized after this tragedy that they were exposing themselves to a lot of reputational risk, and that they needed to protect all of their field workers.
So sometimes it’s reactionary, but sometimes it’s also proactive. The ultimate form of asset protection is human asset protection — that’s what health insurance is. I think some companies are beginning to understand that it’s no longer sustainable for them to maximize profits in the short term at the expense of long-term externalities.
How many people do you now serve, and what is in store for future?
Currently, about 250,000 urban slum dwellers have access to our primary care plan, and an additional 68,000 members have been enrolled in our health insurance plan across 90 companies over the past four years. To achieve sustainability, we need to get to 150,000 insured lives. Those of us who are more optimistic have projected for Q2 of 2015 Titanium Wire Manufacturers ; those who are more conservative have projected for Q2 2016. So, knock on wood — let’s see if we can make it sooner rather than later! It’s pretty ambitious, but, you know, we’re a fairly ambitious bunch of people.
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