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Will tech save health insurance?

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The Health at a Glance study, released on November 7 by the OECD, reveals that Portuguese families have to pay more and more to care for their health. Paying 28% of total health care costs, Portugal is one of the countries where the socalled out-of-pocket is the highest and has increased most in the last 8 years. This terminology covers expenses that are not reimbursed by the state or health insurance or that are not deductible (in taxes, for example), as well as co-payments (such as the moderating fees applied to public services or private hospitals when using insurance or health subsystems).

The report also reports that health spending has steadily increased in most countries in recent decades, although the pace has slowed following the 2008 financial crisis. Higher incomes, new technologies and aging populations are the most important factors for this reality. Average growth is expected to be around 2% in Portugal over the next few years.

The OECD thus indicates that the health care costs in the countries that make up the organization will pass the current 8.8% of GDP to about 10.2% in 2030, which raises concern over sustainability.

An ever increasing number of insured in Portugal

In June of this year, the number of people with health insurance reached 2 522 862, a growth of 5.9 % over the same period last year, according to data from APS – Portuguese Association of Insurers.

The increase in the number of beneficiaries accelerated compared to the total of 2018, when there was an increase of 3%. Looking at the last four years, the largest increase of 37% was in group health insurance, with individual increasing by 17% in the number of insured consumers. (Source: Marketeer – 30/11/2019)

In this context, it is increasingly the companies that have been including health plans or insurance in the benefits offered to employees. According to this year’s Mercer data, 28% of the companies analyzed in its Total Compensation Portugal 2019 study already offer their employees benefits program, in which case 92% of the programs include health plans or insurance.

The Willis Towers Watson Global Study, Trends in Benefits 2019, confirms that in Portugal, along with Italy, health insurance is the most prevalent benefit. The main challenge for companies regarding these benefits, according to 80% of the study participants, is cost and budget.

To find out if group health insurance that companies give their employees is a sustainable perk, Willis Towers Watson recently hosted a conference that brought together the governing bodies of the nation’s leading health insurers. Gathered at a round table animated by Mariana Barbosa, editor of Jornal Eco , on the occasion of the Sustainability of Benefits conference: José Pedro Inácio (CEO of AvanceCare), Maria João Sales Luís ( Executive Committee d Multicare), Natália Bernardino (Senior Consultant Health & Benefits Willis Towers Watson) and Pedro Correia ( Management Commission at Médis).

Cost sustainability

The first challenge raised by 80% of the companies surveyed by WTW regarding the benefits strategy concerns its cost & budget.

In this regard Pedro Correia states that it is impossible in Portugal for health insurance to pay “millionaire” treatments, with the level of premium that companies are willing to pay. Thus, one has to invest to avoid having these therapeutic costs very high (note: related to cancer, a.o. ). According to Pedro Correia, these investments should promote early diagnosis plans within the company, which should be accompanied by communication actions.

Maria João Sales Luís is of the opinion that there is no scope for making preventive plans in companies as it is “a shame” the average corporate capital of 22,000 €. The solution found at Multicare is online medicine and a lifestyle coach.

Companies must face the issue of health and well-being of its employees as an investment and not a cost, defends José Pedro Inácio . It is a cultural change. There are over 300 apps that can help individuals and businesses monitor and control their well-being.

In Health Insurance management, this change of mindset must be assumed by everyone from clients to their employees and promoted by the broker says Natália Bernardo. Increasingly the latter has a relevant role and is a consultant who informs, advises and supports companies in decision making and a strategic line of benefit management beyond the short term. They must decide whether they want to take out health insurance to reimburse current expenses or whether to choose a benefit that ensures the health and well-being of their employees in the most serious situations. It takes courage in the decision-making to shift the focus from immediate management to a medium / long-term vision so that 5/10 years from now, in the face of rising medical treatment costs, and a severe disease, the insurance can respond with the necessary capital

On the sidelines of the conference, TDI asked each of the panelists: What is your view on the technology or solution that impacts health insurance the most and why?

Answer given by Pedro Correia from Médis:

Pedro Correia ( Management Commission at Médis)

“More than the technology itself or the technological solution, it is critical how it is put at the service of customers to manage their health and well-being. We are witnessing a movement of greater awareness of well-being, the importance of healthy lifestyle and habits as fundamental pillars in the prevention and maintenance of health. On the one hand, customer-centric technology with simple, tailored interoperability at each moment will dictate success in continuous and consistent use over time. On the other hand, we realize that it is not just a technological solution, but the interconnection of several that will allow customers a wide range of services: telemonitoring, teleconsultations, health and wellness engagement platforms, content management, etc.”

Answer given by Multicare:

“We believe that the technological path of health insurance will be to prevent disease. Wearables and AI will allow insurers to invest part of their effort in increasing the insured’s healthy standard of living by shifting some of their focus on the medical component to healthy living programs.

When the wearables we are going to use and AI begin to stream a flood of biological data, it will be necessary to have available and capable medical centers to receive and interpret them. We will no longer be seeking medical help and these centers will contact us, informing us that our biological data suggest a pre-disease. This possibility of early detection of the disease will have a direct impact on reducing costs and increasing the success rate of treatments, important factors for the insurance industry.”

Answer given by José Pedro Inácio from AdvanceCare:

José Pedro Inácio (CEO of AvanceCare)

“Digitizing health insurance has been instrumental in creating value from the first contact with the customer, transforming their experience into a simple, modern and impactful journey rather than the traditional industry experience associated with too much paperwork and immobility.

For this, several technologies have been fundamental. I highlight artificial intelligence, which has allowed us to improve our response to customers and partners, as well as removing routine work from teams; APIs, which allow us to securely connect with our partners along the value chain; Big data, which allows us to use data to develop and control our business models and, finally, the internet of things, which will allow us to integrate devices (eg wearables) so that we can take better care of the health of our customers. our clients.”

Response by Natália Bernardo of Willis Towers Watson:

Natália Bernardo (Willis Towers Watson)

“Technologies are increasingly present in the lives of health insurance beneficiaries and play an increasingly relevant role in the decision-making process, predominantly when we speak of generations that have grown up with them. The apps associated with the different insurers of this branch, have brought a closer proximity of the user to the benefit, better service perception and a new communication channel. One example is the expense reimbursement feature, which enables better administrative efficiency, resource savings and reduced reimbursement times, with clear growth in membership and satisfaction of its beneficiaries. Another differentiating service is telemedicine, where people find an alternative that gives them greater accessibility, whether for an online consultation, to obtain a prescription through it, for immediate medical advice, and that can make life easier for families, avoiding trips to urgencies, or at first diluting any geographical distances that may exist. In any case, we understand that we are taking the first steps in the potential that technologies can bring to the management of this benefit.”


  • OECD Health at a Glance Report, published Nov. 7 and unveiled by the Expresso Journal in its Nov. 7 issue ;
  • Willis Towers Watson 2019 Benefits Trend Study
  • AP, Portuguese Insurance Association
  • Marketeer, 11/30/2019
  • Photographs courtesy of Willis Towers Watson


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