Bruno Guarneros
Medical Director
Seguros Atlas
View from the Top

Lack of Insurance Culture, Access Stunts Growth

Thu, 09/07/2017 - 09:31

Q: How have the major medical expenses sector performed in Seguros Atlas’s portfolio of services?

A: It is one of the company’s most important branches but in general it has not grown as much as expected. Only 7 percent of the Mexican population has insurance or about 9 million people. This has increased by only 1 million people in the past five years due to a lack of insurance culture and access opportunities. Unfortunately, insurance is an elite product because it is expensive and certain segments of the population do not have access.

Q: What trends have you seen over the past 30 years?

A: The strongest trend is innovation. The last AMIS convention was focused on technology and on optimizing processes without losing the essence of service, a vital component of our business because we work with people. We need to focus on using technology to offer services to our customers.

Q: What type of technology are you implementing?

A: We are changing our internal systems, developing and using apps. For this, an inter-hospital system is required, along with a call center and a doctor to perform the diagnosis. We must also ensure compliance with data privacy laws. Our app for patients is informative and keeps them in contact with us. Another technological tool is hospital electronic records. We have developed this and are on the verge of releasing a digital card, accessible by phone and which contains a policyholder’s information. It also displays a QR code that hospitals can scan to obtain a patient’s medical history. It will be available in 31 medical units nationally.

Q: Atlas has an alliance with the Consorcio Mexicano de Hospitales. What are the benefits of such alliances?

A: We need the cooperation of hospitals to optimize costs. Our alliance with Consorcio Mexicano de Hospitales will improve quality through certification. A hospital may have the best transplantologist, the best neurologist and conduct many renal transplants but, how many infections occur there? Certification ensures all doctors and nurses are qualified and are specialists in their field.

Q: To what extent should indicators be a part of a hospital’s certification?

A: They absolutely should be. Now, certification is mostly about services offered to patients, ensuring that the labs and facilities are adequate, but there is no follow-up on the results of that service. Individually, hospitals know the number of infections that occur at the facility and publishing that figure would be the transparent thing to do. The cost of medicine is also impacting us greatly because the maximum retail price is established for sale in pharmacies but not for hospitals, which can charge insurance companies a higher rate.

Q: What is the financial impact of fraud in medical insurance?

A: We see falsified information, identity theft either of the policyholder or the doctor, fake prescriptions and receipts from ghost companies, middlemen who take a large cut and dead people that are still alive. Who pays for all of this? Policyholder does through their premiums, because insurance companies pass these costs to the customer. If fraudsters steal MX$500,000 (US$27,777), they are released within 24 hours. Only theft over MX$800,000 (US$44,444) is punished. We need to work with the authorities to change this. It is thought that 10 percent of the cost of insurance premiums is due to fraud. In 2013, fraud cost the insurance industry MX$15 billion (US$833 million) overall.

Q: What trends do you expect to see over the next five years?

A: Insurance for the elderly will be one of the most significant trends. We are facing a change in the population pyramid. Now, a couple ending their work life at 65 will need to pay MX$100,000 (US$5,555) annually for their insurance. However, how much is their pension? They will probably be spending three months of their pension on the insurance. Clients want to be able to go to any hospital, to get discounts everywhere, to pay only the minimum deductible. If clients go to hospitals we have agreements with, it is much cheaper.