Digital Wallets: Current and Future Use for Healthcare Payments in India

The digital wallet market size was valued at USD 1,043.1 billion globally in 2019 and is projected to reach about USD 7,580 billion by 2027, growing at a Compounded Annual Growth Rate (CAGR) of 28.2% from 2020 to 2027. Also in 2019, India had 73.9 million people using digital wallets. The estimated value of mobile transactions across India in 2020 was INR 36.5 trillion, the equivalent of USD 4.9 trillion. The value is expected to more than triple by 2024. The increasing prevalence of the internet and smartphones and targeted government initiatives has spurred growth in digital payments in India. Click here to read the full blog post on Fintech for Health.

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ACCESS Health Participates in Webinar About Fintech Healthcare Financing in the Philippines

On March 2, 2022, Dr. Monica Mittal, Innovation Lead, and Ian W. Porteous, Regional Coordinator of ACCESS Health International shared their perspectives for a webinar titled “How Innovation Fintech Solutions Could Address the Gaps of Healthcare Financing in Philippines.” The webinar was hosted by the Philippine Insurers and Reinsurers Association. The webinar touched on Fintech for Health solutions, including innovative insurtech models that meet the needs of the target audience comprehensively, changing role of different stakeholders, and how the models could be scaled to meet the needs of the mass population. Please click here to view the recording of the webinar. 

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5th Session of the Fintech for Health Special Interest Group held

“Sixty-three percent of the India's total health expenditure is paid out-of-pocket as compared to the world average of just 18.2%. Fintech for Health can lessen this disparity” ACCESS Health hosted the fifth session of the virtual Fintech for Health Special Interest Group (SIG) series on February 23, 2022. ACCESS Health created the Fintech for Health initiative with support from the Metlife Foundation to provide innovative solutions that enable low to moderate-income people in Asia to pay for and access high-quality care using digital financial services. The Fintech for Health team in India continues to engage fintech and health tech players to share knowledge, resources and create new partnerships and models to support health financing for low and moderate income populations during these sessions. Sixteen representatives from leading health tech, fintech, banks, non-profit organizations, and insurance companies participated. The objective of the fifth session was to showcase digital lending solutions supporting the healthcare needs of the patients, providers, and medical equipment dealers alike. Discussions spotlighted financing solutions offered by Arogya Finance and DigiSparsh. Arogya Finance - Transforming healthcare affordability landscape for people in IndiaArogya Finance is an innovative, healthcare-focused fintech that creates easy payment solutions for patients. Arogya Finance provides medical loans to the traditionally unbankable or underserved communities, using innovative risk assessment tools. In its efforts to transform the healthcare affordability landscape it presents a large market opportunity to support healthcare out-of-pocket expenses in India. Patients borrow from and repay Arogya Finance directly, leaving them free to get treated wherever they choose to do so. When a patient is diagnosed with a condition or disease, and if the patient or family cannot pay for treatment, they are referred to Arogya Finance through hospital partners. Arogya Finance undertakes rapid screening and administers a psychometric test to determine the creditworthiness and risk-taking profile of the beneficiary. A decision is made and conveyed within 3 to 72 hours. If approved, care can begin immediately and Arogya Finance pays the hospital directly. The borrower repays the loan within a time frame of 3 - 36 months. All loans are managed on a cloud-based loan origination and management system 83% of percent of people are approved via the psychometric test with a default rate of only 3% for repayments. The discussion led to suggestions for Arogya Finance to possibly cater specific plans for different segments of society and provide loans to support insurance premiums. DigiSparsh - Fintech Lending Solutions for the entire Value Chain of the Healthcare EcosystemDigiSparsh offers lending solutions, including insurance receivable financing, supplier financing, and patient financing. In short, it supports the entire value chain of the healthcare ecosystem. For Hospitals - Provides instant funding to the cashless claims' payment of the hospital which otherwise takes 60 days to come from insurance players. DigiSparsh is trying to solve the problem of blocked working capital for the hospitals due to delayed settlement of cashless claims by funding the cashless treatment amount in just a few hours. Patients - Offers interest-free loans to patients who do not have insurance; and Suppliers - Offers lending solutions to the supply chain of the healthcare sector. This product provides an instant payment option to consumable/medical equipment suppliers of the hospitals. Additionally, DigiSparsh is opening doors for Jan Dhan account holders to set up self-check health kiosks for the customers and provide an outpatient teleconsultation product through those health kiosks. Unequal access to finance solutions has led to unequal access to healthcare: With the low rates of insured populations in India, a person spends three times the typical hospitalization expenses for pre and post-hospitalization expenses. Sixty-three percent of the India's total health expenditure is paid out-of-pocket as compared to the world average of just 18.2%. This Special Interest Group fifth session looked into the potential use of Fintech for Health models and how these can expand to unreached populations. Post-pandemic out-of-pocket expenses to meet medical emergencies have shot up drastically, forcing people to resort to unorganized debt markets. Digital Lending services such as Arogya Finance and DigiSparsh are some of the products that can address a small gap to reduce out-of-pocket expenditure. The global pandemic is an opportunity to accelerate digital financial solutions for health: The global COVID-19 pandemic has resulted in an enormous global reprioritization of digital financial services in the health sector. Fintech companies are now aware of how public health impacts global markets and are looking for new business opportunities which can meet the immediate healthcare needs of the mass population who do not have other avenues of financial resources to cover for unexpected healthcare costs. Digital Financial Services do not yet fully bridge the digital divide: There is evidence that digital financial services can reach and serve a proportion of vulnerable populations (women, rural, adolescent, low-income). However, even in the most advanced digital financial services ecosystems, there are still disparities in who has access to and control over mobile accounts and technology. While digital approaches excel at creating operational efficiencies, they are not yet able to equitably reach potential beneficiaries, and their ability to convey information about complex financial and health concepts remains unclear, particularly in contexts where prepayment and pooling health financing mechanisms are still unfamiliar. Remaining questions about the viability of digital lending to consider: What are some of the challenges with scaling digital lending solutions for the low-middle income population? What happens when the patient defaults in repayment of loans? What are the alternatives to such a problem? What happens when the interest rate is not 0%? Can the lending solutions still offer a loan for patients on a buy now pay later financing model or assess patients via alternative ways to evaluate creditworthiness?

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ACCESS Health Southeast Asia launches report: “Overcoming Barriers to Cloud Adoption in Public Healthcare in Asia Pacific”

ACCESS Health Southeast Asia is excited to announce the publication of their report, “Overcoming Barriers to Cloud Adoption in Public Healthcare in Asia Pacific,” in partnership with the AWS Institute. Rapid digitalization during the pandemic has brought about remarkable advances in healthcare that were long overdue. Cloud services facilitated critical population disease surveillance, contact tracing, and telemedicine amongst other tools. Yet cloud adoption in healthcare is still underutilized and many countries lack the specific guidelines, legislation, or infrastructure needed. Now is an ideal time for governments and healthcare organizations to realize the potential of a digital-first cloud adoption policy for the management of chronic diseases, medical research data, controlling healthcare costs, patient-centered healthcare systems, and health data security.        Research was conducted in 12 countries including: Singapore, Australia, New Zealand, South Korea, Japan, Malaysia, Thailand, Indonesia, Vietnam, Philippines, India, and Bangladesh. Over 40 policymakers, CIOs, CMIOs, and digital health experts were interviewed to gain insight into the progress of healthcare digitization in the region. You can read the report here.

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Partnerships for Care Integration to Ensure Continuum of Care Across Health Systems in Uttar Pradesh

In Uttar Pradesh, the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is increasing focus on how to leverage public and private health systems, programs, and schemes, to offer a better experience to the beneficiary.  Since its implementation in September 2018, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) has gathered strength in moving towards the goal of providing universal health coverage in Uttar Pradesh. After the first phase of implementation, there is an increasing focus on how to leverage the public and private health systems, programs, and schemes to offer a better experience for the PM-JAY beneficiary. The State Agency for Comprehensive Health & Integrated Services (SACHIS) which implements the scheme in Uttar Pradesh, organized a discussion in partnership with the Department of Health and Family Welfare, Department of Medical Education, and National Health Mission, to identify possible opportunities in improving coordination and implementation. The discussion facilitated by ACCESS Health was chaired by Mr. Pranjal Yadav, Secretary, Medical Health and Family Welfare with participation from Mrs. Sangeeta Singh, CEO, SACHIS, Dr. Vedvrat Singh, Director General (DG), Department of Medical Health, Dr. Lily Singh, DG, Department of Family Welfare, Dr N.C. Prajapati, DG, Department of Medical Education, and Dr. Rajesh Jha, General Manager, Community Process, National Health Mission. The discussion acknowledged that participation of the public sector hospitals and institutions in PM-JAY can improve access to care, however, increasing the quality and patient experience is of critical importance. At present, there is little motivation for the beneficiary to use the PM-JAY cover in a public hospital as they are entitled to free care in these facilities. Also, there is a preference for seeking healthcare in private hospitals. Hence the need of the hour is to increase the value proposition of care through an integrated, beneficiary-centric system.  Insights and Opportunities At the community level, integrated beneficiary support through the Health and Wellness Centres (HCWs) for beneficiary identification, telemedicine for specialist care, referrals to higher facilities for diagnostic and hospital care, transport, and post-hospital follow-up in the community.  Specifically for institutional deliveries of high-risk pregnancies among PM-JAY beneficiaries' greater coordination with PM-JAY can ensure that if women need a Cesarean - section service, these could be referred to private empanelled hospitals. The Health and Wellness Centres have these provisions and the discussion clearly highlighted the intent and feasibility to work on integrating the pathway which can connect these services for PM-JAY beneficiaries.  At public hospitals, besides the availability of infrastructure and human resources, there is a need for better information for beneficiaries to navigate the system to access care in facilities and post-treatment care. Equally important is streamlining the supply of drugs and diagnostics which remains a challenge through linkages with public systems such as the Jan Aushadhi Kendra, Amrit Pharmacy, or even private vendors to ensure supply. In larger institutions such as medical colleges with multiple specialties and large volumes of people, there is a need for dedicated help desks, dedicated wards (infrastructure) to provide information, access support, and better services. There was consensus and agreement that this can be done through engagement and information sharing between PM-JAY and other departments.   About PM-JAY in Uttar Pradesh: SACHIS, provides secondary and tertiary care to 31 percent of the state population. It has established a wide network of over 2500 hospitals in the state, 40 percent of these are public hospitals and plays a critical role in the supply of PM-JAY services, especially in areas where there is a lack of private providers and hospitals. ACCESS Health will continue to support in creating the care linkages in the state. 

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“Dialogue, Data, and Partnerships”: Towards Universal Health Coverage in Uttar Pradesh

Sangeeta Singh, Chief Executive Officer, State Agency for Comprehensive Health and Integrated Services (SACHIS) has steered the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) in the largest state of India. Priyamvada Kowshik, Journalist Health & Wellness, in conversation with Sangeeta Singh to understand the challenges and opportunities that lie ahead for Uttar Pradesh. When you look back at the last three years of PM-JAY in the state, what have been the big lessons for you? Two of the last three years of implementation of PM-JAY have been a relentless struggle for the entire country as we fought the pandemic. A big lesson learnt was that we evolved to be responsive. The year taught us how to manage crisis situations, improvise, and keep the scheme running efficiently. We were able to ensure continuity of service to beneficiaries. Communication and regular contact with stakeholders to a large extent has been a crucial factor in surmounting this. Dialogue has also helped us find and address the hurdles in beneficiaries availing services. What do you think has been the biggest challenge in implementing PM-JAY? One of the big challenges has been accurate beneficiary data. The scheme uses the Socio-Economic Caste Census (SECC 2011) data. There are two issues, one is that this excluded a lot of people from the marginalized population from the state, which we have over three years included through the state insurance scheme. The State's policy decision to include families of Antyodaya Ration Card holders (a scheme that provides subsidized food to poor families) has expanded the base. The second issue is that SECC data is not comprehensive, which has affected the identification of the beneficiary. Unlike other states that had some form of state-managed insurance scheme running for its most vulnerable population, and could build on the existing data, we did not have a scheme before PM-JAY. Naturally, data that is running and cross-verified is richer. However, use of Antyodaya datasets has shown encouraging results as the data is verified and there has been visible growth in scheme enrolment and utilization since then. A big learning for a scheme of this magnitude is that we should look closely at the data we have and ensure the dataset includes the categories we want to address. Incorporating the right kind of data and having the right attitude, that is a learning. What are some of the initiatives to increase hospital participation? And what is the role of public hospitals? Increasing the participation of public hospitals is very important, almost 40 percent of the hospitals are public facilities. We are conducting gap analysis of scheme utilization in public hospitals to understand some of the challenges. Based on this we will develop a targeted outreach with the public facilities. The Department of Health & Family Welfare is ramping up the infrastructure in public hospitals and filling in specialist positions which will have a positive impact on utilization and quality of care. NHA has also recommended incentive plans to increase public sector participation. When public hospitals start earning from the treatment provided under the PM-JAY, the scheme will benefit the people of the state. We are confident that in the coming year the public hospital participation will increase in the state. What has been the role of the media in information dissemination, and do you look at media as partners too? Yes. Engaging the press and partnering with the local media and channels impacts scheme utilization. The media workshop conducted a few months ago by our technical partners and Center for Advocacy Research (CFAR) was useful in clearing concepts and the finer aspects of PM-JAY for members of the media. We now know how to move forward and engage the press, partner with local newspapers and channels. When stories of beneficiaries are featured in the local media, it makes a positive impact, people are curious to know more and avail the scheme.  What do you think are the priorities for you in 2022? As we grow and add finer nuances to the systems and processes we have built, it is important to realize that growth comes from alignment with the right partners and building better interdepartmental coordination, as we have done last year. To strengthen these into mutually meaningful partnerships is one of the key agenda for 2022. All government schemes want the best for the beneficiary, so it makes sense to join hands. Our partnership with Project Samuday, a CSR initiative of HCL Technologies in Hardoi district has been a step in the right direction. Our partnership objectives are mutually beneficial-they have been helping us with generating awareness, making Ayushman cards, educating the beneficiaries about PM-JAY and improving access to secondary and tertiary healthcare through the scheme in the district of Hardoi. This partnership has been a good learning experience and has also shown good results. This year we will be building a Partners Forum and bringing newer partners.

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Local and Vocal: How a Community Radio Pilot Helped Generate Buzz Around PM-JAY in Uttar Pradesh

The Community Radio pilot run in four districts of Uttar Pradesh informed, educated and mobilized the eligible population to enroll and use the scheme. As a medium that is accountable to the community and keeps the spotlight on local issues, sustained engagement with this hyperlocal media will result in better scheme outcomes. A dispatch from the field in Uttar Pradesh by Manisha Tripathi and Himani Sethi Munni Devi* of Meerut district in Uttar Pradesh was losing her eyesight and was advised a surgery by her doctors. She didn't have the money for the procedure and was in despair. That's when she heard about the free cashless treatments provided under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) on the local radio channel Radio IIMT. Munni sought the help of the radio bhaiyya to know more about the scheme, and the station also helped her enroll as a beneficiary. Once an Ayushman card was issued to her, she got treated for her eye problem at a hospital, in a free and cashless transaction. Scores of people like Munni tune into their local radio stations to listen to local musicians and programs addressing local issues and events. The hyperlocal medium, with radio jockeys (RJs) bantering in regional dialects, makes educational material relatable for listeners, giving community radio networks a far better reach into the beneficiary base of PM-JAY compared to newspapers and mainstream television programs. Community radio networks are also accountable to the community, as they are part of it and know the local issues and concerns. Which is what made community radio networks effective partners for generating awareness on PM-JAY in Uttar Pradesh. Four districts with five radio stations were selected for the pilot which ran from September to December 2021. To steer the community radio pilot, ACCESS Health with support from the Gates Foundation, facilitated a partnership with SMART, an organization that works with community radio stations to enhance the capacities of listeners by providing them information on government schemes and development programs that help increase their access to health, education, and livelihood. SMART aims to democratize information through the radio, supplemented with a strong and sustained on-ground community engagement. Star RJs with maximum air time and listener following on these radio networks were engaged and trained for the project. Objective: Creating awareness and busting myths The objective of the Community Radio pilot in these 4 districts was to generate awareness about PM-JAY and provide information about scheme benefits, disseminate correct information about eligibility criteria, process, address gaps in information, the how-tos and what-ifs, and resolve problems for the community. Through the hugely popular RJ links, the Community Radio stations also provided information about hospitals in the area. The project ran in campaign mode, with the CEO of the state health agency directly briefing the radio stations and ACCESS Health state team providing regular training and real-time resolutions to problems on the ground. The Community Radio teams were able to address doubts and confusions the beneficiaries had about the scheme, and also mobilized the community and organized camps for enrollment of eligible people into the scheme. "We realized that there was a lack of clarity about the benefits of the Ayushman card, what treatments they could avail, and where. Most people expected this to work only in public hospitals,” says Archana Kapoor, founder of SMART. “The RJs cleared these information gaps that come as roadblocks in availing the benefits of the scheme.” Project Outcome While RJ links and testimonials of beneficiaries encouraged others in the community to enroll in the scheme and avail its benefits, the outreach activities mobilized and provided end-to-end solutions to beneficiaries. The Community Radio stations set up camps to verify beneficiary details for registering for the Ayushman card, coordinated with the village Common Service Centers, ASHA workers, Gram Pradhans, district hospitals, and more to locate and contact eligible candidates for the scheme and narrowcasted scheme information in remote corners where their network may not have reached eligible beneficiaries. The project has also resulted in increased enrollment for the Ayushman card. For SACHIS, the testimonials from the ground provided direct feedback on the scheme. The success of the Community Radio project points at a need to continue engagement with this hyperlocal media of informing, educating, and communicating with beneficiaries in other districts of Uttar Pradesh on an ongoing basis.  *Name changed

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ACCESS Health India Working Towards Building a Health Insurance Ecosystem in Uttar Pradesh

The Indian state of Uttar Pradesh with a population of over 200 million people launched Ayushman Bharat AB-PM-JAY in September 2018, which is implemented by State Agency for Comprehensive Health and Integrated Services (SACHIS). The program is the largest health insurance scheme in the world which aims at providing a health cover of Five Hundred Thousand Indian Rupees per family per year for secondary and tertiary care hospitalization to the bottom 40 percent of the Indian population. The state of Uttar Pradesh provides coverage to 37 percent of its 200 million population with a commitment to move towards Universal Health Coverage. The session Partners in Health aimed to bring together multisectoral allies towards building an AB-PM-JAY ecosystem in the state. The session was Chaired by Secretary to the Chief Minister of Uttar Pradesh and the expert panel comprised of policy makers and practitioners from Department of Health and Family Welfare, Department of Rural Development, Department of Panchayati Raj and Corporate Social Responsibility Partner HCL Foundation. The group deliberated on the challenges and the opportunities for collaborations. The panel discussion highlighted the demand and supply side issues in implementation of AB-PM-JAY. Some of these included limited awareness among eligible beneficiaries and lower enrollment rates, limited participation of the empaneled public sector providers due to inadequate understanding of the scheme and infrastructural and human resources gaps. The crucial linkages between Health and Wellness Center to deliver primary health care and AB-PM-JAY still need to be fully developed to ensure the continuum of care. At Interdepartmental convergence level coordination remains difficult due to multiple beneficiary databases, which do not interact with each other and variety of other departmental issues. The catalyst role of corporate partners in fast tracking health programs was emphasized.  The opportunities for collaboration to continue the momentum were outlined. Some of the significant ones included setting up of Partners Forum a joint multi partner coordination forum; focus on building capacities of demand and supply side stakeholders, understanding the actual supply available for provider expansion and management; grassroot mobilization of communities through positive stories from the happy and satisfied AB-PM-JAY beneficiaries and leveraging the network and the power of local self-governance bodies. The session also formalized a partnership between HCL Foundation, SACHIS and ACCESS Health to leverage the network of integrated community development initiatives to increase demand and supply of PM-JAY in the state.

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InOrder launches Health Answers: a health helpline and patient navigation portal  

ACCESS Health India’s health systems institute, InOrder, recently launched Health Answers, a free service to help people navigate the complex healthcare delivery system. Users can look for answers to their questions either on the web portal http://www.inorder.in/healthanswers/ or call on the toll-free number 1800 121 6780 from Monday to Saturday between 9 AM and 6 PM. The web portal has a number of FAQs answered by experts and a user can find the answer by simply typing the keywords related to their query. The helpline ran as a pilot project in May 2021 for callers in the Telangana state and was officially launched on September 1, 2021. The services will be expanded to the rest of the country in phases. Users can seek information on medical and non-medical services, hospital transportation, how to reach the appropriate doctor and hospital, understanding their financial coverage (through insurance and non-insurance mechanisms), pharmacies, laboratories and diagnostics, availability of hospital beds and medical equipment, and access to donors - blood banks, plasma, and organ transplantation. In crisis situations, the helpline will connect users with volunteer networks and other resources to access food, medical oxygen, and financial aid.

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