I've been studying the healthcare system of the Philippines for about 2 years now. I’ve never been so annoyed with the state of how inefficient things are. If you’ve experienced it first hand going to these places like a normal citizen, you can relate. And, it seems everybody is asking for change and improvement, but nobody is actually changing. It’s frustrating, really.
I’ve talked to a subject matter expert the other day about healthcare systems. And most of the systemic problems are not caused by faulty regulations or stupid policies, they are caused majorly by the inherent politics in every organization. That’s why the system is fragmented and disconnected.
Most solutions are band-aid ones trying to patch some short term fixes here and there — booking /appointment apps, EMRs — hundreds of them in existence (more doctor centric), EHRs — variation of EMRs with a larger scope (and more patient centric), health insurance players having their own proprietary softwares that are obsolete and doesn’t integrate.
On the other hand, doctors do their own thing. They are individual businesses — if you think about it. It’s really complicated in itself how these guys link up to each other.
And to emphasize the Philippine context, we try to pattern all of our standards from the more mature markets (US, Singapore, Canada…). However, unlike our 1st world counterparts where they are better equipped and have better resources, we don’t have much resources to work with. Though, being 3rd world, has its own advantages as well. One of the advantages is that there’s so much opportunity to improve — yet it comes with quite mindset challenge to influence the stakeholders to adapt to innovations.
As a startup founder tackling the systemic challenges of healthcare + insurance, we had to dug deeper in our research and approach. The most obvious ones are EMR systems, HIS, booking appointment apps, telemedicine, patient-pharmacy centric apps, apps that helps you become healthy, so on and so forth. These are all good, however, I believe that it doesn’t really address the perennial problem of it. Disconnection. I think that is the biggest root that’s causing all other problems.
So, how are we solving this? We saw that most doctors hate doing administrative stuff. We saw that health insurance companies spend a lot on administrative work. And, we found the link between the two — claims processing.
Here’s where it gets more interesting. We found out that a lot of doctors have multiple affiliations from different HMOs. It only means one thing — multiple accounts, multiple workflows, and additional administrative burden. This creates a problem because doctors now spend more time doing these stuff than seeing their patients. Or, the doctor hires a secretary to do his job — to file patient records, submit claims, audit receivables etc… All these small inefficiencies that when you sum it up, you’d find a big overall opportunity cost for both doctors and patient (who’s waiting in line).
So how does this affect the health insurance market? It affects it very subtly. Patients and Doctors are the market and channel of these insurers. So if the experience is bad, over time, insurers would lose good doctors (less channel) and lose potential clients (market).
The payment cycle in the PH is 3–6 months. There are a few instances that an HMO are able to reimburse/pay claims in a month yet the majority falls in that long payment cycle.
By the way, there’s also the element of fraud.
Moreover, according to US research, health insurance companies spend 7–20% on administrative cost and 10–30% on fraud off their revenue. And, the quick and obvious mitigation action of these insurance companies is to bulk claims processing, hold the payment out and spread the risk across.
Stash is working to improve the claims process and minimize fraud. Simple. We make it easy for doctors to manage their claims. We make it easy for HMOs to manage those claims as well and help them serve their customers/partners better.
We solve the real cause. It would makes sense for a better healthcare for everybody.