GSMA mHealth - Health Hotline Services in Emerging Markets

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30th May 2012

Health Hotline Services in

Emerging Markets

Health Hotline Services in Emerging Markets


Outline

1. Executive summary and research scope

2. Value of health hotlines

3. MNO-offered health hotlines

4. Stand-alone health hotlines

5. Summary

6. Appendix: Methodology Overview

2


Executive Summary

• Health hotlines (medical call centres) play an important

role particularly in preventative medicine and disease

diagnosis, strengthening over-burdened health facilities

and healthcare service delivery, especially in developing

countries

• MNOs, particularly in developing markets, are increasingly

providing health hotline services with at least 53 now

offering some form of medical information and

consultation service

• Pressure to differentiate and diversify revenue streams are

driving MNOs to launch mHealth services such as health

hotlines

• In markets where health hotlines have yet to be deployed,

adoption barriers need to be removed through strong

collaboration amongst internal and cross-border

stakeholders

• In markets where health hotlines have already been

deployed, endorsements from trusted institutions or

personalities can help improve service awareness and

consideration thereby potentially increasing the

consumers’ adoption of the service


Executive summary and research scope

3


Pan African mHealth Initiative

Bringing together mobile operators

across Africa with a view to

collaboration to achieve universal

health access

Research & Knowledge

Management

mHealth on MDI

mHealth Tracker

Impact Pathway

Aggregated Health Metrics

Reports on research, lessons

learned & best practices

Advocacy

Convening stakeholders and

catalysing dialogue through:

Mobile Health Summit

Leadership Forum

Mobile Health Live

GSMA Development Fund mHealth Programme Leveraging the ubiquity of mobile to increase health access for underserved people in emerging markets



4


Current state of health



5


Research Scope This report will provide a global overview of the health hotlines that MNOs offer but will focus on stand-alone

health hotlines – those that primarily provide general medical information and consultative services to consumers

794

637

157 53

0

200

400

600

800

1000

All MNOs MNOs withoutmHealth services

MNOs with mHealthservices

(non-health hotlines)

MNOs with healthhotline services

16 MNOs are offering health

hotline services as well as

other mHealth services



6


Value of health hotlines • Health hotline services have important functions in the

prevention, diagnosis and treatment segments of the patient

pathway

• By providing connectivity, MNOs play an important role in

health hotlines operated by the government, healthcare

providers and independent providers

• Many MNOS, however, take a more pro-active role beyond

providing connectivity by launching their own health hotline

services

• As proven in the case of NHS Direct in the UK, health

hotlines can help improve the cost-efficiency in the delivery

of healthcare services while maintaining high consumer

satisfaction


Value of health hotlines

7




Health value chain: health hotline function Health hotlines currently play an important role in the prevention and diagnosis segments of the patient

pathway; it also has some utility for treatment purposes (i.e. medication prescription)

8


Types of providers

• Designed to supplement existing

public health facilities to reduce cost

and resources burden Government • Government • NHS Direct, UK • HMRI, India

• Established to supplement

prevention interventions, triage more

effectively, reduce re-admission rates

and ease administrative burden

Healthcare

provider

• HMO / health

insurance

provider

• Aetna’s Informed

Health Line, USA • [None identified]

• Mostly operated by telemedicine

firms; marketed by MNOs to extend

reach of healthcare services

Mobile

Network

Operator

• Patient /

caller

• Medgate (40%-

owned Swisscom

subsidiary),

Switzerland

• Grameenphone

Healthline,

Bangladesh

• Not affiliated with any specific

healthcare provider, MNO or other

group

Independent • Patient /

caller

• Teladoc,

USA

• MeraDoctor,

India

• Medicallhome,

Mexico

Description Who pays? Developed Developing

Deployment Examples

By offering health hotline services, MNOs widen their role beyond providing connectivity in the delivery of

healthcare services

Type of

provider C*

MNO Role

M* B*

*C = Connectivity; M = Marketing; B = Billing (Refer to slide 14 for more information on role of MNOs)



9

NHS Direct: value to provider Through NHS Direct, the National Health Services of the UK saves around £213 million annually



• A 24x7 nurse advice and health information hotline launched in Oct. 2000

• ‘Online patient decision aids’ also accessible via web app (since Dec. 2010) and

mobile (since May 2011)

• 22,500 calls per day or around 8.2 million calls per year are managed

• Operational efficiency achieved allowing healthcare personnel to focus more on

patients who need more care and on cases that require face-to-face interaction

Source: NHS Direct, UK

Top reasons for calls

• Abdominal pain

• Dental tooth/jaw pain

• Rashes

• Chest pain

• Ingestion of toxic substance

Call Outcomes By avoiding the following, millions

of money are saved:

• 1.1 million Accident &

Emergency attendances

• 1.6 million GP consultations

• 0.5 million other face-to-face

appointments

50%

30%

20%

Self-care

Emergency Referral

Non-emergencyreferral

10

NHS Direct: patient perception Patients are highly satisfied with NHS Direct not only because it avoids them unnecessary trips to

clinics/hospitals but also because of its quality of service



Source: NHS Direct, UK based on customer satisfaction research conducted by IFF Research

Quality of advice given

Reassurance provided

Speed

92% were satisfied with the service

Politeness of the staff

Dri

vers

of

sati

sfac

tio

n

88% followed

the advice

provided

77% would

‘most definitely’

recommend the

service again

miniscule

complaint rate

(<1 in 10,000

calls or

0.01%)

11



MNO-offered health hotlines


• At least 53 MNOs from 30 countries have launched some

form of health hotlines

• MNOs provide the ‘face’ for the health hotline services but

rely on third-party providers that provide the call-routing

solutions and supply of ‘doctor agents’

• Among the five types of health hotlines, stand-alone and

packaged emergency services are the most popular

• Stand-alone services are generally more popular among

countries with large populations, primarily Asian and

African countries which also tend to have limited access to

healthcare resources

12


Five types of MNO-offered health hotlines Across all types of health hotlines, MNOs rely on third-party partners who have the expertise and manpower

to answer patients’ medical queries and needs

‘Stand-alone service’

‘Packaged emergency service’

‘Range of expert advice’

‘Health-focused packaged

emergency services’

Types of MNO-offered

health hotlines

‘General info hotline with

medical support’

• Medical information and consultation

• Various emergency services for

medical, roadside, home repair, legal

and laptop/PC repair services support

• Medical information and consultation

but evolved to include legal,

agricultural, education/career advice

• Similar to packaged emergency

services but focuses on medical

emergency services

• General directory/information service

but also provides medical emergency

assistance

Focus

• Telemedicine firms or hospital chains

• Emergency services firms (e.g.

International SOS, American Assist)

• Telemedicine firms or hospital chains

• Legal firms and other domain experts

• Emergency services firms (e.g.

International SOS, American Assist)

• In-house; referrals made to hospital

chain partners

Partner

26

23

2

1

1

No. of

services

launched



13

Marketing

Connectivity

Billing

Non-health customer

support

‘Doctor agents’ Tele triage call

routing

solutions


Value chain: MNO role

Technology

Partner

Knowledge

Partner MNO

Clinic and

Pharmacy

Partners

Patients

Face-to-face

consultation

Prescription

medication

Airtel’s

Mediphone, India

Grameenphone’s

Healthline, Bangladesh

Mobile and Health Regulators

181 million Bharti Airtel

subscribers

37.6 million

Grameenphone

subscribers



14

Deployment overview


Stand-alone services are more popular in Asia and Africa while packaged emergency services are more

popular in Central & Latin America

‘Stand-alone’ ‘Packaged

emergency’ ‘Range of expert

advice’

‘Health-focused

packaged emergency’ ‘General info hotline

with medical support’



Mexico

(4 / 4 operators)

El Salvador

(3 / 5 operators

Nicaragua

(2 / 2 operators)

Panama

(2 / 4 operators)

Ecuador

(2 / 3 operators)

Paraguay

(1 / 4 operator)

Uruguay

(1 / 3 operator

Chile

(2 / 4 operators)

Peru

(1 / 3 operator

Colombia

(2 / 5 operators)

Trinidad & Tobago

(1 / 2 operator)

Guatemala

(2 / 4 operators)

France

(1 / 4 operator)

Switzerland

(1 / 4 operator)

Romania

(1 / 4 operator)

Nigeria

(1 / 8 operator)

Kenya

(1 / 4 operator)

South Africa

(2 / 4 operators)

Russia

(1 / 12 operator)

Turkey

(2 / 3 operators)

Morocco

(1 / 3 operator)

UAE

(1 / 2 operator)

China

(1 / 3 operator)

Hong Kong

(1 / 5 operator)

Bangladesh

(5 / 6 operators)

Nepal

(1 / 4 operator)

Pakistan

(3 / 6 operators

India

(5 / 15 operators)

Sri Lanka

(1 / 5 operator)

Afghanistan

(1 / 6 operator)

15

146

84

343

2915

358

141

62

919

25

1115

920

4111

416

1537

12

169452369

19475525571

4798485

32333

15651

201408

2584

796255

1861520

7141159

105229

591698

1064

1,3671,250

178163

152147

11674

67514742

333230

222121181515

887766441

ChinaIndia

PakistanNigeria

BangladeshRussiaMexicoTurkeyFrance

South AfricaColombia

KenyaMorocco

AfghanistanPeru

RomaniaNepal

Sri LankaChile

EcuadorGuatemala

UAESwitzerland

ParaguayHong KongNicaragua

El SalvadorPanamaUrugay

T. & Tobago

Country segmentation


Health hotlines can supplement existing health facilities especially in emerging countries although stand-

alone services are generally more popular among countries with large populations

Population (in million) Per capita spending

on health (in US$)

Generally larger

population and limited

access to healthcare

resources

Generally smaller

population and better

access to healthcare

resources

Sources: United Nations and WHO

Number of doctors

per 10,000 people

N/A N/A



‘Stand-alone’ ‘Packaged

emergency’ ‘Range of expert

advice’

‘Health-focused

packaged emergency’ ‘General info hotline

with medical support’

16



MNO stand-alone health hotlines


• Of 26 stand-alone health hotlines identified, 23 are deployed

in developing markets

• Some MNOs seem to have discontinued their services most

likely due to low customer adoption

• External organisational factors such as competitive

pressures, government and supplier involvement play a

crucial role in driving MNOs to launch health hotline

services

• By increasing collaboration among stakeholders within a

country and on a regional level, risks in deployment can be

mitigated while improving the chance of operational success

17


2004 2005 2006 2007 2008 2009 2010 2011 2012

Bangladesh

Healthlink by

Grameenphone

and TRCL

Nigeria

Tele

Doctor by

MTN

Turkey

7/24 Doctor

Service by

Avea and

Acibadem

Mobile Health

China

Health

navigator

service by

China Mobile

Bangladesh

Through JBMFS the

following offered their

own health hotline

services:

Robi (which

switched to TRCL in

2012)

Bharti Airtel

Citycell

Through Synesis IT

Banglalink launched

Healthlink

Pakistan

uHealth by uFone

Pakistan

TeleDoctor*

by Telenor,

NexSource

and eHealth

Services

Afghanistan

TeleDoctor by MTN

South Africa

MTN Careconnect by

MTN and Sanlam

Kenya

Daktari 1525 by Safaricom

and Call-a-Doc Ltd

Nepal

IOMSmart Healthline by

Smart Cell and Tribhuwan Uni.

Institute of Medicine

UAE

Mobile Doctors

24-7 by du and

Dubai Healthcare

City

Sri Lanka

‘First Aid

Helpline’ by Dialog

and Med1

India

Mediphone by

Airtel and

Religare

Technologies

India

Doctor on Call by

Tata Indicom and

Healthcare Magic

Aircel Apollo

Mobile HealthCare

by Aircel and

Apollo Hospitals

India

Through Healthcare

Magic the following

offered Doc on Call:

Loop Mobile

Reliance

Communications

1 0 3 1 7 1 4 5 2 # of services

launched

Pakistan

TeleDoctor by Mobilink

Turkey

Medline Sağlık Danışma (Health

Advisory) by Vodafone and Medline

Hong Kong

24-hour Advisory Travel and Medical

Hotline by Smartone

Existing services but unverified

when launched

Evolution of MNO stand-alone health hotlines

Still active Subject to verification

Russia

Mobile

Doctor by

MTS

Romania

Health line service

by Comoste and

Total Care Network

Trinidad & Tobago

Medstar by TSTT &

Fonemed

Switzerland

2000: Medgate (40% of

the company acquired by

Swisscom in 2006)



18


Besides CSR and a desire to differentiate product offerings, external organisational factors such as strong

domestic competition can lead MNOs to adopt health-related mobile VAS such as stand-alone health hotlines

Population size and economies of scale Competitive markets and pressure to

diversify revenue

India

Country No. of MNO-

offered stand-

alone HH

Population

(2012)

Herfindahl-

Hirschman

Index (2011)*

EBIT Margin of selected MNOs****

(2010, 2011)

Pakistan

Bangladesh

Turkey

China**

Mexico***

Philippines

>3

3

4

2

1

0

0

1.25 billion

178 million

152 million

74million

1.37 billion

116 million

95 million

1355

2218

2891

3936

5018

5364

5557

Idea (8%), Reliance (15%)

Telenor (9%), Mobilink (15%)

Grameenphone (36%), Robi (12%), Banglalink (28%)

Turkcell (21%), Avea (-7%), Vodafone (-9%)

China Mobile (29%), China Unicom (27%)

Nextel (19%), Telcel (40%)

Smart (35%), Globe (37%)

Str

on

g

ado

pti

on

Wea

k

ado

pti

on

Sources: United Nations and Wireless Intelligence

*Herfindahl–Hirschman Index (HHI) is a measure of a certain industry’s market concentration. The Index can range from 0 (where there are many small firms operating) to 10,000 (where there is a monopoly).

** Only deployed in the Inner Mongolia province

*** Telcel only provides connectivity and billing support to MedicallHome and, hence, this service is classified as Independent-provided health hotline

**** Not all operators provide financial information on a country level so even operators that do not offer health hotline services are included in the table for benchmarking purposes

1 2

MNO adoption: drivers



19


MNO adoption: drivers Governments should develop a regulatory environment that will incentivise market players, both domestic and

foreign, to invest more in their healthcare industry

Policy and

regulatory

environment that

promotes

investment

Strong supplier

Involvement

• Pakistan: Endorsement from Sindh’s province Ministry of Health of

Telenor’s TeleDoctor

• India:

o Government involvement in development of telemedicine

guidelines & standards

o Discussion on conferring ‘infrastructure status’ on healthcare

industry enabling healthcare players to access low-cost investment

and exemption from payment of various taxes

• India: Apollo Hospitals, Fortis Healthcare and Healthcare Magic

• Bangladesh: Telemedicine Reference Centre Ltd.(TRCL) and Japan

Bangladesh Friendship Medical Services Private Limited (JBFMS)

• Turkey: Acibadem Hospitals Group and Medline Health Group

3

4



20


Collaboration among stakeholders within country and on a regional level – key to addressing barriers to

adoption

Consumer preference for face-to-face

consultation • Endorsement (promotion) by credible health authorities

Underserved consumers inability to pay • ‘Freemium’ and/or subsidised services

Medical associations’ inertia and perception that

health hotlines are unethical • Include medical associations and other stakeholders in

planning, trials and commercialisation

Lack of economies of scale

• Appropriate incentives for healthcare workers

• Automation of the “triage” process as much as possible Lack of highly qualified medical practitioners

• Stimulate partnerships to deploy standardised, national

and/or regional health hotlines

Limited government funding and/or subsidies

• Liberalisation of healthcare market: incentivising private

sector through tax and other incentives

• Increase health economic evidence base

MNO risk-aversion (reliance on proven VAS

services like mPesa) and low competitive

pressure

• Risk mitigation through strategic partnership development

• Quantify tangible and intangible value proposition for all

stakeholders

MNO adoption: barriers and solutions

3

4

5

6

7

2

1



21


• Does the telemedicine partner have the experience? Does it have enough manpower to manage increases in demand?

• Is there an IVR-component that helps pre-screen calls?

• Did the service undergo user testing [to adopt for various mobile channels]?

• Was the service intuitive/ easy-to use and accessible through a short code?

• Was content/call-routing consistent with government/private healthcare providers’ messaging and does it account for local culture?

• Is enough marketing support provided by the MNO or is the service a haphazard response to a competitor’s launch?

• Is the right campaign content/media used to inform the public of the service?

• Do consumers expect the service to be provided free - as healthcare is expected to be a social benefit provided by the

government?

• Does the campaign highlight who the healthcare provider is if an MNO does not have enough credibility on its own to offer the

service?

• Does the service have the support of government / healthcare providers/ other credible individuals or entities?

• Are the benefits of using the service clearly highlighted in the campaign?

• Is the price of the service affordable relative to the cost of face-to-face consultation?

• Is there a cap to service fee/daily package to avoid patients accumulating a huge bill?

• Does the service have free content that can induce trial of service and strengthen the main health hotline service’s credibility?

• Does the service waive liability upfront making the service provider appear non-committal?

• Are ‘agents’/ doctors knowledgeable about and trained to become more customer-centric?

• Does the service cover the most important health conditions?

• Does the service allow doctors to provide service beyond triage?

• Does the service include referrals to clinics / hospitals / pharmacies?

• Is the service effective? Do the doctors diagnose patients correctly?

• Are there follow-up calls to ensure that patients follow doctors advice/prescription?

• Is there sufficient health information and access to further content to help the consumers / patients?

Service design

and

development

Awareness

Consideration

Trial

Usage

Repeat Usage

Customer/patient adoption: drivers for success



22



Summary

Summary • By putting the needs and wants of underserved consumers

– the consumer segment that is more likely to use health

hotlines – at the heart of service design and development,

MNOs can become more successful when launching health

hotline services

23


Summary: health hotline success factors

Collaboration • Integration with existing health services / infrastructure

Consumer wants and needs

• Segmenting customers: premium services to subsidise services for

underserved consumers

• Having a ‘freemium component’ that induces trial of service, only

escalating to a paid service upon appropriate triage

• Full consultative approach

Cost to satisfy • Affordability and value for money against a face-to-face service

• Variable pricing but having a cap on how much can be charged

Convenience of acquisition

• 24 x 7 service

• Referral system with potential discount to referral partners

• Using agents for non-prescription medicine distribution

Communication

• Endorsement by government/medical association/celebrity

• Clearly stating value of benefits

• Inducing trial of service

• Reliance on agent network

Taking into consideration underserved consumers’ wants and needs is crucial to the success of any

health hotline service deployment


Summary

24



Appendix

Appendix

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Appendix

Methodology Overview GSMA referred to existing publications about health hotlines but also did the following to ensure that we have

covered all health hotlines and other health-related services being offered by MNOs:

Visited each of 794 GSMA full-member operator websites and looked for any mHealth or

health hotline-related services

Used the respective website’s search field, if provided, and used certain search words similar to

the words used below

Used the following example search query to ensure that the MNO’s website is fully explored

•mHealth OR medical OR health OR doctor OR physician OR nurse OR wellness OR fitness OR

prevention OR treatment OR diagnosis OR monitoring OR assistance OR emergency

site:www.[MNO_name].com

To verify the launch date or status of the service (whether it is still active or not), we also

referred to various news, press articles and social media websites

1

2

3

4

26


For any feedback,

please email

[email protected]


27

GSMA mHealth - Health Hotline Services in Emerging Markets

Health & Medicine

Transcript of GSMA mHealth - Health Hotline Services in Emerging Markets