AXA’s Michal Matul and Niti Pall ask if the pandemic will finally put digital health on the path to reducing health inequalities at scale in emerging markets
COVID-19 and its associated lockdowns have worsened access to healthcare and widened health inequalities around the world. But at the same time the crisis has offered a solution to the problems it has caused, by opening the door to healthcare via telemedicine or other digital services. Since the outbreak started, digital health services – such as doctor consultations through online chat or over the phone – have experienced tremendous growth in both developed and developing countries. Now, as a vaccine promises to bring a gradual end to the pandemic, the big question remains: Can the digital health services that have become the new normal in the past year help to close inequalities in access to healthcare over the longer term?
How digital healthcare can address growing health inequalities
COVID-19 has increased existing health inequalities within countries and regions, with higher infection and death rates among people from poorer backgrounds who live and work in crowded conditions. Not much data is available for emerging markets, but the data from Europe clearly illustrates this health equality divide. Between the start of March and the middle of April 2020, age‐adjusted death rates in the poorest areas of the U.K. were more than double those in the wealthiest areas.
This discrepancy might get even worse, for three main reasons. First, low- to middle-income people are more prone to develop a chronic disease, which often remains undiagnosed – and which can increase the severity of COVID-19 infections. In France, the odds of developing severe COVID-19 are seven times higher in obese patients, three times higher in diabetics and 3.5 times higher in patients with hypertension. Second, lower-income people are often fearful of visiting healthcare facilities, which may lead to delayed treatment of COVID-19 and other serious illnesses. Third, the farther you go down the income ladder, the more mental health disorders are a taboo – and the more professional support is limited. As a result, pandemic-induced anxiety and depression are ravaging low- to middle-income people – a population that’s already more likely to be laid-off and to live in precarious conditions, which can further exacerbate mental health issues.
The gap in access to healthcare is more acute in emerging markets, where the majority of the population has unequal access to health services. The WHO estimates that about 150 million people around the world suffer financial catastrophe from out-of-pocket health expenses each year, while 100m people are pushed below the poverty line. Low-to-middle-income consumers often forego treatment, as they can’t afford it, can’t navigate the health system, are not diagnosed for chronic conditions and rely on informal medical advice. That means they often end up in hospitals when their condition becomes too serious to manage, leading to costly and often tragic results.
Creating a successful digital health model
Discussion of the promise of digital health is nothing new in global health or development circles. It has long been recognized that there are major benefits to offering high-quality standardised advice through digital services. This approach allows providers to detect issues earlier, keep patients out of the hospital unless necessary, and engage them on daily health maintenance issues, to raise their awareness and improve their lifestyle.
The concept has been proven to work in low-income context by Telenor Health in Bangladesh: It created Tonic, one of the first successful digital health deployments in emerging markets. Using both freemium and paid-for models, it offers several packages that include a limited call-a-doctor service, health tips, a discounts network and the option to book appointments with relevant specialists. The company has served more than 8m people over the last two years.
Digital health is not just about offering a medical hotline: It is about creating a comprehensive health ecosystem to improve access to quality, standardised care. As shown in the diagram below, the first component of a successful digital health model is to become a trusted advisor on health, and to offer nudges that can change patient lifestyles for the better. The second is to provide access to medical advice over the phone, and to create a medical record that can be used to better advise patients in the future. Continuity is key, as well as maintaining high quality through detailed, standardised clinical pathways and appropriate clinical governance. The third component is to provide access to offline services at a discounted price, especially to labs and specialists. And the fourth is about offering financial protection in case of catastrophic health expenses. The first three components make the value proposition tangible to patients in the short term, while insurance cements the proposition and makes it relevant in the long term.
Digital health can only work if it focuses on customer engagement
The key lesson is that continuous engagement is vital, to make sure people discover the service and keep using it in a consistent way. If people use the service once or turn to it only for emergencies, digital health will not fulfill its potential to reduce health inequalities. Instead, these services need to become a trusted navigator that helps people to change their lifestyles and seek care at the right moment and in the right places.
The COVID-19-driven digital health revolution is just beginning. The jury is still out, but ironically the pandemic may actually accelerate the closing of the healthcare access gap in emerging markets. Adoption remains a challenge, and emerging customers are different from affluent ones – hence, different engagement approaches are required to get them to discover digital health services and sustain their usage. Other building blocks, such as technology and mass-scale distribution, are already in place. Today’s technology allows stakeholders to create a health ecosystem that is efficient even in low-cost environments.