Feature – International PMI


operates on a basis of delegating cases to regional, then local providers. Who is nearest? And who has the right aircraft (and medical staff) instantly to hand? But this does not always happen. Most insurers contract direct to one assistance company. The company might profit from not delegating. It could opt, say, in the case of the Copperbelt mineworker to send an air ambulance from Geneva to Zambia and then to Johannesburg.


The idea behind the InterGlobal move is that tighter control is maintained by supervising the rescue by using a network of local assistance companies. The downside of course is that quality of care might not match that provided by an operation with a big reputation to protect. Clearly, InterGlobal, insuring only 132,000 heads worldwide, could not afford to enter the “real” assistance business. Even Bupa International, looking after eight million heads, prefers to rely on globe- spanning International SOS. Stephen Hartigan, InterGlobal’s chief executive, says the acid test of an international insurer is how it responds in an emergency. He is selling the change of strategy as a move to that goal. “We work hard to deliver high standards of customer service and wanted to be sure that our members would receive the same standards of commitment, responsiveness and personalised service when they need immediate medical assistance,” he says. “By bringing InterGlobal Assistance in-house, supported by the expertise and global reach of First Assistance with whom we have enjoyed an excellent and very successful relationship for several years, we are now fully in control of the service.”


A DIFFERENT APPROACH


Another sign of shifting methods within the industry comes from Allianz Worldwide Care (AWC), the international medical arm of Germany’s biggest insurer which was set up 11 years ago.


Headquartered in Dublin, AWC employs 500 staff worldwide, and has enjoyed steady growth with what it claims as industry-leading retention figures. Also part of the Allianz group is the big assistance operation Mondial Assistance, with bases in five continents. But, like a naughty playing- away Premiership footballer, that does not inhibit AWC from looking elsewhere. A laughing Ron Buchan, AWC chief executive, chips in: “We don’t use Mondial exclusively!


August 2011 www.hi-mag.com “The international assistance


business is all to do with a series of subcontractors until you


get to the company that owns the plane. We deal with the


company that owns the plane” Ron Buchan, Allianz Worldwide Care


“We have a unit in Dublin so that when we need to make an evacuation, instead of necessarily going to Mondial who would then go through their series of agents, we handle that ourselves. “The international assistance business works like Russian dolls. It’s all to do with a series of subcontractors until you get to the company that owns the plane. We deal with the company that owns the plane.”


CONTROLLING COSTS


Buchan believes there is a lot of unnecessary flying of air ambulances because the assistance company contracted to the insurer uses its own aircraft instead of delegating to a local company.


“So planes are moving half way across the world to pick people up – that is very common. It takes time and it’s very expensive. If you want to move someone from Kenya to South Africa – Cape Town, say – you don’t fly a plane from Geneva to Kenya to do it.”


Buchan continues: “We have a network of companies we work with. We work with our sister companies too. Our overriding requirement is that we want to go to the company with the plane [that is due to be used in the evacuation]. It’s quicker if you have total control over the process.” However, Buchan is reluctant to criticise the


conventional model in which the insurer trusts its appointed assistance company – which is likely to have a wealth of experience and high levels of medical input. “I wouldn’t say the Bupa model [for example] wasn’t


correct,” he adds. Bupa International uses International SOS, by far the


world’s biggest assistance operation and very “medico- centric” – it employs nearly 1,000 doctors full time. But the iPMI market leader does not just leave the assistance provider to get on with the job willy-nilly. Bupa International handles all emergency medical


assistance through an in-house assistance unit, Worldwide Medical Assistance (WMA), based in its 24- hour emergency medical centre in Copenhagen. Tim Slee, Bupa International sales manager, says:


“International SOS always obtains WMA’s approval for any evacuation arrangements, so it can check the appropriateness of the treatment and costs. This means we can ensure the best value for our customers. “And through our medical centre, our customers also


have access to free medical advice, 24 hours a day, from our range of multilingual medical experts.” But Buchan sees his AWC approach as more hands-on;


and as a natural follow-through from pre-authorisation, at least in semi-urgent cases. He points to the inherent dilemma facing private medical insurance – a problem


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particularly acute in international cover. Put simply, normal market restraints on cost barely exist.


The purchaser of a washing machine shops around among various offers and then judges on quality and cost. “If you are ill there’s none of that,” he


says. “You’ll pay whatever you have to pay once need is established – and what greater need is there than your health and the health of your family?” Buchan, a chartered insurer, has


a wealth of industry experience and is himself a former expat. He started his career with Norwich Union Life, subsequently becoming general manager at Royal Life and PPP healthcare.


THE BUSINESS OF MEDICINE He harbours few illusions as to the deep vein of commercialism running through medicine. “We have to accept that doctors and


hospitals are in business to the same extent as anyone else in business – doctors have a commodity they can sell at a high price and they do. “Pre-authorisation gives us the


opportunity to enter in to the commercial process. This is great because within this area there is 30% of what I would call discretionary cost. If you are a (medical) provider, you see an Allianz or Bupa patient walking through the door, you are too often looking at an open cheque.” Or as Claude Daboul, AWC’s head of


sales and marketing, puts it: “If a doctor tells you you want a MRI or CT scan, how do you actually know?” Medivacs account for only 3%-5% of


iPMI claims by value. But this proportion can only rise because helicopters are judged ever more essential by the medical profession. It is not so much a question of getting the patient immediately to hospital – although that still remains important. The overriding concern in modern medicine is rapid stabilisation carried out by an emergency medicine specialist. But that may still require an air ambulance, whether fixed wing or helicopter to get the doctor there. As intermediaries are well aware,


expatriates in countries with poor medical services – or even downright dangerous practices – take medical evacuation very seriously. It is a life or death service. And it can make or break an insurer’s reputation.


HI HealthInsurance


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