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  • 1. Health Hotline Services in Emerging Markets 30th May 2012Restricted - Confidential Information © GSMA 2012
  • 2. 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 Overview2 Restricted - Confidential Information © GSMA 2012
  • 3. Health Hotline Services in Emerging Markets Executive summary and research scope 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 service3 Restricted - Confidential Information © GSMA 2012
  • 4. Health Hotline Services in Emerging Markets Executive summary and research scopeGSMA Development Fund mHealth ProgrammeLeveraging the ubiquity of mobile to increase health access for underserved people in emerging markets Research & Knowledge Pan African mHealth Initiative Advocacy Management Bringing together mobile operators mHealth on MDI Convening stakeholders and across Africa with a view to  mHealth Tracker catalysing dialogue through: collaboration to achieve universal  Impact Pathway  Mobile Health Summit health access  Aggregated Health Metrics  Leadership Forum Reports on research, lessons  Mobile Health Live learned & best practices4 Restricted - Confidential Information © GSMA 2012
  • 5. Health Hotline Services in Emerging Markets Executive summary and research scopeCurrent state of health5 Restricted - Confidential Information © GSMA 2012
  • 6. Health Hotline Services in Emerging Markets Executive summary and research scopeResearch ScopeThis report will provide a global overview of the health hotlines that MNOs offer but will focus on stand-alonehealth hotlines – those that primarily provide general medical information and consultative services to consumers 1000 800 600 16 MNOs are offering health 637 hotline services as well as 400 other mHealth services 794 200 157 53 0 All MNOs MNOs without MNOs with mHealth MNOs with health mHealth services services hotline services (non-health hotlines)6 Restricted - Confidential Information © GSMA 2012
  • 7. Health Hotline Services in Emerging Markets Value of health hotlines 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 satisfaction7 Restricted - Confidential Information © GSMA 2012
  • 8. Health Hotline Services in Emerging Markets Value of health hotlinesHealth value chain: health hotline functionHealth hotlines currently play an important role in the prevention and diagnosis segments of the patientpathway; it also has some utility for treatment purposes (i.e. medication prescription)8 Restricted - Confidential Information © GSMA 2012
  • 9. Health Hotline Services in Emerging Markets Value of health hotlines Types of providers By offering health hotline services, MNOs widen their role beyond providing connectivity in the delivery of healthcare services Type of MNO Role Deployment Examples Description Who pays? provider C* M* B* Developed Developing • Designed to supplement existingGovernment  public health facilities to reduce cost • Government • NHS Direct, UK • HMRI, India and resources burden • Established to supplement • HMO / healthHealthcare prevention interventions, triage more • Aetna’s Informed provider  effectively, reduce re-admission rates insurance Health Line, USA • [None identified] provider and ease administrative burden • MeraDoctor, • Not affiliated with any specific • Patient / • Teladoc, IndiaIndependent  healthcare provider, MNO or other caller USA • Medicallhome, group Mexico • Medgate (40%- Mobile • Mostly operated by telemedicine • Grameenphone • Patient / owned Swisscom Network  firms; marketed by MNOs to extend caller subsidiary), Healthline, Operator reach of healthcare services Bangladesh Switzerland *C = Connectivity; M = Marketing; B = Billing (Refer to slide 14 for more information on role of MNOs)9 Restricted - Confidential Information © GSMA 2012
  • 10. Health Hotline Services in Emerging Markets Value of health hotlinesNHS Direct: value to providerThrough 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 By avoiding the following, millions Top reasons for calls Call Outcomes of money are saved: Self-care 50% • 1.1 million Accident & • Abdominal pain Emergency attendances • Dental tooth/jaw pain • Rashes Emergency Referral 30% • 1.6 million GP consultations • Chest pain • Ingestion of toxic substance Non-emergency • 0.5 million other face-to-face referral 20% appointments Source: NHS Direct, UK10
  • 11. Health Hotline Services in Emerging Markets Value of health hotlines 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 92% were satisfied with the service Quality of advice given satisfaction Drivers of Reassurance provided Speed Politeness of the staff miniscule 77% would 88% followed complaint rate ‘most definitely’ the advice (<1 in 10,000 recommend the provided calls or service again 0.01%) Source: NHS Direct, UK based on customer satisfaction research conducted by IFF Research11
  • 12. Health Hotline Services in Emerging Markets MNO-offered health hotlines 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 resources12 Restricted - Confidential Information © GSMA 2012
  • 13. Health Hotline Services in Emerging Markets MNO-offered health hotlinesFive types of MNO-offered health hotlinesAcross all types of health hotlines, MNOs rely on third-party partners who have the expertise and manpowerto answer patients’ medical queries and needs No. of Types of MNO-offered Focus Partner services health hotlines launched ‘Stand-alone service’ • Medical information and consultation • Telemedicine firms or hospital chains 26 • Medical information and consultation • Telemedicine firms or hospital chains ‘Range of expert advice’ but evolved to include legal, 2 agricultural, education/career advice • Legal firms and other domain experts • Various emergency services for • Emergency services firms (e.g. ‘Packaged emergency service’ medical, roadside, home repair, legal 23 International SOS, American Assist) and laptop/PC repair services support • Similar to packaged emergency ‘Health-focused packaged • Emergency services firms (e.g. services but focuses on medical 1 emergency services’ International SOS, American Assist) emergency services • General directory/information service ‘General info hotline with • In-house; referrals made to hospital but also provides medical emergency 1 medical support’ chain partners assistance13 Restricted - Confidential Information © GSMA 2012
  • 14. Health Hotline Services in Emerging Markets MNO-offered health hotlines Value chain: MNO role Mobile and Health Regulators Clinic and Technology Knowledge MNO Pharmacy Patients Partner Partner Partners  Tele triage call  ‘Doctor agents’  Marketing  Face-to-face routing  Connectivity consultation solutions  Billing  Prescription  Non-health customer medication support Airtel’s Mediphone, India 181 million Bharti Airtel subscribers Grameenphone’sHealthline, Bangladesh 37.6 million Grameenphone subscribers 14 Restricted - Confidential Information © GSMA 2012
  • 15. Health Hotline Services in Emerging Markets MNO-offered health hotlinesDeployment overviewStand-alone services are more popular in Asia and Africa while packaged emergency services are morepopular in Central & Latin America France Turkey (1 / 4 operator) (2 / 3 operators) Colombia (2 / 5 operators) Switzerland Guatemala (1 / 4 operator) (2 / 4 operators) Trinidad & Tobago Mexico (1 / 2 operator) Romania (1 / 4 operator) Russia (4 / 4 operators) (1 / 12 operator) El Salvador (3 / 5 operators Nicaragua China (2 / 2 operators) (1 / 3 operator) Panama UAE Hong Kong (2 / 4 operators) (1 / 2 operator) (1 / 5 operator) Morocco Ecuador (1 / 3 operator) Bangladesh (2 / 3 operators) (5 / 6 operators) Nigeria Peru (1 / 8 operator) Nepal (1 / 3 operator (1 / 4 operator) Kenya Paraguay (1 / 4 operator) India (1 / 4 operator) (5 / 15 operators) Uruguay South Africa (1 / 3 operator (2 / 4 operators) Sri Lanka (1 / 5 operator) Chile Afghanistan Pakistan (2 / 4 operators) (1 / 6 operator) (3 / 6 operators ‘Stand-alone’ ‘Range of expert ‘Packaged ‘Health-focused ‘General info hotline advice’ emergency’ packaged emergency’ with medical support’15 Restricted - Confidential Information © GSMA 2012
  • 16. Health Hotline Services in Emerging Markets MNO-offered health hotlinesCountry segmentationHealth hotlines can supplement existing health facilities especially in emerging countries although stand-alone services are generally more popular among countries with large populations Per capita spending Number of doctors Population (in million) per 10,000 people on health (in US$) China 1,367 169 14 India 1,250 45 6 Pakistan 178 23 8 Nigeria 163 69 4 Bangladesh 152 19 3 Russia 147 475 43 525 29 Generally larger Mexico Turkey 74 116 571 15 population and limited France 67 485 4798 35 South Africa 51 8 access to healthcare Colombia 47 323 14 33 resources Kenya Morocco 33 42 156 1 6 Afghanistan 32 51 2 Peru 30 201 9 Romania 22 408 19 Nepal 21 25 2 Sri Lanka 21 84 5 Chile 18 796 11 Ecuador 15 255 15 Guatemala 15 186 9 UAE 8 1520 20 Generally smaller Switzerland 8 7141 41 11 population and better Paraguay Hong Kong 7 7 N/A 159 N/A access to healthcare Nicaragua 6 105 4 El Salvador 229 16 resources Panama 6 4 591 15 Urugay 4 698 37 T. & Tobago 1 1064 12 ‘Stand-alone’ ‘Range of expert ‘Packaged ‘Health-focused ‘General info hotline advice’ emergency’ packaged emergency’ with medical support’ Sources: United Nations and WHO16 Restricted - Confidential Information © GSMA 2012
  • 17. Health Hotline Services in Emerging Markets MNO stand-alone health hotlines 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 success17 Restricted - Confidential Information © GSMA 2012
  • 18. Health Hotline Services in Emerging Markets MNO stand-alone health hotlines Evolution of MNO stand-alone health hotlines Afghanistan Bangladesh TeleDoctor by MTN Switzerland  Healthlink by Turkey  7/24 Doctor South Africa UAE  2000: Medgate (40% of Grameenphone MTN Careconnect by Mobile Doctors the company acquired by and TRCL Service by Avea and MTN and Sanlam 24-7 by du and Swisscom in 2006) Romania India Kenya Dubai Healthcare  Health line service Pakistan Through Healthcare Acibadem Daktari 1525 by Safaricom City by Comoste and  TeleDoctor* Mobile Health Magic the following China and Call-a-Doc Ltd Sri Lanka Russia Total Care Network by Telenor, offered Doc on Call: Nigeria  Health Nepal ‘First Aid  Mobile Trinidad & Tobago NexSource  Loop Mobile  Tele  IOMSmart Healthline by Helpline’ by Dialog Doctor by Medstar by TSTT & and eHealth navigator  Reliance Doctor by service by Smart Cell and Tribhuwan Uni.and Med1 MTS Fonemed Services Communications MTN Institute of Medicine China Mobile 2004 2005 2006 2007 2008 2009 2010 2011 2012# of services launched 1 0 3 1 7 1 4 5 2 Bangladesh India India Through JBMFS the  Doctor on Call by  Mediphone by following offered their Tata Indicom and Airtel and own health hotline Healthcare Magic Religare Existing services but unverified  Aircel Apollo services: Technologies when launched Robi (which Mobile HealthCare switched to TRCL in by Aircel and Pakistan 2012) Apollo Hospitals  TeleDoctor by Mobilink Turkey Bharti Airtel  Medline Sağlık Danışma (Health  Citycell Advisory) by Vodafone and Medline Through Synesis IT Hong Kong  Banglalink launched  24-hour Advisory Travel and Medical Healthlink Pakistan Hotline by Smartone  Still active  Subject to verification  uHealth by uFone18 Restricted - Confidential Information © GSMA 2012
  • 19. Health Hotline Services in Emerging Markets MNO stand-alone health hotlines MNO adoption: drivers 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 Competitive markets and pressure to 1 Population size and economies of scale 2 diversify revenue No. of MNO- Herfindahl- Population EBIT Margin of selected MNOs**** Country offered stand- Hirschman alone HH (2012) Index (2011)* (2010, 2011) India >3 1.25 billion 1355 Idea (8%), Reliance (15%)adoption Pakistan 3 178 million 2218 Telenor (9%), Mobilink (15%) Strong Bangladesh 4 152 million 2891 Grameenphone (36%), Robi (12%), Banglalink (28%) Turkey 2 74million 3936 Turkcell (21%), Avea (-7%), Vodafone (-9%) China** 1 1.37 billion 5018 China Mobile (29%), China Unicom (27%)adoption Weak Mexico*** 0 116 million 5364 Nextel (19%), Telcel (40%) Philippines 0 95 million 5557 Smart (35%), Globe (37%) 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 purposes19 Restricted - Confidential Information © GSMA 2012
  • 20. Health Hotline Services in Emerging Markets MNO stand-alone health hotlinesMNO adoption: driversGovernments should develop a regulatory environment that will incentivise market players, both domestic andforeign, to invest more in their healthcare industry • Pakistan: Endorsement from Sindh’s province Ministry of Health of Policy and Telenor’s TeleDoctor regulatory • India: o Government involvement in development of telemedicine 3 environment that guidelines & standards promotes o Discussion on conferring ‘infrastructure status’ on healthcare investment industry enabling healthcare players to access low-cost investment and exemption from payment of various taxes • India: Apollo Hospitals, Fortis Healthcare and Healthcare Magic Strong supplier • Bangladesh: Telemedicine Reference Centre Ltd.(TRCL) and Japan 4 Involvement Bangladesh Friendship Medical Services Private Limited (JBFMS) • Turkey: Acibadem Hospitals Group and Medline Health Group20 Restricted - Confidential Information © GSMA 2012
  • 21. Health Hotline Services in Emerging Markets MNO stand-alone health hotlinesMNO adoption: barriers and solutionsCollaboration among stakeholders within country and on a regional level – key to addressing barriers toadoption MNO risk-aversion (reliance on proven VAS • Risk mitigation through strategic partnership development 1 services like mPesa) and low competitive • Quantify tangible and intangible value proposition for all pressure stakeholders • Liberalisation of healthcare market: incentivising private 2 Limited government funding and/or subsidies sector through tax and other incentives • Increase health economic evidence base • Stimulate partnerships to deploy standardised, national 3 Lack of economies of scale and/or regional health hotlines • Appropriate incentives for healthcare workers 4 Lack of highly qualified medical practitioners • Automation of the “triage” process as much as possible Consumer preference for face-to-face 5 consultation • Endorsement (promotion) by credible health authorities 6 Underserved consumers inability to pay • ‘Freemium’ and/or subsidised services Medical associations’ inertia and perception that • Include medical associations and other stakeholders in 7 health hotlines are unethical planning, trials and commercialisation21 Restricted - Confidential Information © GSMA 2012
  • 22. Health Hotline Services in Emerging Markets MNO stand-alone health hotlinesCustomer/patient adoption: drivers for success • Does the telemedicine partner have the experience? Does it have enough manpower to manage increases in demand? Service design • Is there an IVR-component that helps pre-screen calls? and • Did the service undergo user testing [to adopt for various mobile channels]? development • 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? Awareness • 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? Consideration • 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? Trial • 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? Usage • 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? Repeat Usage • 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?22 Restricted - Confidential Information © GSMA 2012
  • 23. Health Hotline Services in Emerging Markets 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 services23 Restricted - Confidential Information © GSMA 2012
  • 24. Health Hotline Services in Emerging Markets SummarySummary: health hotline success factorsTaking into consideration underserved consumers’ wants and needs is crucial to the success of anyhealth hotline service deployment Collaboration • Integration with existing health services / infrastructure • Segmenting customers: premium services to subsidise services for underserved consumers Consumer wants and needs • Having a ‘freemium component’ that induces trial of service, only escalating to a paid service upon appropriate triage • Full consultative approach • Affordability and value for money against a face-to-face service Cost to satisfy • Variable pricing but having a cap on how much can be charged • 24 x 7 service Convenience of acquisition • Referral system with potential discount to referral partners • Using agents for non-prescription medicine distribution • Endorsement by government/medical association/celebrity • Clearly stating value of benefits Communication • Inducing trial of service • Reliance on agent network24 Restricted - Confidential Information © GSMA 2012
  • 25. Health Hotline Services in Emerging Markets Appendix Appendix25 Restricted - Confidential Information © GSMA 2012
  • 26. Health Hotline Services in Emerging Markets AppendixMethodology OverviewGSMA referred to existing publications about health hotlines but also did the following to ensure that we havecovered all health hotlines and other health-related services being offered by MNOs: 1 Visited each of 794 GSMA full-member operator websites and looked for any mHealth or health hotline-related services 2 Used the respective website’s search field, if provided, and used certain search words similar to the words used below 3 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 4 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 websites26 Restricted - Confidential Information © GSMA 2012
  • 27. Health Hotline Services in Emerging Markets For any feedback, please email mobilehealth@gsm.org27 Restricted - Confidential Information © GSMA 2012

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