The evolution of IPMI in Latin America is pushing borders and that is giving patients and insurers cause to reconsider their options, writes Owain Thomas
As with the property market, it is all about location, location, location in the Latin America international private medical insurance (IPMI) market.
However, rather than focusing on a two-bed house in need of fixing-up, for medical insurance customers location is a key deciding factor in how they will be using their cover.
The panel at Health & Protection’s first Latin America IPMI Roundtable in Miami in association with Flywire, explained what national conditions and circumstances can mean for their customers and how their products are being used.
Download the Latin America IPMI roundtable supplement by following this link.
As Redbridge chief medical and risk management officer Dr Boris Garcia-Zakzuk began, many buyers of IPMI want the capacity to come to the United States for treatments that they cannot get in their countries.
“That is especially so with some countries that are changing their structure, for example Argentina is eliminating the subsidies to its healthcare system.
“The same thing happened with Peru after former president Castillo left a big mess there, now everybody wants to have the opportunity to come to the States.”
A significant part of this is to access treatments not available in their own countries, although not everywhere comes under this.
“One big exception is Brazil, they have a treatment subsidised by the government for hepatitis C,” he continued.
“Meanwhile in the United States a lot of people don’t get treatment for hepatitis C, and a lot of countries in Latin America don’t even get the medication, and those type of things they want to get here.
“For leukaemia, in most of the Latin American countries the treatment continues to be chemotherapy with a bone marrow transplant, in the US it is mainly CAR-T cell therapy which has a success ratio over 95%. Those types of things, people are aware of and want to have access to.”
Richer benefits, better facilities
Meanwhile, IPMI plans are being used in some areas for the richer benefits and to give access to better facilities.
As World of America CEO and chairman Lourdes Peters explained, one example of that is Costa Rica.
“We sell IPMI there locally because we’re registered there, and the utility of the product is probably 99% in Costa Rica because they have very good healthcare, so they’re buying the product to get to the best hospitals,” she said.
“Similarly, Brazil has excellent medical care, so they’ll use the insurance to stay in Brazil. However, you also have Honduras, which doesn’t have very good hospital infrastructure, so people there are going to be coming to the United States.”
In terms of what healthcare is being used, many IPMI customers will have a domestic plan in their home country as well which they will use for smaller day-to-day expenses and treatments.
But IPMI is commonly designed and utilised to cover the larger big-ticket items.
While this may seem a generally harmonious situation there is a notable limiting factor, especially in the current geopolitical environment.
With so much IPMI use undertaken by those travelling for treatment, having suitable visas to enter other countries, particularly the United States, is now a vital consideration.
“The visa limits the market so you can only target people that already have a visa, you cannot go deeper, penetrate more of the market that don’t have visas, or they go into Europe alone,” said Robert Parra, president and CEO, Suprabrokers.
US challengers rising
One of the most dynamic and evolving changes in the market is where people are visiting to undergo treatment.
The US remains the number one destination, particularly for those closer nations, but its dominance is easing.
“That’s shifting a lot and it varies by country,” said David Capote, president for LATAM at Trawick International.
“Obviously Mexicans tend to go to the US just because of proximity, Houston is a huge destination for them, and Central America varies a little bit.
“But there’s a lot of Ecuadorians going to Colombia.”
Other common arrangements include patients from Venezuela going to Colombia or those from Peru visiting Chile.
The Southern Cone area of Chile, Argentina and Brazil is generally credited with good medical care so numbers visiting the US are limited, with the panel agreeing that many US-based Brazilians instead return to Brazil for treatment.
But many hospitals are promoting themselves very heavily across Latin America, sometimes with the support of insurers, and they recognise the influence that brokers and distribution have over clients’ decision making.
Trans-Atlantic attraction
However, there is one longer-distance connection that is growing increasingly strong – Spain.
“Madrid competes against Miami as the new hub for Latin Americans going outside their countries, they are going to Spain a lot now,” said Parra.
That was echoed by Capote, who added: “It’s an attractive market because of the language which helps and hospitals have been very proactive in promoting themselves.
“And if you’re in Montevideo, a flight to Miami or a flight to Spain is the same distance anyway. So if you’re being incentivised as a client with eliminating deductibles or paying for flights, why not go to Spain, especially with the quality these providers have as well.”
Those incentives, along with a reported “more human service” are becoming key in influencing patient decisions.
Best Doctors Insurance chief revenue officer Luciano Garrido explained some of the incentives being offered by hospitals.
“Some are giving incentives to clients to cover their stay for three or five days, no charge. So people can stay there, do their tests and everything.
“Some insurers are eliminating deductibles and others even pay for flights. So there’s a lot of things being done to move them to Spain and other countries.”
Cost controls
Furthermore, another reason for patients going away from the US and to Spain or other countries is the sheer cost of treatment and it potentially exhausting plan benefits.
“Not all policies are equal, people don’t pay attention to that and there are coverages that run out, like transplants are not unlimited value,” Garrido continued.
“People try to come to the US for a transplant and they don’t have the coverage. We recommend certain hospitals where they’re going to get the coverage. It’s happened several times.
“They end up in Colombia or in Spain, because if they were to come here they may have $500,000 or $300,000 coverage which is not enough.”
While these are likely welcome developments for patients and potentially for insurers in helping reduce costs, they can also add further complexities for managing these cases.
“As there’s more utilisation in Europe we insurers have to make sure we have our networks and cost containment in place because you still have to have those,” continued Trawick International’s Capote.
“Even though it’s less expensive than the US, you still want direct payment opportunities for your customers to make sure the experience is positive and sometimes some insurers may have lagged in the past having that set up because the focus is Latam and US.
“And then there’s a claim in France where someone’s calling your medical team in Paris wanting to know the closest hospital. So having that platform set up is important,” he concluded.
Download the Latin America IPMI roundtable supplement by following this link.
