Fintech's Role in Reducing Disparities and Financial Barriers to Health Care Access

commentary

Jul 26, 2021

Close up hand of patient paying with smartphone, photo by Ridofranz/Getty Images

Photo by Ridofranz/Getty Images

By Sam Alom and Sonja Marjanovic

Interest is growing in the potential of fintech to address pressing societal challenges, including access to health care.

Fintech brings together finance and digital technologies and is a fast-growing sector. It uses innovations such as mobile money, blockchain, and artificial intelligence within banking and other financial services to improve convenience, financial inclusion, financial transacting, and data analytics, and help inform decisionmaking for service providers and consumers alike.

The applications of fintech are being explored and tested in a range of areas, including as an innovative route for securing access to health care finance. According to the World Health Organisation, nearly 100 million people have been driven to poverty because of the costs of meeting health care expenses. As well as having the potential to expedite payment processes and reduce complex transaction costs, fintech is being considered as a means of broadening financial access to meet the health care needs of underserved communities.

This potential may be particularly pertinent for low-income countries where smartphone ownership is increasing (PDF), but out-of-pocket spending for health care is high, bank account ownership is not a given, and attaining good credit scores may be a challenge for many. In high-income countries where health insurance coverage may be fragmented or inaccessible, or where public health care systems fail to meet demand, fintech may also be a promising intervention to bridge accessibility gaps.

Fintech is being considered as a means of broadening financial access to meet the health care needs of underserved communities.

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Various fintech-enabled finance approaches have been developed and are being tested or implemented in health care, but there is very limited insight and knowledge sharing about what works, when, and how.

Many fintech-enabled health care applications are not new in their underlying approaches—for example insurance and microfinance. However, the digital conversion of these approaches is an innovative way of potentially increasing the scale, reach, and sustainability of access to health care funds. It is the application of fintech to tackling health care access challenges that are innovative but underexplored.

Several types of fintech-enabled health care financing can be applied in efforts to support access to both in-person health care and telehealth, with some fintech health care financing providers combining more than one type of approach in their offering. Examples (PDF) of existing fintech applications for health care access include digital saving, digital lending, insurtech (data-driven and internet-enabled insurance coverage offers), and crowdfunding approaches that include both donations and mutual aid activities.

For example, Arogya Finance (PDF), a digital lending company in India, offers pre-approved point-of-care lending with low-interest rates and digital health care loans for emergency point-of-care needs, using a digitally assessed alternative risk scoring tool.

Health wallet applications (PDF) have also arisen globally. Examples are numerous, including 'M-TIBA (PDF)', a pioneering mobile-phone enabled platform which enables customers to send, save, and spend funds for health care, allowing them to pay for medication and services at M-TIBA-approved health care facilities without any transaction fee.

Insurtech, in comparison to conventional insurance, broadens health care access, such as through using data from internet-enabled devices to dynamically—and in a customised way—inform price premiums. For example, in Malaysia, PolicyStreet is an insurtech company that aims to democratise health care access by making insurance more accessible and affordable, while in India, PolicyBazaar offers family-level insurance.

Another increasingly popular approach is crowdfunding, which also makes use of digital platforms to raise mutual aid funds and donations. One example, Xiang Hu Bao, in China, provides a mutual aid platform facilitated by a digital interface, protecting patients with a basic health plan against 100 types of illness. All users in the fund share financial risks and medical costs and do not have to make upfront payments/premiums.

Another example, Hizafat Care in India, is a medi-fintech platform that brings together multiple health care funding needs posted by individual solution seekers. The platform uses strategic campaigns to attract potential funders, who may donate money to support health care financing in specific, clinical areas of interest.

Crowdfunding medical expenses is growing globally—not only in low-resource settings but also in developed countries where it is more frequently used for one-off financing rather than for funding care for chronic conditions. Moreover, online platforms like GoFundMe and Leetchi have been gaining traction (PDF) internationally.

Better and timely evaluative evidence and learning from existing efforts could deepen our understanding of the potential of fintech to increase the scale, reach, and sustainability of access to health care funds to those in need.

Diverse fintech-enabled health care finance models have been actioned across a number of countries (PDF). However, the evidence on their take-up, implementation and success criteria, impact, sustainability, and scalability is scarce. This hinders efforts to understand the potential and boundaries of fintech for health care access and how to implement and achieve impact at scale in the future.

Further research may be needed to understand which populations stand to benefit most from fintech approaches in developed and developing countries.

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Different fintech approaches and combinations may come with a mix of common and unique challenges, enablers, implementation, and success criteria that need to be met to cater to specific patient populations and health care contexts. Further research may be needed to understand which populations stand to benefit most from these approaches in developed and developing countries, and what combinations of fintech solutions are needed by specific patient segments. For example, to what extent do solutions need to support only access to funds—and for what types of services and costs—or do they also need to make financial transacting and convenience easier and safer? What do patients and the public need to know about these approaches to effectively engage with them? How dependent is take-up on operational and logistics-related factors and how dependent is it on broader social, economic, cultural, and political factors?

More also may need to be understood about how much awareness of the existence of different types of fintech-enabled health care services there is among target populations, how acceptable they are to different stakeholders in health care systems, how trusted existing providers are, and the extent to which fintech can in practice facilitate more patient-centred health care.

Examining the extent to which it is possible to integrate fintech-enabled health care financing into existing health care systems and financing infrastructure may also merit further research. Such integration may matter, in view of scalability and sustainability efforts.

Any efforts to understand the promise and mitigate possible misuse of fintech for health care access, evaluate progress with existing efforts, and inform current and future practices may need to be rooted in deep stakeholder engagement. This could involve a diversity of organisations, including health care authorities in the public sector, finance providers, digital tech platform providers, the health care industry, health care service providers, not-for-profits, and ultimately the patients and populations that stand to benefit.

Given the growing pressures on health care systems globally and the need for innovative approaches to financing health care, the time may be ripe to develop a robust evidence base and share learning on fintech-enabled approaches that could support universal health coverage agendas and healthier and more stable societies.


Sam Alom is a research assistant at RAND Europe, working on innovation in health care. Sonja Marjanovic is director of Healthcare Innovation, Industry, and Policy at RAND Europe. For more information, email: healthcareinnovation@randeurope.org