Digitalising health insurance to provide better support for patients

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Extract from the article: Universal health insurance is undoubtedly the government's most important social reform. If it becomes operational, it will solve one of the problems of greatest concern to the Togolese people, namely the provision of health care. Health costs are im

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Universal health insurance is undoubtedly the government's most important social reform. If it becomes operational, it will solve one of the problems of greatest concern to the Togolese people, namely the provision of health care. Health costs are impoverishing the Togolese, and the lack of financial resources means that people die every year. There are still social inequalities and systemic and organisational vulnerabilities. These are issues that the « Innovation for the health of vulnerable people in Africa » (ISPV) project, supported by the association Coursier d'hôpital international (CH-I), the start-up DokitaEyes and the Union des mutuelles de santé de l'archidiocèse de Lomé (UMUSAL), aims to address. The 3 organisations coordinating this project are offering people an innovative approach to health insurance through "Mutualised DokitaEyes". Togolese people will be able to take advantage of this package, which consists of digitising the entire health insurance circuit in 04 parts, by joining the mutual insurance scheme digitalised by the DokitaEyes digital application. After six (04) months of activity, the project promoters have drawn up a positive balance sheet with encouraging results. The project was presented to journalists on Thursday 21 December 2022.

Launched in August 2023 in Lomé to cover the populations of Greater Lomé and Zio, Dokitaeyes mutualisé (DOM) has already proved its worth in these prefectures. In just 4 months, 400 people have signed up to the project, which offers a package of health services.The cost is affordable for everyone: the first year costs 15,400 CFA francs, and the following years 14,200 CFA francs. Around 120 people have benefited from home visits and 24 state-qualified nurses have been trained as fixed medical facilitators who work in the health centres and help patients. The role of the Medical Facilitator (MF) is to give patients easier access to hospital care. They accompany vulnerable patients (the elderly, pregnant women, children and disabled people) free of charge throughout their medical journey in hospital.

An innovative project to improve access to healthcare services

The project proposes a solution called « Mutualised DokitaEyes », which aims to improve access to preventive and curative healthcare services for low-income populations.  In its experimental phase, it is testing a digital health insurance system comprising 4 components: The first component is the DokitaEyes healthcare booklet, via which patients can enrol and pay their contributions. The second part is a digital platform for validating patient enrolments without physical contact. The third component is a platform dedicated to medical advisers, enabling them to validate prescriptions from healthcare providers for insured members in real time.The fourth component is a platform dedicated to monitoring reimbursements of benefits within 72 hours, compared with around thirty days under the traditional paper-based system....

The package also includes a personal service for policyholders. This involves the provision of a medical facilitator to monitor patients throughout their treatment and home visits for medical monitoring by state-qualified nurses who are members of the Association Nationale des Infirmiers et Infirmières du Togo (ANIIT). The Le Coursier d'Hôpital association and its partners are offering people excluded from traditional insurance the luxury of having healthcare staff at home.

Clearly, the Togolese will no longer have to worry about signing up for health insurance.Using an application from their home, patients can pay their membership fees and contributions online, without having to go anywhere. All they have to do is sign up for digital health insurance.

« In carrying out this project, we have noticed that people find it difficult to meet their health costs when they are ill. These are vulnerable groups who live in the most remote areas and have no identity or employment contract with an employer.They need to be included in a mutual health insurance scheme tailored to this population group, with a solidarity-based tariff. So, thanks to the Union des Mutuelles de Santé de l'Archidiocèse de Lomé (UMUSAL), we decided to offer a mutual health insurance scheme to vulnerable people. We just had to overcome the difficulties of traditional insurance to offer a wonderful experience.We are now offering people excluded from traditional insurance the luxury of having a carer at home. A luxury that only celebrities and their families can afford.Today, even the hospital can come to the porridge vendor. All you need is a subscription to the MUSAL mutual health insurance scheme », explained Koffivi Agbetiafa, Executive Director of the Le Coursier d'Hôpital International association.

The expertise of the Le Coursier d'Hopital association through the DokitaEyes platform can help provide a customer experience that will put an end to all the setbacks associated with health services in hospitals in Togo that incorporate digitalisation.

« We're not just digitising the documents, we're also digitising the processes, from patient enrolment through to payment to the healthcare provider.Everything is done on an application called 'DokitaEyes' », explained Claudine d'Almeida, Communications Officer for the association Coursier d'hôpital International.

« The advantage for the population is that they can have comfortable health cover.Health cover means we don't have to turn to our nearest and dearest when we have a health problem.The added comfort is that we no longer have to go to insurance agencies to pay for our membership and our contributions... Even if, by chance, a member of the insurance scheme does not fall ill, he or she can still enjoy the service by being visited at home four (04) times a year by a nurse to assess and monitor vital parameters in order to prevent chronic illnesses », she added.

Benefits of digital health insurance

Digital health insurance has significant impacts and spin-offs.  Claudine d'Almeida, CH-I Communications Officer, reassures us: « For members, digital health insurance reduces the risk of families becoming impoverished as a result of having to pay for health care directly. Pockets are no longer emptied when a member of the family needs health care. Digital insurance now makes it possible to monitor members' vital parameters in order to prevent chronic illnesses, resulting in a higher number of healthy members and guaranteeing financial equilibrium for the mutual. For health facilities, thanks to digital health insurance, the management of patients in consultations is better controlled thanks to the digitisation of care.In the long run, a healthy population with good purchasing power is a sign of sustainable development, and the health budget dedicated to the specialisation of professionals and centres and to research is possible ».

Promoters are currently working to increase take-up of this health insurance offer. This initiative comes at just the right time, as the Togolese government is preparing to roll out its universal health insurance programme from January 2024.

William O.