ALLIANZ-EFU: PAKISTAN'S FIRST HEALTH INSURANCE COMPANY

The long-term mission is to make healthcare accessible and affordable to the people of Pakistan

By SHABBIR H. KAZMI
 Apr 04 - 10, 2005

In March 2000, Allianz Aktiengesellschaft (Allianz AG), a global leader in the insurance industry with an active presence in 70 markets across 5 continents, and EFU Group, the leading insurance organization of Pakistan signed a joint venture to form a new company for providing health insurance cover to the people of Pakistan. Allianz EFU Health Insurance Limited, is the first specialized health insurance provider in the country and aims to play a pivotal role in developing the health insurance market in Pakistan.

Together, Allianz and EFU, bring a rare blend of international expertise with a local perspective. Allianz-EFU has a single-minded focus-making quality healthcare accessible and affordable for a wide spectrum of the local population. Allianz-EFU is also the first company in Pakistan to offer health insurance to individuals, families and all sizes of organizations starting from small companies to large organizations employing thousands of employees. And to ensure quality, they are implementing an integrated healthcare delivery system.

In an interview, Baqar Naqvi, Chief Executive, Allianz-EFU said, "The healthcare cost is rising rapidly in Pakistan. As a result, employers who provide healthcare benefits to their employees, as well as the general public, all over the country are faced with the challenges to overcome the issue. They demand greater value and efficiency in triangulation of costs, access, and quality. The initial potential for health insurance in Pakistan was actually gauged by EFU when they approached Allianz for a joint venture; it was seen to be tremendous. The management of healthcare is an important challenge that needs to be taken in our country. We need to ensure that our people have access to good quality healthcare so that they can contribute towards the society and economy."

Comprehensive Care, Convenience, Choice, all at the same time is need of the day. Allianz-EFU takes pride in offering high quality health insurance plans for employees. With Allianz-EFU taking care of their health, employers can enjoy extra peace of mind. We cover healthcare through our network of hospitals, where staff and their dependent family members receive the most appropriate treatment. And we even have the systems in place to make the process simple and transparent. We offer flexibility to choose amongst the five different benefit packages.

In any customer-centric business, it is the little difference that sets a company apart. In the case of Allianz-EFU, we are dedicated to becoming the healthcare provider of choice. Personalized service, customer dedication, and development of products that fulfill clients' needs are just some of the promises that we are making, and that we intend to keep. Our financial stability and experience form the basis of our customer-oriented philosophy. Allianz-EFU uses computerized systems that enable us to track medical events, benchmark practice and analyze clinical practice in detail.

The factors that make Allianz-EFU Family Scheme unique are:

* '24-hour' Help Line providing round-the-clock access to friendly and knowledgeable doctors for help during medical emergencies.

* Health Card Assurance offers fast and easily accessible medical treatment at selected Network Hospitals. It's a passport to the best possible medical care.

* High Benefit quantification provide complete protection offering very high benefit ceilings to clients and each of their covered family member as high as Rs500,000 per year.

* Network hospitals number exceeds 95 hospitals country-wide. These have been carefully selected to provide the best possible hospital care. The list is increasing with the need of clients.

* Flexible Claims Settlement Options ensure 'peace of mind'. In non-emergency situations, just inform us three days in advance of hospitalization and we will arrange credit facilities at one of the Network Hospitals of the client's choice. There will not be a need to make a payment, or getting involved in claim settlement hassles. Alternatively, one can go to any Network Hospital directly, settle the bills and claim reimbursement from us.

At Allianz EFU we use computerized systems that enable us to track medical events, benchmark practice and analyze clinical practice in detail. All these activities are aimed at ensuring that patients receive the most appropriate care. If a patient needs extensive treatment, Allianz-EFU staff doctors will work closely with the hospital to ensure that the best approach to treatment is being arranged.

To provide that extra peace of mind, we will issue a personalized health card to each employee or individual client. In case of an emergency, this card guarantees hospital admission in one of our network hospitals at preferential rates. It features the insurance coverage details, emergency phone number and family details.

We have a 24-hour a day, 365 days a year, medical hotline. The medical hotline is manned by our qualified staff doctors whose primary role is to guide and assist patients in case of any medical emergency.

We have developed a network of hospitals that meet our stringent quality criteria. These hospitals are accredited based upon the credentialing of their physicians/surgeons and favorable assessment of their facilities.

Globalization of the economy, employee mobility, high cost of employee replacement, and the need to retain valuable employees has posed new challenges for the employers. At the same time cost of medical treatment is escalating at an alarming rate. Healthcare episodes range from high frequency low-cost conditions, through to major surgical events requiring intensive care costing thousands of rupees. Today, employees demand and choose to work for companies that offer medical benefits.

Some companies offer medical benefits to their employees by maintaining an accounts ledger of medical expenses and arrangement of in-house reimbursement of claims. They not only experience steadily rising costs but also face sudden peaks in expenses caused by major medical events. Managing healthcare requires a combination of clinical knowledge, contractual administration, tracking systems and healthcare management expertise. As their primary focus is to make a profit in their core business they neither have the time nor the resources to undertake healthcare management on their own and then there is the risk associated with major medical events.

The answer therefore is to out-source medical benefits to a healthcare specialist. The healthcare specialist for a growing number of leading businesses in Pakistan is none other than Allianz-EFU.

Health care business is a very difficult type of business, which has to be monitored carefully from a financial perspective and also from a quality perspective. In the same manner that life insurance cover has been made mandatory, I feel that the government should consider making health insurance also compulsory for all employees. It would automatically generate a high level of interest amongst the various insurance companies in the country to develop quality systems and expertise in the area of health insurance, thereby creating more jobs and a better trained workforce. With the growth of healthcare industry, we can start focusing on improving quality standards, which is something that is considered a luxury at present.

In the end Naqvi said, "Allianz-EFU has access to extensive experience and ideas from around the world on how these changes can be handled and are willing to take leadership role in moving the country towards this new goal. At the end of the day, I am sure that it can also be done at quite affordable rates, which will enable as many people as possible to benefit. Our long-term mission at Allianz-EFU is to make healthcare accessible and affordable to the people of Pakistan.