GSMA mHealth - Health Hotline Services in Emerging Markets

Health Hotline Services in
Emerging Markets

30th May 2012

Restricted - Confidential Information © GSMA 2012

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 Overview

2 Restricted - Confidential Information © GSMA 2012

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 service



GSMA Development Fund mHealth Programme
Leveraging 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 practices



Current state of health



Research Scope
This report will provide a global overview of the health hotlines that MNOs offer but will focus on stand-alone
health 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)


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
satisfaction


Health value chain: health hotline function
Health hotlines currently play an important role in the prevention and diagnosis segments of the patient
pathway; it also has some utility for treatment purposes (i.e. medication prescription)



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 existing
Government  public health facilities to reduce cost • Government • NHS Direct, UK • HMRI, India
and resources burden

• Established to supplement
• HMO / health
Healthcare 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, India
Independent  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)



NHS Direct: value to provider
Through 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, UK

10


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 Research

11

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 resources



Five types of MNO-offered health hotlines
Across all types of health hotlines, MNOs rely on third-party partners who have the expertise and manpower
to 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
assistance



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’s
Healthline, Bangladesh 37.6 million
Grameenphone
subscribers



Deployment overview
Stand-alone services are more popular in Asia and Africa while packaged emergency services are more
popular 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’



Country segmentation
Health 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 WHO


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 success



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 uFone



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 purposes



MNO adoption: drivers
Governments should develop a regulatory environment that will incentivise market players, both domestic and
foreign, 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 Group



MNO adoption: barriers and solutions
Collaboration among stakeholders within country and on a regional level – key to addressing barriers to
adoption

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 commercialisation



Customer/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?


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 services


Summary

Summary: health hotline success factors
Taking into consideration underserved consumers’ wants and needs is crucial to the success of any
health 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 network


Appendix

Appendix


Appendix

Methodology Overview
GSMA referred to existing publications about health hotlines but also did the following to ensure that we have
covered 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 websites



For any feedback,
please email

mobilehealth@gsm.org


GSMA mHealth - Health Hotline Services in Emerging Markets

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