Health insurance procurement from a Nordic perspective

15 October 2015
If News 7/2015 Personnel. If is the largest Nordic health insurer, with operations in Norway, Sweden, Denmark and Finland. We purchase health services on behalf of our corporate clients’ employees for more than NOK 250M each year.

​As the Nordic health care systems are different, the Employee Benefits insurance solutions also vary quite a lot within the region. Health insurance products and markets are different as well. We also experience that private healthcare offerings are unlike in the Nordics. Thus, identifying areas to implement Nordic solutions can be challenging.

It is also worth to reflect on the fact that Health insurance is different from traditional Employee Benefits products.

It is a service-oriented product, with high frequency in contacts between If and the clients’ employees. It is a product that is frequently used and appreciated, and therefore a highly visible benefit.

Nordic coordination

If has had a Nordic coordinator, placed in Norway, responsible for the network for two years now. Initially the focus was to establish procurement agreements with the largest private medical providers in Norway, ensuring that we obtain the best possible prices. Parallel to that a Nordic procurement strategy was developed, to set the framework for If.

The next step was to develop a system to follow up our partners on a large set of criteria, ranging from quality, to prices, to administrative routines, service, geographical coverage, customer satisfaction and overtreatment.

We have also established, as the first insurance company, a report on these criteria that enables us to compare our providers against each other. A very useful tool both in negotiations and in the selection of the right providers for If.

The next challenge was to tackle the frequency treatments, physiotherapy etc. With ca 150 providers in the network and with more than 60% of annual claims we needed to handle this in a more professional way. In Norway we entered into an agreement with Nordic Netcare to administer the network, and to handle the customer communication and claims handling.

The network now consists of more than 700 partners. NNC serves our clients with a team of physiotherapists focusing on the right treatment for the underlying cause. In the other Nordic countries, we currently have local set ups for physiotherapy.

Nordic cooperation

The Nordic procurement strategy has been challenging to implement. The first challenge is that the Nordic partners operate differently in each of the countries, no one Nordic model is difficult to establish in the way we envisioned it. For instance, MR and X-ray are not done in separate institutions in Sweden, but are done at the hospitals as part of the preparations for surgery. In Norway on the other hand this is done separately before course of medical action is decided.

The needs also vary. We have found that the need to send clients outside own country is by far the greatest in Norway. The private hospitals cannot handle for instance cancer treatments or heart surgery.

For the heart surgeries we send outside Norway we have selected one clinic in Denmark, also used by If in Denmark and thereby obtained reasonable prices. For cancer treatments we send all our cases to Finland, and our partner has a cooperation set up with Norwegian private hospitals.

However, in Denmark, for instance, cancer patients are sent primarily to Sweden and Germany. With this cooperation in place our clients will get the treatments in Finland but can rest at home in between, with the follow ups close to home. So working with this from a Nordic perspective gives If a strong base for negotiation, but may not be conformed Nordic.

Rewarding results

It is essential to prepare for the changing demand in the market. We find that a health insurance must be flexible and able to serve wherever the current need is. As this product is a reflection of each country’s current public health care system, we must always be ready for new challenges such as new medical treatments, movements in waiting time on certain treatments. We also experience that the constant merger and acquisition activity on the provider side can present as a challenge both in regional presence and in medical services provided.

To ensure that If can serve the clients in the best way we must maintain a top network of providers in the Nordic region. We are only as good as the weakest provider, and this is a meaningful responsibility. The customer satisfaction index shows that taking this responsibility serious is rewarding, for both If and our clients.

Marianne Hartvig