What Does Singapore Know About Selling Healthcare Products?

Buying health insurance in the U.S. is not yet as straightforward as other consumer purchases, but that is changing. Health systems in Singapore, Australia, and New Zealand are far ahead of us in offering consumer choice and addressing health disparities.

By this time next week, Debbie Gordon, Chief Marketing Officer for Network Health, will be in Singapore study how that country's healthcare system engages consumers. Gordon, who is one of nine 2013 Eisenhower Fellows, is also traveling to Australia and New Zealand during a five-week intense study of healthcare systems in other countries. The intent is to discover what the U.S. can learn from them.

Gordon leads the marketing efforts of the Medford, MA–based nonprofit health plan, which provides comprehensive health coverage for 215,000 state residents.

"There are market forces and government regulatory forces coming together, for example [health insurance] exchanges, and the rise of high deductible health plans," says Gordon. "All these things seem to put a lot of responsibility on consumers. So, my quest was to find countries or systems I could study that have not only mastered the cost and quality equation, but [have done so] specifically through the consumer angle."

In Singapore, which has recently been held up as a model of lower-cost, higher-quality healthcare, consumers have higher co-pays and are required to maintain an individual health savings account to help pay for their healthcare.

The cost of medical care is also completely transparent in Singapore, so consumers know what they are paying for upfront. U.S. advocates for medical price transparency have scored some victories, but U.S. health consumers are far off from Singapore's system of going online and comparison shopping.

"Singapore is a highly regulated place, but what is most compelling to me is that they have an out-of-pocket system, an insurance system, [and] there is a safety net," Gordon says. "There are features that you would recognize and at the same time one of the tenets of their healthcare system is 'personal accountability,' and I think that's what we're doing, almost inadvertently. What I imagine they've done is establish systems and supports for individuals to make good decisions for themselves and their families. That's what I want to learn from."

In Australia, Gordon is going to study how that country is approaching the health disparities that exist in its Aboriginal population. Life expectancy, disease rates, and preventable hospital admissions all lag behind the rest of the country's population significantly. Network Health is an approved Medicaid provider for its state, and Gordon says there could be opportunities to learn some best practices.

"From where I sit, in a health plan that serves a predominantly lower income and heavily minority population… I thought, 'I'd really like to go and learn how they are approaching these disparities in their population,' and the role that consumer empowerment has in that context," she explains.

Gordon will spend the bulk of her trip in Australia. She cites the vast size of the country as the main reason for spending about four weeks there versus one week in Singapore. Already, she has meetings lined up with hospitals and health plans as well as advocacy organizations and government officials.

"I think that we need to start thinking about our industry as a consumer industry and then approaching consumers as if we were selling computers, or smartphones, or clothing, or food, or consumer products that we are accustomed to shopping for," says Gordon. "We need to teach consumers how to shop for it [healthcare]; we need to establish mechanisms to enable that. And it's really about reframing our industry as a consumer market."

While buying health insurance is not as straightforward —yet —as buying an electronic gadget off the shelf, Gordon believes there are already products on the market that serve as a model for healthcare, such as car insurance or buying a house. One thing that is certain, says Gordon, is that health insurance exchanges will expedite the rise of consumer empowerment.

"More people will be buying insurance, or will be covered by insurance. Therefore insurance companies stand to gain just by increased volume," she says.

The increased attention on helping consumers eligible to buy insurance on the exchanges could serve the rest of the population well because it could force health insurance companies to become better at communicating clearly, something she acknowledges health plans haven't done very well, which could be a contributing factor to U.S. consumers being slow to take on more responsibility for their health.

"I don't think this is a market where people feel really confident about trying new things," she says. "It's hard to branch out, because, like your house, you've got to know that it's not in a flood zone, that the roof doesn't leak, that the windows work. There's a lot of uncertainty when you're buying a health insurance product. And I think we don't have great literacy, frankly, into the terms and conditions of a health insurance plan."

Gordon will be blogging about her trip to Singapore, Australia, and New Zealand. She leaves July 15.