Why Health Insurance Should Be More About Health Than Insurance

Arturo Sanchez, CEO and Co-Founder from Sofia Salud

Mexico is a bit of an outlier in that most of the health insurance products that people are used to buying are actually medical expenses insurance, rather than health insurance. The distinction is subtle but has deep consequences, insuring you against medical expenses versus insuring your health are very different things. The former is a purely financial product, while the latter requires a solution that actually is designed around health (rather than designed around medical expenses).

At Sofía, we believe that insuring you against medical expenses is not enough, because yes, paying for care is a huge aspect of healthcare, but it’s far from the only one. Actually getting care is complicated and hard to understand; in a single care episode you might see a physician?someone recommended, but it could be that they are not even the kind of doctor you really need to see. Who tells you which specialist you should go see? (The answer, by the way, is, an internal medicine physician, and that’s why all of Sofía’s doctor@s de cabecera hold this speciality). And if that specialist points you to another physician, they won’t have access to the first physician’s medical records. If there were studies involved in either of those consultations, you’ll have to carry them with you (hopefully in some digital format, but often the data is on an actual physical printout).

That’s why we have designed our product to be a health companion, and not just a financial instrument. From primary care, which is an integral part of?our insurance product, Sofía is right there in our app from the first moment at which you might need care through a videoconsult, and then if you need to see another physician (the Sofía app and team will help you find the right one), your health record is there in the app. The second physician will have access to the record too (because they’ll be part of our medical network). If you had lab tests done, those too will be attached to your medical records. And throughout all these touch points, the Sofía insurance will be covering you from the financial perspective of the episode, meanwhile the Sofía technology and team will be helping you navigate the episode in a way that focuses on your health.

Through this example, I’ve laid out how this shift from health insurance being a purely financial instrument (focusing on health expenses, or gastos médicos mayores, as these products are known in Mexico) to being a healthcare companion looks like in the specific example of Sofía. One piece of good news is that we are not the only ones pushing to make this a reality. Other companies in the industry have launched insurance plans that aim to aid in the provision of care and not just the payment of expenses. I see this as a positive as competition drives for better consumer products in all fields, and in particular in this undertaking, given the magnitude of the change in consumer expectations that going from health expenses insurance to real health insurance represents. It is good to have multiple companies working to make this a reality.

To talk about why I believe we’re uniquely positioned at Sofía to drive this change, we need to look at the fact that the problem of care delivery is at its core a problem of coordination and incentives. Technology has excelled at moving these situations to a much better state; eBay allows for coordination and incentive alignment among merchants, while Uber solves the problem of the coordination and incentives of people paying to use a car for a specific trip without owning the car or having a prior relationship to the driver. In an analogous way, technology is the key for making a care episode, in which a patient needs to engage with multiple parties, several physicians, lab centers, pharmacies and hospitals, an experience that feels coordinated and easy to navigate. In this regard, a company like Sofía, which at its core is a technology company, is positioned to write the software necessary to coordinate all these parties and give patients the best experience in much the same way eBay did for e-commerce and Uber did for ride-hailing.

Given all this , I venture to predict that in 10 years, if you ask someone in Mexico about health insurance, the default expectation will be for a good product that is more than just financial protection. They will think about the way an insurance plan helps them access care when they need it. Furthermore, I also predict that the best regarded products will be those that use technology to make the whole healthcare experience seamless and easy to understand (and which will be built and sold by a tech-only company).