Compensa: Private insurance should direct people to primary healthcare

TALLINN - According to Merko Kimsto, head of the Estonian unit of Compensa Life Insurance, a managed care pathway starting with a primary medical assessment should become standard practice in private health insurance.

Compensa is redesigning its health insurance service based on this principle, so that individuals can quickly receive a professional assessment and be directed to the right specialist when needed.

Kimsto explained that people often manage their own healthcare journey, selecting specialists and what they believe are necessary tests based on their symptoms. This results in patients wasting time and money, as well as taking up limited appointment slots with specialists for services that may not resolve their health issues. Meanwhile, in many cases, a family doctor or general practitioner could offer the fastest assistance.

"As insurers, we must also look at ourselves in the mirror. For years, the main selling point for health insurance has been quick, direct access to specialists - and Compensa has been part of this," Kimsto said. "This can give people the impression that seeing a specialist is always the right first choice for any health issue."

According to a Norstat survey commissioned by Compensa, three out of four Estonian employees consider employer-provided health insurance necessary. Currently, approximately 72,000 people, or eight percent of the working-age population, are covered by health insurance. Kimsto noted that while the growth in health insurance is welcome, new policies do not add more doctors, nurses, or their working hours to the healthcare system.

"If we build health insurance solely around quick, direct access to specialists, we risk creating a parallel queue with the same bottlenecks as the public system. Health insurance should help people get a professional assessment first and then, if necessary, quickly guide them to the exact right specialist," Kimsto stressed.

As a solution, Compensa Life Insurance has expanded its partnership with the Salu healthcare service center to offer a service where the care pathway begins with an online medical consultation. A healthcare professional assesses the health concern and helps determine if treatment, analysis, diagnostics, an in-person appointment, or specialist care is required.

"With this solution, the insured can access an initial digital consultation with a family doctor or GP within one to two days, free of charge. If needed, an appointment with a specialist is arranged within three to seven days. For subsequent treatment, Compensa settles the bill directly with the service provider, meaning the individual doesn't have to pay the full medical bill upfront and later claim reimbursement," Kimsto explained.

According to Kimsto, a managed care pathway helps keep health insurance a valuable and sustainable employee benefit. Unnecessary or duplicate visits and tests increase the medical costs for the entire group of insured employees, which can affect the price and terms of the policy for the next insurance period.

"This doesn't mean that people should use their insurance less or delay necessary treatment. On the contrary, help should be sought as early as possible for any health concern. We are not in any way restricting or prohibiting our clients from seeing specialists as they have before. Rather, we are trying to encourage a way of resolving health issues that guides the person immediately to the appropriate specialist and doesn't leave them to navigate the choice of healthcare services alone."