Around 60% of Malaysians remain uninsured or underinsured.

Knowing that healthcare is going to become more expensive. How do I take charge of my own health today?

Hi everyone and welcome to Insured Truths. This is a series where we bring together experts across the healthcare and insurance industry to have real conversations about one thing that is truly close to our well-being, health insurance. I am Shankari, co-founder of InsuredSpeaks and your host today. Just a quick intro, InsuredSpeaks is a review and rating platform where people can share their insurance claim experiences and rate their health insurance providers. We started InsuredSpeaks as an initiative to increase transparency around health insurance claims. We wanted to hear other people's story and create an informed community on claim experiences. But as we started talking to more and more people. We realize that health insurance is still a very confusing topic to many. It is often an isolated experience for many families. This lack of understanding and misinformation is what's creating the fear, and which is pushing people away from an institution that is meant to protect them during vulnerable times.

So with our series, we wanted to slow things down, to talk openly, to ask better questions, and to help people feel a bit more control of their health insurance decisions. In today's episode, The Next Chapter from Malaysia's Health Insurance, we are honored to be joined by Miss Rhenu Buller. Miss Rhenu is a senior Healthcare and Business strategist with over 25-years experience across Asia Pacific, Australia and Europe, helping governments, global organizations and healthcare leaders rethink how healthcare is delivered, financed and made more accessible. She spent nearly two decades with Frost and Sullivan where she advised on healthcare transformation, digital innovation and sustainable growth strategies. Miss Rhenu, thank you so much for being here today. How are you?

Very good. My pleasure to be here. Thanks for having me.

Okay. You have been working closely with policymakers, investors and innovators on healthcare systems in your own context. Could you please tell us a bit about yourself?

Sure, I guess my foray into healthcare started at a very early stage. I started in the pharmaceutical industry first. So, I read at that time, I worked in the, you know, drug development and understanding that whole process of how drugs get to the consumer. And as part of that, you also understand what consumers or patients generally need. So from there, I joined Frost and Sullivan after about ten years in the pharmaceutical industry. And that was where I think I started getting exposed to different aspects of healthcare in terms of both, you know, personalization of healthcare, but more importantly, how the cost of healthcare was starting to change with the changing demographics. Because when you look at our population today and I'm talking about first, 20 years ago, we were aware that we were seeing these shifts, the ageing population. With ageing population, you do get rising healthcare costs. On the good side, you also had new technologies coming in, new products, new surgical interventions, new forms of diagnostics. But innovation also requires costs. So as these new innovations come in, the cost of treating also started to grow.

So looking at all of this, at that point, I was really fortunate to be able to work with different countries, the governments of different countries and the healthcare departments that were looking to understand how were they going to manage these populations of the future, because depending on just government, on taxes, which was, you know, the main source of income for governments at that time, but that's one of the sources other than commodities and so on. But just looking at that, the cost of health care and providing healthcare obviously was going to outpace whatever they could keep up with in terms of income. You know, you add to that your ageing population, so your taxpaying population goes down. But these populations then need a lot more in terms of healthcare. So I think, you know, I started really looking at how different countries were approaching the problems that they were facing. Now, when you have smaller, contained countries where populations are smaller, when you look at countries like, let's say, Switzerland or Singapore, you're looking at populations of, let's say 4,5,6 million people. Then you get larger countries, you're looking at, you know, Indonesia, you're looking at the US, you're looking, you name in Malaysia and you start looking at hundreds of millions of people. So the scale is very, very different. So I think when and that really got me exposed to thinking, how do we do that? And one of the aspects you have, technology. You do have different mechanisms of payment. Public versus private funding mechanism, but also more importantly, the rise of what I call the rise of the consumer. Because end of the day, it is our health. So we need to be informed of what are the different steps we are taking to manage it.

Exactly, I couldn't agree more. Okay, right now that you have gone through all these countries and I have observed how their healthcare system is and their insurance system. Is Malaysia on par with them?

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I think Malaysia has a very solid foundation. We have a very strong public system which provides access. You know, people can go in and essentially get care. Yes, you have to wait long, but that's with almost every public healthcare system in the world. Then on the other hand, you also have very high quality private health where you pay higher costs, but you don't wait as long. So I think we have a strong dual system foundation, which, if you ask me, is a good basis and a good starting point of where we really need to go.

Okay, so as we said, we are actually moving towards a more digital and connected health system. What do you think are the biggest challenges we need to overcome to ensure that our Malaysians are better protected?

Yeah. Now when you talk about digital health systems, it's not just us. I think that governments around the world are grappling with this. Some are a little bit further ahead and I think we can learn from those. But I wouldn't say there is a perfect system where everyone has now implemented digital health fully. I think the first is the fragmented data systems, because when you look at digital health and you look at the technology, they've come in at different phases and depending on whether sometimes it's a state based system, then you have a federal based system, then you have the private hospital system.

So all of these essentially may be using different data platforms. So data is really fragmented. The interoperability of that data is not there. And I know that we're, you know, going towards one health record. And I think that's really important. Australia has also been trying to implement that. And hopefully it's getting there but with that one health record, one of the things we will hopefully be able to do is take away wastage from the system. And when I talk about that, what I mean is, if you've taken certain tests now in a certain hospital or a certain clinic, those tests should not be repeated unless warranted for. And because we don't have it all in one place, it's really difficult to track. So if I take Korea, for example, Korea has mandatory health checkups every year, every year or two. You know, you have to go for mandatory health checkups. And then that data is there in your health record and when you do your subsequent checkup, it's also there so you can actually track progress whether it's progressing or regressing, and take interventions accordingly.

So I think that digital technology, if you ask me, is there. I think the the challenges are really in the fragmentation of the data, the interoperability that will do for the systems to actually speak with one another. And then you've got consumer trust because it's like, no, I don't want my healthcare to go with my data to go out there, because if my data goes out there, my insurance premiums are going to go up. So they automatically connect to all that, oh, I won't get insured. So I think there's a lot of concern as well from the consumers around.

Yes. Because people don't want to show their record that it's like they have pre-existing conditions that will lead to exclusions in the policy and everything also.

But you see, that's the other problem, right? When you are not transparent with this and somehow or other, if that pre-existing condition is discovered, obviously your claim is going to get denied. Because the purpose of taking insurance is to protect yourself. And you? It works best when there is transparency to start with.

Would the private hospitals, they need to cooperate with this initiative as well. The one citizen, one record. Yes. So the data is actually a very powerful asset actually. So they have to copy it as well and all. Do you think that will be feasible at the execution point?

Well I think that's where some you need I guess government intervention. Yes. This needs to happen. These are the different, you know, steps for it to happen. It will take time. And I think with all of this, with every digital implementation system, it'll be a phased rollout. The best way is you start with a pilot. Let's say we've decided, okay, since we have bank size, our pilot. So the private hospital in banks are, you know, public. And you start with that population pilot and then you learn and you slowly roll it out. And I think these are things that have been planned. If I'm pretty sure that these are things that, you know, our government and our Ministry of Health is looking at.

Okay. Let's steer this conversation slightly in a different direction. Now, despite all this, the growing number of insurers and the government initiatives, still around 60% of Malaysians are remained uninsured or underinsured. Why do you think this protection gaps still exist or continue to persist?

Yeah. So it's hard to say. What's the ideal percentage of private health insurance, right. Because when we say Malaysia's we are 40% private health insurance, you'd be really surprised to know that in some developed countries, it's even less. it was quite surprising to me when I moved to Australia many years ago and back now, but when I moved there to find out that at that time it was only 20%. Because the view of the population was, I am paying high taxes. That's different. I'm paying high taxes and because I'm paying high taxes, the government, I'm paying high taxes so that I get free healthcare.

So why should I pay high taxes and then at the same time have to pay for private health insurance? So what the government then introduced is a incentive system, to incentivize those who are high income earners to take private health, because essentially then the public health system could be kept for those who really needed it and couldn't afford it. So then a system came into place where if you earned above a certain amount, and if you did not take private insurance, you would pay an extra 2% on tax or something like that, right? An extra percentage. So it then automatically made sense since I'm going to pay that in tax anyway, I might as well use that to pay for private health insurance. And that helped to increase the private insurance uptake. So I think for us here in Malaysia, it all comes down to people understanding their personal circumstances. Why are they taking insurance? Why do they need it? What can they afford? What do they need? What I think really needs to happen is a really good diagnostic system for people individually, for them and their families, their dependents, and so on to understand their circumstances today, to understand what is important to them, to understand the ability to afford if something actually happens, and looking at their, you know, history and so on, what they may need.

Once you get that understanding, then you make a decision. What level of healthcare do I need? Because sometimes people like, oh, I have to take the best healthcare possible with all these 50 diseases because I want to be protected against everything. But is that really what's necessary? So I think that we need a few things to happen. We need for clarity and education on what medical health insurance is different from, you know, income protection or from life. So really, what are you protecting when it comes to medical and health? What is important to you? And then different levels of, I guess even policies. I think we have something like that today, but really understanding. Do you need a, you know, bronze, gold, silver, platinum and why do you need it? Yes. You know, understanding that and this can change through life. So you may start to say today I need the basic because I'm, let's say in my 20s. So today I need this basic insurance.

And I'll put it there because it's insurance in case something happens to me and I cannot afford to pay. I rather pay this right. And then as you progress through life, you decide, okay, now my needs have changed and I may need something else. So I think people need to understand that first. I think secondly, our products need to be simpler. It's very complex. And I'm someone who's. I've studied these so I understand it, but when I'm looking at this, I'm like, how does someone who has not studied it and understand it? Are we intentionally making it complex?

Then you go to different websites, different insurance providers, websites. The terms they use are also different. The way they display the products of the same thing, say investment link products between these two companies are starkly different. And it makes, what's the difference between it really confuses lame and confuse consumers. When I, when I start talking to other people, this is like they say, I don't understand anything.

I just believe what my insurance agent said. Yeah, this is what has been sold. He said, this is his covered and that's it. That's pretty much it. They want to know. That's it.

Exactly. And that's not necessarily the right way to buy. So there are I'm in here to possibly you've seen that there are now these comparison sites that come up right. Yes. So you put in all your your data, your age, whether you want a single you want family, you want, you know, coverage with children. You put in all of that. And then what's important to you? Then you'll give you the okay, these are your three possible options and then compares okay. That's the price. This is what's covered. It's not. And it's really simple like tick tick tick. Then you decide. Now then you need someone to talk. You need to talk to someone first. Because we are at the stage where potentially you should be asking the right questions. And I think that's the other piece of education we need to do.

What are the five questions you must ask whoever you're buying from before you actually sign up?

That's actually a very good thing, asking the correct questions. Most of them will stick to their budget. I have this budget and I want to be covered with everything. So I think the need based analysis is very important. As if you said yes. As you said earlier, healthcare cost is rising. And because of that, insurance premiums are also rising, but the wages are not rising at the same rate. So even it's making it difficult for people who want to afford health insurance and sustain it. That's another question and also there's another aspect that people are not seeing insurance as a necessity, but it's more like something nice to have this perspective. So how can we make the healthcare in the insurance system more sustainable in the long run?

So I think it depends again, on the individual's current financial situation. Because if I'm earning, if I'm in the lowest, if I'm at minimum wage, insurance is a nice to have.

Because if I'm at minimum wage, that's why that's what our public healthcare system is for. It is to support people who are unable to afford even the basic right now, let's say as I move up, then I start looking at what I could potentially. What are some of the different things I want to to spend on? And you're absolutely right that premiums are rising above wages. And that's where having products that could suit the needs, its needs based, and understanding at each stage of your life. What is your biggest need right now? So if I am, let's say the sole income earner or if someone is the sole income earner in their family and they've got two children, let's assume something happens, you know, and they are unable to work for six months to a year. What do they need? They need to ensure their medical costs are covered, and they need to ensure that there will be enough income coming in to support for that period of time. So then they need to look at a product that meets that right now, finding the budget for that product.

That's where budgeting comes in because it's priorities. You know, do I get my Zus coffee? Or do I pay five ringgit a day for insurance? and the person could also make a choice that I don't want to pay these high premiums, but I am going to put aside. Instead of paying 100 ringgit a month for premiums, I'm going to put a 100 ringgit month in the investment fund where I will have enough to hopefully pay for certain surgeries. But again, that's a decision you have to make individually. Are premiums going to go down? No, premiums are not. It's not. Healthcare costs just are not going to go down. I think that's something we have to accept.

So if you look, if you think that it's going to get cheaper at some point. No. So what is so important is knowing that healthcare is going to become more expensive. How do I take charge of my own health today so that I may not need to do all these things? And that's where the whole preventive health, you know, holistic health.

Staying healthy. That's the cheapest way, actually. That's the cheapest way to potentially, manage healthcare costs.

Yes. I actually seen in some of the financial like the investment league, they'll have this bronze the levels for wellbeing. If you're healthy and didn't claim or this one. There's actually some incentives. They are rewarding people to be healthy. So I think it is aligned. Being healthy in the end is the best way forward. So when talking about digitalization, we of course can't avoid talking about AI. Telehealth and predictive analytics are transforming our healthcare. How do you see these technologies reshaping health insurance in the next 5 to 10 years?

So when we look at how AI is being used, it's being used to get really large data sets. So you get data sets from huge populations. You know, you look at the previous years, what's been spent, how it's been. So these data sets are now being used to calculate potentially, the way programs or costs or policies are being structured.

So that's I think the first one really looking at long term data sets, what, you know, by population, by history, by health, history by age and so on. So I think what this will do is this will give a better indication of what potentially could be the costs, and it could shape the future of different policies to come. I think the other way that could also be used is, as I said, when you're doing an analysis, when you're putting, you know, your needs, your current situation that analyses it can also be used to recommend and propose what could be potentially right. Structures. It's being used for comparisons as well. So I think from the insurance side it's being used to help them basically run their business. But from the consumer side it can also help us to make better decisions with the right information.

Yes. Absolutely. Right. Another aspect is the digital adoption rate. So Malaysians in general are tech savvy. Most of them use mobile phones, apps and everything. And half of the population are financially literate. You can say that, however, we are digital first insurance in tech platforms like. Ouch. It's rising, but the adoption rate is still low.

Yeah, I think that's where again, education, trust. Trust is really important and understanding because when you look at, and it depends who's buying insurance as well, if someone is in their 20s and, you know, they've grown up in the digital age, they would feel a lot more comfortable with looking at these and making comparisons as compared to, let's say, someone who's much, you know, who hasn't been so familiar with it. And that's where I think those in that age can help their older generations, I guess, you know, to do that. But I think very importantly, when you look at the platforms, the trust of the consumer is really important, which is why today, in today's age, I think 100% digital. We're not ready for that because we've been so for so long.

We've been so used to talking to someone and trusting, I would say, that person for what we buy. Oh yeah, they said, this is it, just buy it and I'm just going to buy it and forget about it. Whereas that's how it is, not the most transparent way.

Today with this, you have the ability to now compare, let's say these are four different policies from four different companies. And then from there you may decide as a person to shortlist one of the two. Then the next step could potentially be to talk to someone. So you still need, I think, a hybrid tech and human touch, at least for this transitionary period. I would say the next, you know, the short term mid-term. Once you have that and you have you build that, trust and people will learn. Okay, it's been going. Then when they do their subsequent renewals or their subsequent comparisons, they already have that confidence to do it. So that's why I think this transitionary period, a hybrid approach of human tech, is potentially the way to go.

So insurance agents still need to play in role.

I don't know whether I would use the term insurance agents. I think, for all these platforms that are providing this, I would even use the term educators.

I think I would use, I would say, insurance educators to actually be able to talk through a person to say, these are your two. And we think this is the best option, and the educator needs to be neutral. The educator should not be from.

Any particular insurance company. You have to be buying.

You have to be the person. They have to be the one who's providing the best 1 or 2 options. And then yes, as the consumer can make my decision.

Yes. So the unbiased does need to exist. That's only when the trust comes in actually. Okay.

Why don't you talk a little bit more about what you're trying to do. Because then you, you know, we build that in. So I think it'll be really nice to talk about what you've been trying to do and your experience.

Okay. So, when we started, actually, we are a review and rating platform. We want to hear, so all these consumers, policyholders, they already have this insurance and they are having experience on the claim and everything when, so we wanted to create a place where people can share their experiences. Oh, I went to this hospital and the GL took this long to issue. And so we want to hear these stories. What's actually happening? You already have the product. Are you actually receiving the actual benefits that you were promised years ago? Right. So that's how we started off. And then people started reading the insurance provider. Oh, this one is good. And that's how we want to create awareness. So but when we started talking more and then we realized that people don't like the agents because there'll be when once they go to the hospital there's a different story. Oh you have this, this. And then they're like, no, my agency that I can claim. So these kind of stories exist.

So there is actually a misinformation and misunderstanding of what was sold in the beginning and what is they actually entitled to. So that's when we realize knowledge is important. The the education part. People need to know all this. What is riders. What is the premium waivers? I'm not sure whether people are aware of all these terms.

Absolutely. And and how are you helping people understand what they're buying.

At the moment? In the end, it's going to be we'll have all these resources. Our podcast is one of the ways is to educate people as well, to know about what's going on in the current health insurance. The reviews and rating systems. We also plan to have a quiz where people can test how well they know about their health insurance. So these are all the things that we are as appearing in the app.

Yeah, that's great. And I think one important aspect again is I guess that whole demographic, you know, that assessment of yourself, your health needs, your health insurance needs at this point. I mean, one thing people don't also, understand is when they take insurance, if they take a certain like when you buy car insurance, if you take a deductible to say, okay, I will pay the first 1000 ringgit if something happens, and then after that it's covered. The premiums go down significantly. And I think that is something that also people need to understand when they want to buy the insurance online. If they say, okay, I will pay the first 1000 and then the rest, insurance will cover. That's actually a really good way. When you talk about how to manage, you know, budgets and costs. I think that's a really good way to decide how much I can put aside rather than no, I want to be 100% covered for even the first ringgit. Now for that, you're really you are going to pay a, you know, significantly higher premium. and I think the other way also is having those what are your must know questions before you buy. You know, you know, before you buy it.

I think those are something that potentially would be really good to work on.

Yes. Another aspect we are looking at was the policy reviewer platform. So this is where, if you look at your policy statement, it is at least more than 60 pages with all the clauses and everything. How have you read through the whole pages?

Yeah, no one can. So the idea is when they upload this document so they can actually communicate with the bot and ask, okay, I have this diagnosis and I'm going to this hospital. Is my policy covered? Is this a panel hospital? So they will be well informed even before heading to the hospital? How much? deductibles they have to pay? Well, they have to pay double for the rooms. Everything. They'll already be well informed. So that's the ultimate goal, actually.

And I think that's where, as you mentioned, we asked about how we use AI. I think that's how AI can be used. But what I would like to see is people doing this before they buy, because then, you know, because once you've already bought, there's nothing much you can do because your bot will come back and tell you that.

“Oh, yeah, sorry, but you're not covered”. What are you going to do? So where people should be putting this in is the ask the question before you buy. So if I'm going to do this is have scenarios put a draft policy in. And if it tells you well yes you're covered. Great. This is what I need or no if you want this this this this is how it should change. So I think all these needs to happen before people buy.

Yes, but the underwriting is another issue as well because everyone say everyone has different needs.

So that's the needs based analysis. So that's why it's individual. But this is where again with AI, AI is tailored.

Can tailored to personalize it. Yes I think that's where AI can reach this needs actually because I also see that at one point, although every people's needs are different, fundamentally, it's still the same. You want to protect your family. You want to have an adequate, protection in terms of medical health, maybe life insurance.

You want a certain amount. Everyone do wants the same thing. Maybe the amounts are different.

But I also think, though you want the same, I don't think you want the same thing throughout your life.

So I think life's reviewing what you want. And as I mentioned, when you are, you have dependent children. Your needs are very different from what they are from when you are in your 60s and you have no dependent children. So I think, you know, you look at your life in buckets your first 20 years, then 20 to 40, 40 to 60, 60 to 80. And what you need at each stage.

Is totally different. Yes. Okay. Absolutely. Right on that. to close off, what is your message to our viewers here today?

I think first take ownership. We all are responsible for our own health. Understand what we need. Really do an in-depth analysis of what's important to you. What do you need at different stages of life? And I think from there, once you have that study, study what is out there, spend a little bit of time, because when we are going to buy a car, I'll tell you this.

You will go and check the different models, right? You will. You might even do a test drive. I would say maybe as much effort into the health insurance you're going to buy that you would put when you're buying a house or a car. Learn, educate, understand.

Okay. Thank you so much for the insight today.

Pleasure to be here.

So, thank you so much for your insights today. It's very inspiring to have you with us, and we hope our viewers learned something about health insurance today. So we hope everyone can take ownership of your health insurance decisions. And with that, you can take more, more confident with what you actually have, whether you're protected or not. So stay tuned for more upcoming episodes in our series InsuredSpeaks, thank you very much.