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          Designing health insurance for international energy workers in Africa

          With the energy output continuing to grow across Africa, Marco Giacomelli, Head of Generali Global Health, looks at the healthcare challenges faced by organisations operating in often challenging environments.

          Energy output in Africa is growing. According to research by BP, oil and gas production rose by 5.0% and 9.0%, respectively in 2017, while coal production increased by 3.6%. Power generation increased by 4.4%, largely driven by strong growth from natural gas-fired plants and hydro generation.

          Impressive numbers for a continent that faces many significant challenges.

          The difficulties in extraction and transportation cannot be underestimated. Of the 2.5km of road per 1,000 people, less than 25% are paved. Deduct towns and cities from the equation and it’s easy imagine how underdeveloped road networks are in more remote localities, where much of the exploration takes place. 

          Disease is another major concern with HIV/AIDS, tuberculosis and malaria at endemic levels in many areas. 

          Energy exploration is labour intensive and many workers are expatriates. Drilling platforms can need a team of 200. Factor in onshore logistical staff and supporting industries, and the numbers of people in remote locations can be significant.

          Designing health insurance for international energy workers in Africa

          Large numbers of workers in high-risk environments create health and safety minefield. If an accident or illness occurs, the environment makes it difficult to provide quick and effective medical care. International private medical insurance (IPMI) providers can overcome these hurdles by developing well designed products and procedures able to cope with medical emergencies.

          Three issues are critical:

          • Plan design and approach to underwriting
          • Transportation and patient care
          • Keeping employees healthy and well

          Plan Design and Underwriting

          Developing a medical insurance program for energy companies with workers operating in remote locations brings its own challenges. The design must be bespoke and take into account unique challenges of each site. 

          • Transporting a patient to a medical facility is often more complex and expensive, with air ambulance assistance required needed more often
          • Often epidemic levels of disease increase the likelihood of workers falling ill
          • Social and political issues can be an issue; civil unrest, terrorist activity, kidnap and ransom and violent crime are all a concern

          Health insurance plans will often include a rig to shore evacuation benefit, non-emergency transportation that provides transportation outside of country if treatment is not available locally* and cover for common communicable diseases.

          Assistance is an essential part of any plan design but the situation in Africa can be particularly challenging. The accessibility and reliability of the healthcare infrastructure varies considerably, with particular issues in remote locations. It’s here that private clinics have been set-up to manage the demand for quality healthcare. In some cases, emergency assistance companies have established clinics after requests by oil and gas exploration companies.

          Clinics will typically offer day-patient services to a good standard of healthcare. Many operate on a fee-for-access basis via a membership system. IPMI providers need to account for the fact that employers might already be paying for access to clinics when designing their products. Generali Global Health’s association with Generali Global Assistance solves this issue through their ability to embed access fees to EA clinics within the plan design and premium structure. By erasing the need to pay for both clinic access and health insurance we remove a major obstacle for energy companies wanting to fund high-quality health insurance for their workforce.

          Transportation and Patient Care

          International private medical insurance providers need to work closely with each customer to understand cover required. This facilitates contingency plans that can react quickly to circumstances as they arise. Risk levels, employee numbers, local transportation links and communication channels are all important.

          Following an accident or illness, a potential four-stage process kicks-in: treatment on-site, evacuation to a local clinic, evacuation to a specialist treatment facility, and evacuation to another country.

          Stage I will typically involve an on-site doctor, able to deal with minor ailments. A decision can then be taken on whether evacuation is required, with the aim of align the patient’s condition with the local medical facilities. Evacuation will often be to a local clinic for treatment or stabilisation initially and then onward to a specialist hospital if necessary. In more severe cases, immediate international evacuation to a centre of excellence may be required.

          Transportation and Patient Care

          Remote locations and challenging transport links can add significant cost to treatment, which needs to be taken into account when pricing a policy. This is a particular issue in Africa, a vast continent with a limited number of top-tier medical facilities. The exception is South Africa, a country with a large number of first-class hospitals and clinics and widely considered Africa’s centre of medical excellence.

          Employee Wellness

          A healthy workforce will be more productive thanks to reduced absenteeism. A lower incidence of claims can help contain future premiums increases. 

          A site should be set-up with health risk assessment program, a robust health and safety framework, a suitable medical evacuation plan and an on-site medical team. Staff can be monitored through pre-employment health risk assessments and annual check-ups. And educational is possible via medical staff briefings and educational material outlining how to stay safe and protect against local diseases.

          Data analytics and predictive modelling can uncover medical trends in larger group populations, driving the implementation of healthcare strategies that tackle the root cause of an issue. Data can highlight a recurring illness within a local employee group, for instance, which can be investigated and addressing at source.

          Customer centric approach to managing health risks of this kind implies a deeper commitment by IPMI providers to ensure the wellbeing of insured individuals members.

          Developing countries like Africa present unique challenges to the international private medical insurance sector. The energy sector on the African continent faces substantial obstacles from remoteness, poor transport links, disease, access to healthcare and political unrest. Health insurance programs designed for employees operating in these environments must be able to meet these risks and challenges. Evacuation cover, communicable diseases, non-emergency transportation and access to local clinics should all be considered when creating cover for workers in these circumstances.