Development of Health Insurance in the GCC & MENA Region

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1 Development of Health Insurance in the GCC & MENA Region Dr. Michael Bitzer Arab-German Finance & Investment Conference November 17, 2011

2 Agenda Healthcare Expenditures in the GCC and MENA Insurance penetration in MENA region Health insurance in the GCC and MENA KSA UAE Qatar Kuwait Bahrain Oman Munich Health National Health Insurance Company Daman 11/17/2011 Daman Health Insurance Company 2

3 Healthcare Expenditures 52% The governments in the GCC and MENA region still shoulder a high percentage of all healthcare expenses 36% Country US Germany MENA GCC 70% Total healthcare spending as a % of GDP Total healthcare spending, on a per capita basis (USD) # hospital beds per 10,000 people # physicians per 10,000 people 16.2% 11.4% 4.3% 3.8% 7,410 4, *Source: Lester R 2010, The World Bank 11/17/2011 Daman Health Insurance Company 3

4 Drivers for Increasing Healthcare Expenditure in the MENA region - Population growth - Increasing wealth - Increasing life expectancy - Higher education - Greater awareness of healthcare Healthcare Expenditure - Increasing chronic diseases (diabetes, obesity, ) - Provider driven demand - New medical technologies 11/17/2011 Daman Health Insurance Company 4

5 Insurance Penetration in MENA Region The insurance sector remains undeveloped in the MENA region. WHY - Cultural factors - Lack of awareness - Life insurance almost non-existent - Lack of compulsory insurance in key areas - Inadequate tax rules However, health insurance has gained an increasing importance! *Source: Lester R 2010, The World Bank 11/17/2011 Daman Health Insurance Company 5

6 Insurance Penetration in MENA Region Non- Life Penetration (% of GDP) United Arab Emirates Kuwait *Source: Lester R 2010, The World Bank GDP per Capita Germany total : > 3% 11/17/2011 Daman Health Insurance Company 6

7 Health Insurance Indicators Country Health Gross Written Premium as % of Total Gross Written Premium *Source: Axco Intelligence Platform KSA 53.0% Lebanon 37.8% UAE 27.5% Jordan 25.1% Syria 21.0% Bahrain 18.9% Iran 17.0% Tunisia 16.4% Morocco 10.0% Egypt 8.8% Libya 6.6% Kuwait 2.2% The figures for Oman, Qatar, Iraq, Algeria, and Yemen are not applicable due to lack of statistics available 11/17/ Daman Health Insurance Company

8 HEALTH INSURANCE MARKETS IN THE GCC

9 Health Insurance Market- Kingdom of Saudi Arabia Regulatory framework: compulsory health insurance for expatriates and Saudi nationals working in the private sector Medical GWP as % of total GWP (2009) Population: 27.1 m, ~31% expatriates. Provider: Increasing regulatory and competitive pressure on providers to acquire international accreditation and improve service standards also resulting in gradual cost increase Competition: increasingly sophisticated, highly price sensitive. Overall service levels below standard. Health insurance market: Health insurance, which includes both compulsory and non-compulsory lines of business, remained the largest line of business in 2010, accounting for 53% of total GWP. Three major players represents 64% of total market share. Sources: SAMA - Saudi Insurance Market Report 2010 Source- Central Department of Statistics & Information /17/2011 Daman Health Insurance Company 9

10 Health Insurance Market- United Arab Emirates Regulatory environment: Abu Dhabi: Compulsory health insurance for expatriates implemented in 2006; Almost 100% coverage with 2.3 Million covered (Ref: HAAD Statistics 2010) Dubai: Implementation of mandatory health insurance system scheduled in 2008 postponed. Renewed discussions in by Dubai Health Authority (DHA) Northern Emirates: No compulsory health insurance for expatriates but regulation under discussion Population: 8.2 Mio of which 7.36 Mio (~ 88%) are expatriates (Ref: 2010 estb. as per National Bureau of Statistics, UAE) Provider: Still governmental dominated (40 plus public hospitals) however private sector is showing gradual growth stimulated by increasing demand GWP CAGR: 75% Competition: Competition for business remains fierce in all Emirates from 60 Insurers *Source: Business Monitor UAE Insurance Report Q /17/2011 Daman Health Insurance Company 10

11 Health Insurance Market- Qatar Regulatory environment: currently no compulsory health insurance, but draft legislation being considered Population: 1.7 m (2010 Census), ~75% expatriates, young population Provider: government investing heavily in developing provider infrastructure in addition to private sector organic growth Competition: market limited to few multi line insurers offering health insurance typically as an add on Health insurance market: Outside of energy sector demand has historically been modest, however, evidence of growth developing in private sector Health Insurance growth: Estimates indicate annual premiums have grown to $110 an increase of almost 100% over the past 2 years Sources: Axco Insurance Report 2009, BMI, WHO 11/17/2011 Daman Health Insurance Company 11

12 Health insurance market- Kuwait Regulatory environment: compulsory medical insurance through MOH (50KD / ~180USD per employee), controlled through renewal of residency visa providing free access to governmental providers through referral system of primary health clinics as per residency area Population: 3.56 m (est. 2010), ~68% expatriates, young population Provider: private provider segment only started developing since 2000, lack of quality and capacity in governmental provider segment Competition: market dominated by national insurance companies, however more focus on general business GWP CAGR: 31% Health insurance market: relatively underdeveloped compared to other GCC countries Sources: Axco Insurance Report 2009, BMI Kuwait Insurance Report Q /17/2011 Daman Health Insurance Company 12

13 Health insurance market- Bahrain Regulatory framework: Privatized insurance market, currently no compulsory health insurance but regulation under discussion. Population:1.234m(est.2010),46% young population expatriates, Provider: More awareness of health insurance concept; improved facilities especially in tertiary care; new highly equipped medical facilities already operating (King Hamad Hospital) Competition: No more market domination by previous national companies and competition is mainly on price and quality Health insurance market: growing, gaining overall in importance (medical GWP as 15 % of total GWP rose from 13% in 2009 to 15% in 2010)Political instability in 2011 did not have big negative impact on the health insurance market Sources: Central Bank of Bahrain Insurance Market Review 2010, The report Bahrain, IMF 11/17/2011 Daman Health Insurance Company 13

14 Health Insurance Market- Oman Healthcare Ecosystem: Strong healthcare system underpinned by robust public sector; WHO ranks the healthcare system (in 2000) as 4 th best in the world and one of most effective in outcomes Regulatory environment: No compulsory health insurance for expatriates, but regulation under discussion; Nationals have free access to public providers Population: 2.34Mio (Ref: 2010 census est.), ~24% expatriates, young population with median age of 24 years Provider: Aggressive, low-cost private providers dominate the primary care / clinics with 817 clinics versus 172 in public sector; Good quality governmental hospitals (60 versus 5 in private sector), however access restricted to Omani nationals (few exceptions e.g. emergency cases) Competitive environment: * Small, crowded & fragmented ; *~ 700 Mio USD total annual premiums competed by 21 Insurers, including 10 local companies leading to severe competition & soft premiums; Highly price sensitive market Health insurance market: Non-life insurance market incl. health grew only by 5.5% in 2010, as oppose to 16% in 2009; Forecasted to shrink in 2011 Sources: BMI Oman Ins Report Q3 2011, Axo Insurance Report 2009, WHO 11/17/2011 Daman Health Insurance Company 14

15 Munich Health Munich Health: One of the three business fields of Munich Re Group RI Munich Re Group PI MH MH Clear and strong commitment to Health as a strategic global market for MR Group Organization that combines primary insurance and reinsurance competence while maintaining reinsurance independence to our cedents Enable growth within existing lines of business through innovative products and solutions that go beyond traditional approaches (new market potentials) by innovative service offerings 11/17/2011 Daman Health Insurance Company 15

16 Munich Health Specialised health risk management with global set-up Munich Health Overview Examples global presence Consistent steering of global health activities under one roof: Specialisation as main driver for utilisation of synergies increasing expertise through best-practice know-how and enabling flexibility solutions in order to drive innovation along health value chain Unified Munich Health platform is basis for synergies 11/17/2011 Daman Health Insurance Company 16

17 Leveraging flexibility across the range of business models to create value Risk-taking Risk management Financial protection Service Sales Administration Medical mgmt Network mgmt Health supply Market specific 11/17/2011 Parts of the value chain covered 17

18 Daman Overview Daman National Health Insurance Company History: Founded in 2005 and licensed in mid 2006 Owners: 80% Abu Dhabi Government, 20% Munich Re Employees: 1,450 Members: 2.1 m [300,000 full private health insurance members, 1.2 million Basic members (government subsidized for low income), 605,000 thiqa members (Nationals, expenses covered by government)] 18 11/17/2011 Daman Health Insurance Company

19 Thank you

20 Insurance Penetration Insurance Penetration (% of GDP) *Source: Raymond Yeung, OECD- Asia Regional Seminar 11/17/2011 Daman Health Insurance Company 20

21 Health Insurance in Other Selected Markets Libya Population: The population of Libya as of October 2011, is approximately 5.7 million Size: Area of approximately 1.8 million square kilometers GDP: Approximately 90.5 billion (2010 estimate) 11/17/2011 Daman Health Insurance Company 21

22 Health Insurance in Other Selected Markets Population: The population of Egypt, as of October 2011, is approximately 76.8 million Egypt Size: Area of over 1 million square kilometers GDP: Approximately $128 Billion (2011 estimate) 11/17/2011 Daman Health Insurance Company 22

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