Read the Conversation
EF: How do you visualize 2023 for Bupa? Do you see it as a challenge or an opportunity?
FL: I see both challenges and opportunities. A challenge can present itself as an opportunity, and Mexico has huge challenges in healthcare in general. More healthcare players in Mexico are needed to generate more health. Only 9.8% of the population has private health insurance1, which is insufficient. As an insurance player, Bupa must offer useful products that will be used more and create more health. As we insure more people, the next step is to work on preventive care. Prevention is the best cure in the insurance world, and we must provide new and affordable products and services that are simple and useful. Mexico has great doctors, professionals, and excellent hospitals, but we must work on affordability. The four major stakeholders, hospitals, doctors, patients, and insurers, must simplify things because the system can be very complex unless you pay privately. On the administrative side of things, we must work to improve quality assurance.
EF: You were appointed in October 2020 during the pandemic. What attracted you to the position, and what mission did you set for yourself to achieve in Mexico?
FL: Bupa was founded after WW2 in the United Kindom with the mission of generating health; today, it has the same purpose on a global level. In 2019, after strategic reflection, Bupa concluded that its model and capacities perfectly fit Mexico and has since focused on further developing health in Mexico. Originally, Bupa Mexico was a part of Bupa Global Latin America and managed from Miami. Brazil and Mexico began as independent entities because of their dimension and their capabilities. In 2020, Bupa Mexico had an insurance business with a specific international medical product with a concrete sales channel; today, we have many products with traditional sales channels that reach most market segments. We have reached agreements through commercial partners (BBVA and HDI) who put our products on the Mexican market, wrapped up in a digital layer.
Not all countries work similarly, so we have had to "tropicalize" the product and adapt it to the Mexican market. We then acquired Vitamedica, a TPA in Mexico, with a huge assistance network, a very large network of medical providers, and an excellent client attention platform, which we have since grown. We want to build on the products Bupa can offer a newer, easier, and more useful national product that we think will benefit the market. Since we acquired Vitamedica, it has been firmly in the market, looking for new clients and managing employees. At the end of 2022, we acquired Bité Médica, our first hospital incursion. Bupa has a very clear idea of how to dispense medicine and manage hospitals. Our model is not hierarchical; the heads of the departments run the day-to-day work at the hospital. We have grown from a small insurance company in 2019 to what we are in 2023, reaching new market segments through different channels and a relevant digital signature. It has been a wonderful project for a professional like myself who feels lucky to work in health.
EF: What were the greatest lessons learned in managing during the pandemic in Mexico?
FL: The biggest lesson was being flexible and adapting at all levels. Bupa, a big company, successfully faced difficult circumstances and adapted from one day to the next. The lockdown came suddenly and was traumatic, and adapting was not just about working from home; it was about continuing to offer services in a new and different situation. We very quickly came up with "Bupa, At Home" to attend to people at home; this was more comfortable for our insured and safer for society not to go to hospitals. Our "Bupa at Home" improved significantly over time, and we also came up with "Bupa at Home Covid," offering all the necessary equipment to provide Covid home care. Bupa has a legacy of adapting to different countries; there are no red lines, and nothing is impossible. With technology and the team, anything can be achieved.
EF: Telemedicine was well received during the pandemic. Do you think the trend will continue? Is it compatible with advancing access?
FL: The pandemic was a sad period of time for the world, but it accelerated digital medicine or telemedicine. Digitalization is a new communication channel between doctor and patient, with the hospital or insurance company in the middle. However, telemedicine does not substitute for a face-to-face appointment; it is an additional, efficient, and immediate communication channel, which adds to the doctor-patient relationship. Approximately 70% of the doctor's appointments can be done via video consultation to give results or instruction, and the remaining 30% must be face-to-face for tests, studies,2 etc. With the present technological evolution, it is not imperative to physically go to the doctor for urgent consultations in many specialties –and that is here to stay. Telemedicine peaked during the pandemic and now appears less popular, but that peak acted as learning for the journey with the physicians. Innovation, when applied, proves what is useful and practical and what is not, and some of it survives.
Digital medicine will remain, and I specify digital medicine because it is a broad topic. As part of our preventive health plan, we have a scanner that detects eight variables that provide information on an individual's state of health; if any variable falls outside of the normal or healthy parameters, the person can activate a video consult with a doctor. If the doctor deems it necessary, extra analysis, tests, or a visit to see a doctor are planned. It is important to focus on digital medicine and what it brings -digitalization is not the goal- it is a great means to improve services and health. In the digital world, the companies that work in health, the patient, and the physician must be on the same page. It will evolve and improve because it is useful, and as new generations emerge, it will become easier.
EF: After acquiring Bité Medica Hospital, are you planning to expand operations and open medical centers in Mexico?
FL: Bupa will expand when it sees opportunities to fill gaps or where we feel we can improve services and health. Bupa wants to develop and grow in Mexico because it has the capacity and experience to do so and because it encourages and animates the market. Competitiveness is a healthy sign in a market, and the lack of it makes for a mediocre environment. We have a very clear model with hospitals and medical centers and have had great success in Spain and Chile, among other countries.
EF: What KPIs do you use to measure the different disease burdens? What diseases are most prevalent, and has the pandemic changed the measuring method?
FL: The variable we measure is the activity and the usage rate frequency, measuring patients that use the insurance for the first time and, after that, their frequency –the times they return to the hospital. The most expensive disease specialty continues to be oncology, followed by cardiac diseases and the one-shot area of childbirth. Then we have areas such as pediatrics, clinical, etc., that have lower medical expenses but where assistance is very high. Measuring solely by cost shows cycles; in 2020, it was all about the pandemic. Although oncology and cardiac patients still needed to go to their doctors, other issues were not prioritized.
After a two-year halt in many non-urgent medical areas, a huge wave of activity and expense impacted us because we are coping with our yearly burden and what was not done in previous years. But by now, we have stabilized. COVID is still present, but the expense has been reduced, and we are back to normal and measuring costs by specialty and frequency. Nowadays, people are more aware and concerned about their health; I believe the post-Covid psychological effect generated by the pandemic increases the frequency and impacts higher insurance usage.
EF: If you had to create your own startup company tomorrow in the Mexican healthcare sector, what would it be and why?
FL: Mexico has an endemic problem and needs prevention; prevention combined with an easy, useful, simple product. The country has connectivity; there are 84.4 million cell phone users in the country which is a huge amount- and it allows access to many people. Mexico has great medicine, professionals, and hospitals, but the core issue is to stop people from getting sick. People go to a doctor and look after themselves only once they are sick, which involves double the work of the patient and the doctor. With the large population and people who do not care for themselves sufficiently, preventive care is Mexico's biggest challenge, and the companies that work in health must be responsible for providing the right products and services. When I arrived in Mexico, I found the concept of Major Medical Expenses very difficult to understand; the mechanisms of how it functions are extremely complex. There is no certainty on how much the patient must pay, which I found difficult to comprehend. Over the next few years, the demand for preventive care and a good, easy insurance product will increase.
EF: What strikes the most when you evaluate and compare prevention in Spain and Mexico?
FL: In Spain, the product already includes prevention, whereas in Mexico, they are two different products:
- Major medical expenses: which cover the sicknesses cure
- Minor medical expenses cover preventive medicine.
Latin America has a younger population than Europe, and people do not think much about prevention in their thirties. But it is a cultural issue, and health and insurance companies must educate the population on the virtues of prevention. Thankfully, much prevention can be done digitally, so after the initial investment, which can be large, through selling health insurance, it can be passed on cost. It is an area of opportunity where there is much to do. Europe, the United States, and Latin America work very differently, so we must be intelligent about tropicalizing the product for the people to find it useful.
EF: Is there any final message you would like to share?
FL: There is a lot that could be changed regarding health in Mexico; the insurance companies, the private hospitals, and all who work in the health sector are primarily responsible for innovating and putting useful products on the market. I firmly believe in digitalization as a tool to improve the quality of our services. People are concerned about health and money, but money cannot buy good health, making health the most important. We have to make people's lives easier. Mexico is fortunate to have Bupa as it can facilitate health for Mexicans. I am fortunate to work in Bupa, Mexico, where there is much to develop and opportunities for the taking. Mexico is in luck, and I am delighted to be Bupa's leader in the country.