BR Exclusive. A healthy business: persuading patients to prioritize prevention

With Romania being among the worst countries in Europe for deaths caused by heart disease, stroke and different types of cancer, and with a life expectancy nearly six years below the European average, prevention is mandatory for the national health. BR sat down with Fady Chreih, CEO of private healthcare network Regina Maria, who talked about how important both prevention and education are and how Regina Maria has made its contribution to these two facets of Romanians’ wellbeing.

By Anda Sebesi

In March, the Romanian minister of health, Sorina Pintea, told evz.ro that it is imperative for Romania to have a code of laws for the healthcare system. “Healthcare laws need to be drawn up. We need to start with prevention, malpractice, transplants and vaccination. All of these laws need to be compiled in a code and need to be consistent. We have a working group within the Ministry of Health which includes notable members of the medical community. Their job will be not to write the laws but to set up their structure. For this we accessed a grant of EUR 650,000 to harmonize the local legislation,” stated Pintea.

Having said that, the local authorities have given the green light for medical operators to push the pedal on prevention among Romanians. But how does the country stand when it comes to prevention? “Unfortunately, Romania is still lagging behind most European countries in terms of prevention and medical education. It is somewhat understandable, since in many parts of the country there are no medical facilities – private or public, however unacceptable,” says Fady Chreih, CEO at the private healthcare network Regina Maria.

He comments that in terms of Romanians’ mindsets, the country has a major gap between large urban areas, with a more active and educated population – people who go to the doctor at least once or twice a year for their annual check-up and lab tests – and smaller cities, where most people visit the doctor only when the pain becomes intolerable or when they have aggravated symptoms.

“We need a national prevention strategy, a plan where, ideally, both the public and private systems come together in a multi-year prevention campaign, stimulating Romanians to go to the doctor, to have annual check-ups and tests, in an attempt to diagnose any serious issues early,” says Chreih. He warns that Romania is among the worst countries in Europe for deaths caused by heart disease, stroke and different types of cancer, and that local life expectancy is nearly six years below the European average. “This is one of the effects of having the lowest per capita healthcare spending in the EU, not even a third of the EU average,” adds the representative of Regina Maria.

And here the private medical subscription comes into play, as it is, in itself, a prevention tool. Although at the beginning it was mainly targeted at young, active people working for corporations, recent years have seen an increase in the market for individual subscriptions. This means that more and more people are choosing to buy this product for their families too – children and elderly alike. “A subscription gives you unrestricted access to a pool of doctors, lab tests, investigations which can be done for free or with a substantial discount. By not paying every time you access services, people feel encouraged to actually use them. The product has a very high usage rate, of over 80 percent,” says the CEO.

It can cover check-ups and exams in most medical fields, hundreds of lab tests, compulsory investigations and screenings for men and women (Pap test, ultrasounds, mammograms, PSA). According to Chreih, in addition, there are two more components that promote prevention within the Regina Maria subscriber base: medical workshops and medical screening campaigns developed for and with its corporate clients (subscriber companies).

“We have also initiated several screening campaigns for any Romanian who wants to get tested at Regina Maria, by offering promotional screening packages and discounts, in order to make prevention more accessible to the general public. We’ve had over 7,500 screenings in the past year and we intend to further increase this number, as it is still very low,” he adds. In addition, Chreih says that for the companies in Regina Maria’s portfolio, its doctors have held over 850 workshops since 2016, ranging from stress management, cardiovascular risks, nutrition (for example, employees who rarely eat fruit, vegetables and other low-fat foods at work were 93 percent more likely to see a greater loss in productivity, according to studies in the US), anti-smoking, to first aid, women’s health and others.

According to stats, Romanians who have private medical subscriptions used medical services more often that those without. “Having a subscription encourages people to go to the doctor. The medical subscription acts a safety net, which one can use either for treatment or prevention. And it is, of course, cheaper to prevent than to treat. It is cheaper to use a subscription that costs EUR 10-11/ month, than to pay out of pocket every time you use private healthcare services,” explains the Regina Maria CEO.

Private medical system prevails

According to a study on the performance of the private medical providers conducted online by the research company GfK, in November last year, 62 percent of those who used medical services in 2017 chose the private healthcare system, with 31 percent of them having subscriptions at a private supplier. The question is what should be done to increase their number? “It’s all a matter of infrastructure and increasing operational capacity, at which private suppliers have done a great job. The top three players on the market have invested massively in the development and modernization of health infrastructure in Romania,” says Chreih. According to him, Regina Maria alone has put around EUR 70 million in the last seven years into network expansion, as well as state-of-the-art equipment. “I’m sure that if a more in-depth study of the private medical sector were made, the actual investment figure of the top players would round up to EUR 200 million. And, of course, this yearly expansion has been reflected in an annual increase in patients and accessibility, and in the number of subscribers – all with double-digit annual growth,” he adds.

According to the same study, most of the Romanians who used the private medical system chose Regina Maria (38 percent). Chreih says that there are two main reasons for this: service availability (triggered by network expansion) and service quality. “Increased usage comes as a natural development of regional expansion. Furthermore, we also invest heavily in quality. We are market leader in terms of the quality of medical services, which means we have the capability to manage complex medical cases in modern and safe conditions; we recruit the best doctors and train top medical teams and many more. Currently, we are the only healthcare provider in Romania with three internationally-accredited hospitals for quality and patient safety,” he says.

He adds: “In addition to the high-quality services accessible to all our patients, we also have a unique medical program for Romania, available in our Private Care VIP clinic: it’s a personal medical consultant, dedicated to each patient, who advises and helps patients across their entire medical journey. This doctor coordinates the medical process, makes your appointments, sets up meetings with teams of different specialists for a holistic approach to your health and offers personalized recommendations for a healthy lifestyle.” At its VIP location, Regina Maria offers a one-day check-up, an integrated medical evaluation that includes all investigations, lab tests and medical exams necessary for a full health assessment, in just one day. This is especially targeted at highly active but busy people, expats or businesspeople who travel often and who don’t have the time to schedule multiple doctors’ appointments.

Private healthcare is still in its infancy

According to the same GfK study, the main advantages of the private medical system cited by respondents nationwide include the fact that players are well-equipped (cutting-edge medical equipment, availability of instruments, consumables) and offer good conditions for in-patients (fewer infections, short waiting times, good organization, enough time dedicated by physicians to patients in consultations, good remuneration, and sufficient and friendly auxiliary stuff). In this context, is the Romanian private medical system converging to the standards of medical service providers from abroad? Why are there still so many Romanians who choose to get treatment abroad?

“Regina Maria hospitals provide care standards similar to those offered by hospitals abroad, at prices as much as ten times more accessible than those outside Romania. However, let’s bear in mind that private healthcare is still scarcely available outside Bucharest and another two-three big cities in Romania,” says Chreih.

In addition, he notes that some medical units don’t have the capability, medical expertise or equipment to perform specialized surgery for severe pathologies. Furthermore, it is true that the Romanian healthcare system is understaffed – it lacks specialists in certain medical fields, or the existing specialists cannot cover the number of patients who need assistance. “This is, I would say, the main reason why some Romanians still prefer to get treated outside the country,” he says.

The golden nest

At present, medical subscriptions generate 30 percent of Regina Maria’s business and Chreih says that the company is satisfied with this number. “Of course, the subscription market will continue to grow in value and volume, together with the entire business. We have already had annual double-digit growth for the past few years, and I’m sure we will continue to see a rise, especially since medical subscriptions are now tax deductible,” adds the CEO.

Apart from being a business generator for private healthcare networks, studies indicate that medical subscriptions are among the benefits offered “by default” in the additional benefits package. Employees expect to receive one from any company they work for. It has already become a standard in the industry. Furthermore, although there are not yet any studies in this regard on Romania, research in the US shows that making wellness and healthcare more of a priority in a company helps with establishing a company culture that attracts and keeps the best talent, decreases work-related stress by 12 percent, increases job satisfaction and productivity, and improves happiness. And, what’s more, these programs have a 1:3 ROI.

“The largest age range for subscriptions is 25-45 years old (almost 60 percent), followed by 45-55. But we also have individual subscriptions and corporate subscribers who decide to pay for their parents’ or children’s healthcare. This is why we’ve seen an annual increase in the 60+ and 0 – 14 age groups,” adds Chreih.

Pushing the pedal on customization

With the support of a sales team in Bucharest and all major cities in the country where Regina Maria is present, specialized in large corporate clients, retail and SMEs, the medical provider promotes its medical subscription product in a sustained manner with the aim to attract potential customers and increase its availability. “One of the most important ways to increase availability is to offer personalized packages. We started out with subscriptions for large corporations but, during recent years, we were also the first to launch several types of medical subscriptions for individuals (adults and children), for SMEs and start-ups,” says the CEO. The medical provider also has ongoing partnerships with most expat communities and, fortunately, it is the top provider of health services for expats and international patients who need to be treated in Romania. “We do our best to adjust our offer to the actual needs of each segment.”

When customizing packages for its clients, Regina Maria looks first at the industry – what risks it involves; what is the environment that employees work in; is it office or factory work? Then it looks at the age groups and gender split. “Fortunately, having over 20 years of experience is very useful since we have a database with information on every industry, which allows us to evaluate certain characteristics for each industry, assess the company profile and how it compares to other organizations in our portfolio, that are active in the same industry or field,” says Chreih.

Focusing on organic growth

Speaking of its business strategy, the CEO says that the company has continued its recent expansion strategy and focused on organic growth as well as acquisitions. “We have signed five transactions this year, strengthening our medical imaging and laboratory divisions. Aside from M&A, we have directed most of our investments towards our hospitals: Ponderas Academic Hospital, where we made available robotic surgery through a EUR 3 million financing; the new hospital in Cluj which is almost ready to receive its first patient; Euroclinic Hospital – the third medical unit in our network to receive international accreditation as a center of medical excellence.”

According to him, Regina Maria is now the only healthcare provider in Romania to have three hospitals awarded with international accreditation. As for the cities which contribute the most to Regina Maria’s business, Chreih says that for the private medical provider there are two healthcare capitals: Bucharest and Cluj. “Cluj is the city where we made our second largest investment after Bucharest, of over EUR 9 million in the past seven years. To this we add another EUR 15-16 million which represents the cost of developing the first integrated private hospital in town, which we will open this year,” says Chreih. However, Regina Maria has a very good presence in other parts of Transylvania as well, such as Targu Mures and Brasov, but also in Oltenia (Craiova and Slatina) and in the south of the country, especially in Constanta. “We are present in 16 counties right now, but we have nationwide coverage through our extensive network of 290 partner clinics,” adds the CEO.

Education is the key

Apart from its role as a private medical provider, Regina Maria aims to play a crucial role in educating Romanians when it comes to prevention. “I believe that any player in this field should invest in and promote the importance of healthcare education and prevention. I am confident that private companies can be reliable partners for the public healthcare system in developing and supporting a nationwide prevention network. Top private players already have the infrastructure (a number of clinics in the country, medical equipment etc.) necessary to provide prevention services and screenings as part of a national program,” says Chreih.

The company has already invested many resources in offering this type of service to its subscribers and retail patients. It has also turned its website into an educational platform where people can find information on probably any medical condition or seasonal recommendations. “With the growing access to the internet, people must turn to reliable and trustworthy sources of medical information and we feel we have the obligation to help them differentiate between what is credible and specialized information and what it is not,” concludes Chreih.

Feedback channels are crucial for the business

As Chreih says, it is crucial for the medical provider to have a conversation with its patients, which is why Regina Maria has about six feedback channels, online and offline, where people can give their feedback. It also has a dedicated customer care department, which ensures that all messages and inquiries are answered and that it finds solutions for most problems. “The organization is growing at a very fast pace; at the same time, our expectations and our patients’ expectations are increasing and there is a need to find some sort of balance in order to function properly,” says the CEO.

Because people have a lot of medical questions or uncertainties, the company launched “Intreaba un medic” (“Ask a doctor”), a special section on its website, where people can upload medical questions and even documents and send the inquiry to its team of doctors who reply within one or two days. It’s a free service, used so far by over 3,000 people.

Plus, because Facebook has turned into a customer service channel, Regina Maria launched a new Facebook page, Regina Maria Raspunde (“Regina Maria answers”), which is managed by the customer care department. “It is also now possible for our patients to make their doctors’ appointments online and not go through the call center. This was just another way to promote ease of access and give people control of their time and health.”

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