Interview. Fady Chreih (Regina Maria): How medical subscriptions help heal an ailing system

Fady Chreih, CEO of the Regina Maria, private healthcare network, tells Business Review about the importance of prevention and emphasizes the role of medical subscriptions in the development of the local healthcare system.

By Anda Sebesi

How does medical subscription work in comparison with the insurance, and what are their main benefits?

Insurance and subscriptions are complementary and have different roles on the three levels of the medical system: continuous education and prevention (through medical subscription), evaluating and solving minor medical situations (covered by subscription and with the possibility of claiming on insurance or not), and more serious problems requiring surgery and/or hospitalization (where the patient claims on medical insurance).

In brief, medical subscriptions have the following advantages: first, the prevention and early detection of serious medical issues. In the long term, this will help increase the overall health and life expectancy of the public. Figures reported by companies in Europe and the US show that healthcare and wellbeing programs aimed at employees have a significant impact on reducing costs associated with medical leave, as well as increasing productivity levels and staff retention. The ROI is approximately three to one.

Second, they can be customized to respond to specific industry needs (for example, employees in the automotive industry have different health issues than those in banking or IT). Regina Maria has developed personalized medical subscriptions for SMEs, startups and individuals, including children.

Third, it is about ensuring continuous and unconditional access to primary care and, also, a direct relationship with the private healthcare provider, with ongoing patient monitoring by the GP, through an electronic medical record.

Fourth, medical subscriptions contribute to the development of medical infrastructure, through the profit reinvested by private healthcare providers. They are an important driver in the expansion and modernization of the national medical network, filling the gap left by the public system. Even health insurance relies on the infrastructure developed by private healthcare providers, since these providers are the only ones that actually invest in the Romanian healthcare system.

Last but not least, they ease the operational and financial burden on public hospitals (and, consequently, on the budget of the National Health Insurance House), by allowing the subscriber to access primary care, included unconditionally in their medical subscription package.

In Romania, there is currently a reverse investment pyramid to those in other EU states: more money is spent on hospitalization and less on prevention. Therefore, local life expectancy is seven to eight years lower than in Western European countries. Romanians treat more than they prevent. They go to the doctor when they are already sick, rather than having regular medical checkups that could prevent severe medical conditions, which also place a great burden on public hospitals.

On the other side, insurance is a financial instrument that covers a potential risk: the patient uses it mostly in the event of serious medical problems that require surgery and/or hospitalization, involving high medical costs.

What is the next step in the development of prevention packages in Romania?

Regina Maria was the first to introduce the concept of medical subscriptions in Romania, 21 years ago. Since then it has been the engine leading the development of the healthcare market.

Corporate subscriptions now number more than 1 million. Over 400,000 of them are in Regina Maria’s portfolio, and our forecast for this business segment is an increase of 15 percent in 2017.

The trend focuses on further customization of these medical products, depending on the customer’s profile and their field of activity. Another logical step to support the evolution is to go beyond large corporations. We have demand from smaller companies and entrepreneurial businesses, where the penetration of medical subscriptions is still very low. Regina Maria anticipated this trend and introduced last year the first prevention packages for SMEs and startups.

How have prevention packages influenced the development of the Romanian healthcare system?

It is a simple circuit. Growing demand for medical subscriptions in the past 20 years has brought profit to the private healthcare providers which, in return, have reinvested this profit in medical infrastructure – either by opening new clinics and hospitals nationwide, or by modernizing existing ones and buying state-of-the-art equipment, training medical staff and aligning overall medical activity to European standards.

In fact, private providers are the only ones who have contributed to the development of the Romanian health system. Hundreds of millions of euros have been invested by Regina Maria and other providers in new openings and medical equipment. We have also supported healthcare professionals (HCPs), by creating a proper environment for them and convincing them to stay and work in their home country.

To understand the proportions, you can analyze the investments made by Regina Maria so far. In 2017, over EUR 2 million was invested in Q1 and we intend to continue our expansion this year. We are looking at a simple equation, directly proportional growth: more medical subscriptions bring more private hospitals and clinics to the country. We are a constant partner for the public system: medical subscriptions reduce the burden on the public system, and moreover, prevention packages increase the level of medical education in Romania, which, in the long term, means better health and quality of life.

More private medical networks are focusing their investments on expansion. Is there any room for further development on the local market?

There is plenty of room for the expansion of private medical networks, as (currently) a quarter of Romanians do not have sufficient access to basic healthcare services. And this is not only a business strategy, but a social need. We are making efforts to cover the gaps where the public system has delayed investments in new medical units or staff.

Our first stop was communities with larger numbers of inhabitants where demand for services is higher. Regina Maria is planning its biggest investment outside Bucharest: at the end of this year, we will open the first private hospital in Cluj-Napoca, a EUR 15 million investment.

Almost all large cities in the country are home to private medical providers and patients’ trust is increasing every year. A study carried out by GfK for Regina Maria indicates that 64 percent of inhabitants from these cities used our services in the past year.

By introducing fiscal deductibility for medical subscriptions, we expect to make the next step towards smaller towns. Demand will grow and healthcare services will develop accordingly.

How can the current exodus of Romanian doctors abroad be stopped?

Indeed, since the liberalization of the labor market in Europe, the public system was powerless in the face of a massive exodus of doctors: over 40,000 have left Romania in the last ten years, according to data provided by the Ministry of Health. In order to stop this phenomenon, we must do one simple thing: respect their dignity. And I am not referring only to their salaries, but also to a decent work environment in which they can improve themselves professionally. Regina Maria, as well as other private providers, has tried to respect these needs and has been actively involved in keeping doctors in the local system, by offering a solid alternative to leaving the country.

Moreover, we contribute to the practical and theoretical training of doctors, at the highest level. At Ponderas Academic Hospital we have the only private training center in Romania for laparoscopic surgery, which serves not only Romanian, but also foreign doctors.

At present, we have 1,700 doctors working in our network and we are taking all measures to increase this number and to keep the best specialists in the country.

More and more complex medical procedures are premiering in Romania. What lies behind this and how can Romania encourage innovation in medicine?

The road to excellence is paved with the experience of the best specialists helped by state-of-the-art medical equipment. In a word: investment, in human resources and their training, as well as in technology. At Regina Maria we are trying to build a long-term business strategy in such a manner that our investments materialize in substantial benefits for patients. And it is fulfilling when our efforts are acknowledged: we have the only hospitals in Romania with international accreditations – Ponderas Academic Hospital and Baneasa Hospital.

This allows us to attract the medical elite. Among our collaborators are some of the most respected surgeons in Romania, who have chosen to work in the private medical system because here they have the necessary infrastructure to perform complex surgery. Last year we invested millions of euros in equipping the existing units and recently we opened the Central Laboratory, the biggest investment in medical lab equipment in Romania, with a value of EUR 3.5 million.

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