What is the medical loss ratio?

The medical loss ratio is the relation between what an insurer pays in health claims and what it collects in premiums. When it rises, insurance gets more expensive for everyone. Part of it comes from care delivered at a higher level than needed, such as emergency visits for mild conditions.

Digital guidance targets that avoidable part: members check before they go, get a recommendation and reach the right level of care.

Medikorp works with insurers in Ecuador to measure that effect in a pilot, with indicators agreed before it starts.

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Full glossary

Digital triage

Digital triage is an online symptom assessment done before the patient reaches a health facility. A clinical engine asks questions based on what the person describes and suggests the right level of care: self-care, online consultation, in-person visit or emergency.

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Smart routing

Smart patient routing sends each patient to the service they need based on their triage result: general practice, specialist, telemedicine or emergency. It applies rules agreed with the provider network, so the patient reaches the right place and the network keeps its capacity for the cases that need it.

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Telemedicine

Telemedicine is any health service delivered remotely through technology, such as consultations, follow-up of chronic patients or reading test results. Teleconsultation is one part of it: the scheduled appointment between the patient and a clinician by video call, phone or chat.

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Levels of care

Levels of care organize health services by complexity. The first level handles general consultations and prevention close to the community; the next levels bring together specialists, hospitalization and more complex technology. In Ecuador, the Ministry of Public Health organizes its network with this model.

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White label

A white label solution is technology a company offers under its own name and design, even though another provider builds it. In digital health it lets an insurer, a hospital or an app launch triage or telemedicine under its brand without building the clinical engine from scratch.

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LOPDP and health

Ecuador's Organic Law on Personal Data Protection (LOPDP) treats health data as sensitive data. Processing it requires a clear legal basis, usually the person's explicit consent, and security measures that match the risk. The data subject can request access, correction or deletion.

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