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  • October 2023
  • 3 minutes

Ethics of Ecosystems: Strengthening the evolving healthcare paradigm

An older woman smiles and looks at a health app on her phone while sitting on a yoga mat and holding a silver water bottle.
In Brief
Health insurers are increasingly turning to ecosystems to provide a range of products and services. This article discusses how health ecosystems underpinned by a strong ethical framework can optimize and expand how insurers serve their customers.

Recently, a health insurance conference sponsor asked me to give a talk about “The Ethics of Ecosystems.” This topic is definitely timely: Healthcare product and service delivery via digital channels rapidly achieved acceptance during the COVID-19 pandemic and continues to strengthen. Pandemic-driven technological advances in data storage, aggregation, and analytics also continue, enabling new ecosystem platforms and enhanced opportunities for health insurers to partner with health and wellbeing products and services providers.

This topic is also quite meaningful for me, as for the last three years I have been leading an RGA team in developing a comprehensive digital health and wellbeing solution. The platform delivers a myriad of customer-friendly value-added digital health services, including:

  • Symptom triage technology
  • Ways to locate the right healthcare services
  • Virtual doctor consultations
  • Scheduling for in-person doctor visits
  • Medication management
  • Patient recovery tracking
  • Motivating exercise goals and rewards

The invitation for me to speak clearly shows how attractive ecosystems have become, both as a delivery model for products and services and as an integral element for conducting business in the digital health space. The proliferation of these systems also raises important concerns.

How do ethical concerns factor in? An ecosystem can provide several positives for health insurers, especially given high consumer interest in wellness and wearables. Services form the heart of such an ecosystem, and data drives not just its functionalities, but also how that ecosystem can best serve its users. A clear basic responsibility for health insurers is to make sure customer data is treated respectfully – that is honestly, transparently, and with integrity.

The Issues

Although health insurers are increasingly using ecosystems to present products and services to their customers, skepticism still exists around the ethics and motives for providing such a platform. Concerns range from “Won’t our customers wonder why we (their insurer) would offer them health services?” to “I wonder if customers would think ecosystem network doctors offer cheaper treatments or deny certain medical services because of the expense?” Standards and guidelines can ensure all data collected and used by an ecosystem is treated honestly, transparently, and with high standards of integrity. 

During the past few years, data privacy concerns that used to be paramount have lessened somewhat. Recent research is finding that customers are more willing than they were before the pandemic to allow companies to aggregate their personal data and use it for analyses, as long as it is anonymized. 

That being said, the most recent developments in artificial intelligence (AI) capabilities, especially around generative AI, are raising new concerns around technology in general, which is seeping into perceptions around ecosystems.

For insurers, soothing these concerns starts with a strong ethical profile. This means taking the time to formulate and codify a set of guidelines and rules that govern permissible and prohibited use of data for both insurers and their ecosystem participants. It also means incorporating specific items related to ecosystem data and its use, and strongly adhering to the rules.

Guidelines should lay out rules around data use that focus on what is right for a company to do, morally and ethically, rather than what data and current technology advances make it possible to do. In a nutshell, what insurers should do, rather than what they can do. 

Steps to Take

How do insurers achieve transparency, honesty, and integrity around data? All these elements require clear communications with partners, clients, and customers about data received and plans for its use. Insurers should inform customers and stakeholders of the ethical use guidelines and ensure their own adherence. 

  • Transparency: Clear explanations of data aggregation and use, and of the ecosystem’s security and privacy controls, are essential to ease client and partner concerns. 

  • Honesty: Openness about what the ecosystem can and will deliver, and what it either cannot or will not, is only part of the equation. Ecosystem members must also communicate strongly that they are ethically responsible participants on the platform. 

  • Integrity: Insurers joining or creating an ecosystem need to show that their motivations for doing so have strong ethical underpinnings. They will need to develop and/or strengthen data ethics guidelines and consider customer data protection with every action and transaction.


The goal of developing or participating in an ecosystem should be to support and improve customer health journeys by enabling faster access to ecosystem benefits such as considered care pathways, remote monitoring, and coaching. 

Ecosystems can enhance customer offerings and engagement. Aggregated insights from available data may help improve service capabilities, product design, pricing, positioning, and the overall customer journey. 

A company’s values should flow into an ecosystem to ensure it has strong ethical underpinnings. Whether an insurer is a developer, sponsor, or participant, a strong ethical foundation supported by company leadership can create a path to success. 

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Meet the Authors & Experts

Emma Wilkins
Emma Hickey
Vice President, Digital Health and Propositions, Global Health