Global Medical Trends

Transcription

1 Global Medical Trends Celine Ng Tong October 13, 2017 The Actuarial Society of Hong Kong Copyright 2017 The Actuarial Society of Hong Kong. All Rights Reserved.

2 Introduction to Medical Trend Copyright 2017 The Actuarial Society of Hong Kong. All Rights Reserved.

3 MEDICAL TREND DEFINITION Inflation in unit prices Trend is an annual factor used to project the cost of healthcare for a future rating period. Changes in demographics (aging population) M E D I CA L T R E N D D R I V E RS Increasing utilization of medical care services Improved medical care technology

4 DEFINING GLOBAL MEDICAL TREND Medical inflation (increase in cost for services /supplies; can be driven by currency fluctuations) Changes in treatment mix (potentially more expensive options being administered) Utilization changes (more/less of certain age groups leveraging health services) Regulatory changes = Y E A R O V E R Y E A R C O S T I N C R E A S E F O R M E D I C A L C L A I M S O N A P E R - P E R S O N B A S I S

5 MMB GLOBAL MEDICAL TRENDS SURVEY Data provided by 220 insurers across 63 countries. Conducted between March and May Medical trend data percentages are available for 48 countries for which an acceptable number of responses were submitted Insurers were asked about future expectations and main drivers on their portfolio Asia Pacific Europe LATAM MEA North America 17% 12% 1% 42% 26% 2%

6 MMB GLOBAL MEDICAL TRENDS 14.0% 13.5% 12.0% 10.0% 9.7% 10.2% 11.0% 8.0% 6.7% 6.0% 5.6% 4.0% 2.0% 3.6% 2.8% 2.6% 2.0% 0.0% Global Asia Europe North America Latin America 2015 Inflation 2016 Inflation 2017 Inflation 2015 Medical Trend 2016 Medical Trend 2017 Medical Trend #REF!

7 ASIA MEDICAL TRENDS C H I N A 2016: 10.0% 2017 Proj: 11.0% S O U T H K O R E A 2016: 7.6% 2017 Proj: 6.0% H O N G K O N G 2016: 8.4% 2017 Proj: 8.3% I N D O N E S I A 2016: 13.1% 2017 Proj: 13.1% I N D I A 2016: 15.3% 2017 Proj: 14.0% M A L A Y S I A 2016: 11.5% 2017 Proj: 12.7% S I N G A P O R E 2016: 10.0% 2017 Proj: 9.4% T A I W A N 2016: 7.7% 2017 Proj: 9.2% T H A I L A N D 2016: 9.4% 2017 Proj: 9.5% Breakdown: Outpatient: 7.5% Hospitalization: 9.3% P H I L I P P I N E S 2016: 11.8% 2017 Proj: 11.1% V I E T N A M 2016: 12.5% 2017 Proj: 7.9%

8 IS THIS SUSTAINABLE? Trend impacts medical claims costs on a compounded basis For future projection purposes, medical annual trend rate is converted to a compounded trend rate,. Impact of trend on claims costs: ( T R E N D P E R I O D ) ( C U R R E N T P E P M ) * ( 1 + A N N UA L T R E N D ) ^ As an example, Hong Kong GP costs are expected to increase by 44% by 2022 assuming medical trend remains as is IS THE INSURANCE INDUSTRY ADEQUATELY PREPARED TO MANAGE THE IMPACT OF MEDICAL TREND IN THE LONG-RUN?

9 Approaches to Manage Medical Trend Copyright 2017 The Actuarial Society of Hong Kong. All Rights Reserved.

10 COMPONENTS OF FUTURE MEDICAL CLAIMS COSTS Large Claims above reinsurance point Current Claims Current Claims PEPM Trend Future Claims PEPM includes portion of large claims below the reinsurance point Claims Adjustments

11 WHERE TO START? THE DATA IN YOUR PORTFOLIO WILL TELL YOU D E M O G R A P H I C S I N P A T I E N T C L A I M S H E A L T H C H E C K - UP How did the member profile change year-on-year (age, gender)? How did the health profile of the members today compare to three years ago? How many of the members are in the high risk category? M A T E R N I T Y W E L L N E S S P R O G R A M S O U T P A T I E N T C L A I M S How many of the members may be predisposed to pregnancy complications? What wellness interventions are in place and offered to members? Were there any changes in GP/SP visit patterns of members (number of visits, type of SPs)

12 SAMPLE COST DRIVER ANALYSIS Copyright 2017 The Actuarial Society of Hong Kong. All Rights Reserved.

13 THREE AREAS OF FOCUS A S C O S T S R I S E, I N S U R E R S A N D E M P L O Y E R S R E C O G N I Z E M O R E M U S T B E D O N E High Cost Illnesses How to address the precursors to these claims, mitigate highcost care and create incentives for prevention Lifestyle Risk Risk of poor health and illness due to unhealthy lifestyles Utilization risk Increasing use of care by members leading to increasing healthcare cost Growing controllable disease claims represent an opportunity for employers need to redefine their role and shape the healthcare market to meet their strategic objectives.

14 HIGH COST ILLNESSES Based on (dollar) amount claimed, what were the top 3 causes of claims cost in 2016 based on your book of group or overall business? Based on (frequency) incidence of claims, what were the top 3 causes of claims in 2016 based on your book of group or overall business? Vietnam Vietnam Thailand 78% 89% 11% 22% 44% Thailand 56% 11% 11% 11% Taiwan Taiwan South Korea South Korea Singapore Singapore Philippines 60% 40% Philippines 20% 60% 20% Malaysia 83% Malaysia 17% Indonesia 44% 56% 22% 56% 11% 11% Indonesia 78% 78% 11% India India Hong Kong 86% 57% 57% 43% Hong Kong 86% 14% 29% China 63% 25% 75% 25% 25% 25% China 63% 38% 25% 38% 25% 0% 10% 20% 30% 40% 60% 70% 80% 90% Gastro-Intestinal Diseases Respiratory Conditions Cancer Diseases of the circulatory system Infectious Diseases Endocrine and metabolic diseases Obstetrics and pregnancy 0% 20% 40% 60% 80% Respiratory Conditions Gastro-Intestinal Diseases Infectious Diseases Diseases of the circulatory system Cancer Osteomuscular diseases Endocrine and metabolic diseases

15 MANAGING LIFESTYLE RISKS INSURERS WERE ASKED TO SELECT THE TOP THREE HEALTHCARE RISK FACTORS THEY BELIEVE INFLUENCE GROUP MEDICAL COSTS THE MOST: Metabolic risk High blood pressure, high cholesterol, high blood glucose Dietary risk High carb consumption, low fiber and vegetables, overweight/obesity, physical inactivity Emotional/ mental risks Stress, sleeping disorders Occupational risk Work-related risks, ergonomics, occupational carcinogens Environmental risk Urban indoor/outdoor air pollution, ozone, water sanitation, climate change Global 93% 48% 41% 36% 30% Asia 91% 53% 25% 42% 53% Europe 93% 38% 58% 38% 18% Middle East/Africa 96% 41% 30% 22% 41% Latin America 95% 74% 26% 32% 21% *Insurers were asked to select the top three risk factors (out of a set of 10 options). The above data reflect the top five responses selected.

16 MANAGING HIGH COST & LIFESTYLE RISKS Sleep Financial Wellbeing Physical Activity / Wellness Weight / Nutrition Behavioral Health Medical Devices Pharmacy Condition Management CSR Pregnancy / Family Smoking MEMBER Telehealth 2nd Opinion Advocacy Navigation Incentives Challenges Assessments Testing Communication

17 SAMPLE INTERVENTIONS TO MANAGE UTILIZATION RISK E M P L O Y E E S P R E F E R R E D P R O V I D E R S / N A R R O W N E T W O R K S C E N T E R S O F E X C E L L E N C E S H I F T T O C O N S U M E R I S M P E R F O R M A N C E - B A S E D / V A L U E - B A S E D C A R E M O D E L E X P E R T M E D I C A L O P I N I O N B A L A N C E Q U A L I T Y O F C A R E A N D C O S T C AT E R T O E M P L O Y E E P R O F I L E A D M I N I S T R AT I O N E F F I C I E N C Y O N S I T E C L I N I C S A N D V E N D O R S T E L E H E A L T H & O T H E R H E A L T H A P P S M A N A G I N G A B U S E O F M E D I C A L C A R E P R O V I D E R S

18 SAMPLE EMPLOYER INTERVENTIONS Design Solutions Flexible benefits and defined contribution structures Coverage and benefits scope Cost sharing Individual worksite programs Eligibility Delivery Solutions Administration outsourcing Vendor management Claims management Consumerism education Financing Solutions Insurance pricing and negotiations Health vendor pricing and negotiations Self insurance and profit sharing Captives Cash flow management Health Management Solutions Wellness Health risk management Disease management High cost case management Absence management On or near-site clinics Cost Shifting (to Employees) Cost Management

19 THANK YOU!