1、2021 Global Medical Trends Survey Report 2021 Global Medical Trends Survey Report Table of contents Executive summary and key findings .2 About the survey .3 Global average medical trends by country, 2019 2021 .3 Asia Pacific .4 Europe .8 Latin America .9 Middle East and Africa .10 North America .11
2、 Spotlight on telehealth .12 Whats driving costs .15 Top conditions globally .15 Managing medical trend .16 Impact of the pandemic .19 Global Medical Trends 1 Executive summary The 2021 Global Medical Trends Survey reveals that while the pandemic has had a significant impact on health care utilizati
3、on and overall costs in 2020 due to a sharp decline in nonurgent surgeries and elective care, the resulting decrease in medical trend will be short-lived. Globally projected health care benefit costs will take a sudden drop in 2020 before rebounding to 8.1% in 2021, up from 5.9% this year and 7.2% i
4、n 2019. Average increases across different regions next year will range from 5.8% in Europe to 8.5% in Asia Pacific to 10% in the Middle East and Africa to 13.6% in Latin America. Health care benefit cost increases in the U.S. are expected to remain stable at 7.3% next year, according to other Willi
5、s Towers Watson research. Looking beyond 2021, over two-thirds (67%) of respondents expect medical costs will continue to accelerate over the next three years. Roughly 90% of Middle East and Africa insurers expect higher medical trends over the next three years as do 77% of insurers in Europe. Only
6、40% of Asia Pacific insurers expect a higher medical trend. The pandemic has helped to accelerate the adoption of telehealth with half of insurers globally currently offering telehealth across all plans. Although its still early days and many issues around telehealth need to be resolved, including i
7、ts place in plan design, we believe that telehealth is here to stay. For this reason, a special section of this report is devoted to telehealth. Key findings Overuse of care drives costs. The most significant factor contributing to rising medical costs related to provider and employee behavior is th
8、e overuse of care. While 65% of insurers are most concerned about providers driving up costs by overprescribing or recommending too many services, 55% also cite overuse of care due to insureds seeking inappropriate care. Member coinsurance continues to be the most popular cost-sharing approach. Insu
9、rers once again identify member coinsurance as “typical” or “most typical” in all regions with the exception of Europe where insurance plans are more heavily integrated with government health programs. Using contracted networks of providers for all treatments is the most popular cost management meth
10、od with 73% of insurers identifying it as most effective. Sixty percent of respondents cite the placing of limits on certain services as the second most effective tool for managing costs. The cost burden of mental health conditions is expected to grow. Respondents rank cancer (80%), cardiovascular d
11、iseases (56%), and conditions affecting musculoskeletal and connective tissue (41%) as the top three conditions that currently affect medical costs. Gastrointestinal (40%) moved into the top three conditions causing the highest incidence of claims along with cancer (48%) and cardiovascular (36%); ho
12、wever, about four in 10 respondents predict mental health conditions will be among the three most common conditions affecting costs within the next 18 months (40%) and among the three most expensive in the next 18 months (39%). Gaps in coverage persist for alcoholism, drugs and HIV/AIDS. Between 50%
13、 and 53% of group policies regardless of size include exclusions for alcoholism and drug use, while between 41% and 47% exclude on the basis of HIV/AIDs. Group policies for less than 50 employees are more likely to exclude preexisting conditions. Claim data classification. Nearly half of insurers gl
14、obally (48%) use the ICD-10 claim-coding system, while only 14% use a local coding system. This facilitates more consistent reporting of claim data and more accurate identification of core claim driver 2 Global Medical Trend 3 Given that 2020 was an extraordinary year globally due to the pandemic, m
15、ost countries are seeing a decrease in trend from 2019 to 2020. Some countries are even expecting a negative trend for 2020. Global average medical trends by country, 2019-2021 COVID-19 has undoubtedly had a major impact on projected medical trends for 2020 and 2021. Given that 2020 was an extraordi
16、nary year globally due to the pandemic, most countries are seeing a decrease in trend from 2019 to 2020. Some countries are even expecting a negative trend for 2020. Many insurers and employers are reporting a decreasing trend in claims ratio in 2020, as most nonurgent treatments and surgeries were
17、delayed especially between March and August. In turn, these delays created a need for some private facilities to make up for lost revenue in 2020. The Willis Towers Watson COVID-19 claims modeler suggests significant volatility in 2021 results, which are dependent on the impact of COVID-19 and wheth
18、er or not a vaccine becomes available early in the year, who pays for it and the extent of its availability. In addition, there is uncertainty about how COVID-19 testing and treatment costs for 2021 will continue to be split between government, insurers and employers. Further uncertainty around medi
19、cal trend lies ahead in future years as we start to see the true impact of delayed treatment in 2020 and the long-term effects on those who contracted COVID-19. Nevertheless, there is a silver lining here, as COVID-19 has greatly accelerated the adoption and use of telehealth, which, in turn, could
20、help to offset those potential higher costs and provide a more efficient way for insureds to access and use health care in the future. It may also, of course, increase utilization due to ease of access. About the survey Willis Towers Watson conducts the Global Medical Trends Survey every year betwee
21、n July and September. Two hundred and eighty-seven leading insurers representing 76 countries participated in our 2021 survey. Global results presented here have been weighted using GDP per capita. The U.S. medical trend data are drawn from the Willis Towers Watson National Trend Survey research. Fi
22、gure 1. Participant profile Figure 2. How do you expect the medical trend in your overall book of business to change over the next three years compared to current rates? 1% 4% 0%20%40%60%80%100% Signifi cantly lower Global Latin America Europe Asia Pacifi c Middle East and Africa LowerAbout the same
23、 Higher Signifi cantly higher 3% 30%63% 4% 3% 37%54% 1% 49%39%11% 1% 71%6%21% 87%11% 2% Overall, we expect projected global trend to drop to below 6% in 2020 before rebounding back to above 8% for 2021 due to the catch- up on delayed treatment, potentially leading to worsening health conditions and
24、some unexpected cost increases coming through, such as those for personal protective equipment (PPE). China. COVID-19 has not had as much impact on cost or utilization in China as it has in other countries. The costs of medical care continue to increase for treatments, particularly those outside the
25、 scope of social security coverage. Asia Pacific The region shows a significant drop in trend to 6.2% in 2020, but this will spring back above the 2019 trend to a projected 8.5% in 2021. The central government is planning to eliminate the individual medical account and at the same time offer coverag
26、e for outpatient expenses under social security. The initiative was announced in September 2020, with more details to come on coverage. This is expected to impact the cost of treatment in the future; however, it will probably take a while for the initiative to be fully implemented given the variatio
27、n in government funding at the provincial level. Hong Kong. The low utilization of medical services during the pandemic and the recession forecasted by the government are the two main drivers of the slowdown in medical trend for 2020 and 2021. Demand for medical tourism from mainland China has also
28、dropped due to the travel restrictions and social unrest in Hong Kong. India. India has not seen the same reduction in trend as other countries have for 2020. While utilization decreased during part of the year (April to July), India is currently in a situation with low claim frequency and average c
29、ost of procedures increasing (due to the cost impact of COVID-19 precautions on non-COVID-19 claims). At the same time, the treatment and pricing protocol of medical care is not regulated in India, and hospital billing practices continue to pose a challenge. The government did, however, take some sm
30、all measures to issue guidelines around pricing for COVID-19 tests and treatments, which helped with cost management to an extent. The year 2021 could see an increased rate of trend, higher than provisionally reported, as utilization starts to return to normal levels; however, we also may see an inc
31、reased awareness in the areas of prevention and wellbeing, and a rising trend in favor of home care rather than immediate hospitalization for medical treatments, which could help mitigate a larger potential increase. Indonesia. Medical trend rates in Indonesia are projected to be slightly lower in 2
32、020, not only because of the impact of COVID-19 on reduced elective procedures but also due to various other factors, including the increased utilization of BPJS Kesehatan (universal health insurance) especially for chronic/critical illnesses and ongoing costly treatments. This allows insurers to sp
33、lit their risk with the government and will help stabilize future medical trend rates. The BPJS Kesehatan also provides coverage of all medical treatments related to COVID-19, which helps to stabilize the trend rates despite the expected continued demand for private health care. 4 Global Medical Tre
34、nd 5 Figure 3. Global average medical trend rates by country, 2019 2021 Country Gross cost trendNet cost trend (of general inflation) 2001920202021 Global 7.165.888.125.134.606.17 Latin America10.838.9713.635.756.6211.17 North America5.552.767.133.652.155.50 Asia Pacific7.476.228.505.885.
35、106.78 Europe5.584.245.764.023.274.15 Middle East/Africa8.658.6610.017.396.946.98 Latin America Argentina*56.9947.2960.503.4428.8547.75 Barbados and East Caribbean 10.0010.0010.005.905.548.39 Brazil*11.969.3811.518.235.828.21 Chile*4.883.184.072.63-0.191.14 Colombia*6.276.896.922.753.383.71 Costa Ri
36、ca*7.008.009.254.906.467.00 Ecuador12.0012.0012.0011.7312.0110.84 El Salvador*7.4310.007.717.359.947.11 Guatemala*8.008.8311.804.307.0010.02 Honduras*6.177.989.671.804.836.69 Mexico*9.3011.5011.715.668.808.93 Nicaragua10.0012.0015.004.627.5311.04 Panama*10.6711.009.4011.0211.918.90 Peru5.006.008.002
37、.864.296.21 Puerto Rico5.00-6.0018.004.27-4.4517.36 Trinidad and Tobago10.0010.0010.009.0011.008.72 Venezuela85.00150.00250.00-19821.02-14850.00-14750.00 North America Canada4.170.137.032.22-0.485.76 United States#7.917.247.306.106.625.06 Asia Pacific Australia6.506.006.004.894.574.18 China*8.689.10
38、9.325.786.066.77 Hong Kong*8.166.246.685.304.244.18 India*7.8012.0010.003.268.666.38 Indonesia*10.339.9712.007.517.109.06 Malaysia*10.6410.8212.559.9710.719.75 New Zealand5.60-2.0020.003.98-3.2218.62 Philippines*7.758.508.825.276.785.94 Singapore*7.677.678.177.107.847.65 South Korea7.005.004.006.624
39、.733.55 Sri Lanka5.005.005.000.700.34 0.35 Taiwan*4.004.004.003.463.502.50 Thailand7.007.508.006.298.567.44 Vietnam*12.9310.1310.1510.136.936.25 Country Gross cost trendNet cost trend (of general inflation) 2001920202021 Europe Belgium2.002.503.000.752.251.91 Cyprus5.000.001.004.44-0.700.
40、00 Denmark5.506.504.504.775.803.30 France4.171.032.302.870.751.60 Germany5.007.007.003.656.685.82 Greece4.504.504.753.984.963.74 Hungary10.0010.0010.006.636.666.83 Ireland4.471.438.333.591.036.63 Norway*5.275.996.433.103.594.23 Poland*5.856.507.333.543.284.75 Portugal*3.79-1.833.973.49-1.632.62 Roma
41、nia*12.6210.3311.508.798.0910.05 Russia7.2510.0011.002.786.918.01 Serbia7.507.5015.005.656.0613.06 Spain2.851.934.752.152.234.10 Sweden9.006.007.507.305.545.97 Switzerland4.00 1.501.003.641.890.40 Turkey23.2517.5016.008.075.504.00 United Kingdom5.676.336.503.885.154.96 Middle East and Africa Bahrain
42、7.007.007.006.004.404.50 Burkina Faso0.5015.0010.003.7311.807.90 Cameroon*3.506.254.001.053.451.75 Cote dIvoire15.0015.6718.3314.1914.4716.93 Egypt*12.1310.8812.33-1.745.024.10 Gabon19.5021.5025.0017.4818.5022.00 Ghana12.1714.6717.174.965.018.62 Guinea10.005.003.000.53-3.50-5.00 Jordan7.000.004.006.
43、70-0.202.40 Kenya8.506.509.003.301.404.00 Kuwait5.007.5010.003.907.007.70 Madagascar25.0020.0030.0019.3814.5023.50 Mozambique7.005.005.004.22-0.19-0.71 Nigeria17.3314.6718.675.941.276.30 Oman4.504.505.504.373.502.10 Saudi Arabia10.0010.0012.0011.219.1310.04 Senegal10.0015.0015.008.9813.0013.08 South
44、 Africa6.506.006.002.373.572.84 Togo5.008.0010.004.316.008.00 Uganda20.0010.0015.0017.136.0610.15 United Arab Emirates9.008.008.0010.939.006.50 Zambia15.0020.0025.005.206.6012.95 *Countries with significant (5+) participation. Due to the hyperinflationary nature of the Venezuelan economy, Venezuela
45、has been excluded from Latin America regional and global totals. #United States data is from various years of the Willis Towers Watson National Trend Survey. 6 Global Medical Trend 7 Malaysia. Medical trend in Malaysia is expected to continue its rise albeit at a slower pace compared with previous years. For 2020, the number of doctor visits and admissions dropped significantly during March and April due to the government-imposed lockdown (MCO), which has caused the overall trend to decrease. During this period, many elective surgeries were postponed. For outpatient care, there has
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