1、2019 Global Medical Trends Survey Report2 Executive summary While global medical trend continues to show some modest increases around the globe, the overall rate of increase remains relatively stable. For 2019, the projected global, weighted medical trend is 7.6%, which continues to outstrip genera
2、l inflation by a factor of more than 2:1 on a global basis. However, this value is just 0.5% higher than the reported value for 2018, with no increase at all expected in Europe. Despite the relative global stability, it is concerning to see how the trend continues to edge upward in some of the large
3、r, more significant medical markets such as Brazil, China, India, Mexico and the U.A.E. The largest increases are expected to be seen in the Middle East and Africa where the regional trend increased from 8.5% to 9.9% in 2018 and is projected to rise to 12.4% in 2019. Other regions show closely guard
4、ed optimism, with most predicting either medical trends will stay the same or increase by conservative amounts. There are continuing concerns about the manner in which treatment is provided, with fears that it is not being directed on the basis of strict medical need. Respondents also expressed misg
5、ivings about reliance on pharmacy services and the cost implications of innovative future treatments. To further darken prospects for the future, there are several conditions that are projected to represent significant sources of claims. Alongside circulatory conditions and cancer, which are illness
6、es that most industry experts would expect to appear, are mental and behavioral disorders. The cost of mental conditions is already rising steeply. A paper presented at the World Economic Forum estimated costs at 2.5 trillion in 2010 and projected them to rise to six trillion by 2030, an increase of
7、 240%. 1This suggests that cost may increase worldwide as more employees rely on their health insurance to help them manage new diagnoses. Key findings Europe continues to have the lowest level of gross medical trend increase for private medical insurance, substantially due to the existence of socia
8、lized medicine and the integration of treatment with private plans. While this helps manage costs in some of the largest countries such as France, Spain and the U.K., it is not universal across all of Europe. For some countries, such as Hungary, we continue to see a public health care system under m
9、uch greater strain, which results in more patients utilizing the private sector. 2019 Global Medical Trends Survey Report There are continuing concerns about the manner in which treatment is provided, with fears that it is not being directed on the basis of strict medical need. 1 Patricio V. Marquez
10、, ScM., and Shekhar Saxena, Ph.D., “Making Mental Health a Global Priority,” National Center for Biotechnology Information, U.S. National Library of Medicine. (July 1, 2016). Retrieved from https:/www.ncbi.nlm.nih.gov/pmc/articles/PMC5198754/2019 Global Medical Trends Survey Report 3 Insurers are pr
11、edicting that pharmacy costs will become an increasingly significant part of medical expenses over the next five years. Sixty-six percent of insurers in the Americas foresee a moderate increase in pharmacy expenses in the next year, while 52% of insurers in Asia Pacific agree. Overuse of services an
12、d care are identified as being the top two factors driving medical costs per person. Seventy percent of insurers worldwide identified an overuse of care due to medical practitioners recommending too many services, while 52% of insured members were seen to be overusing available care. The high cost o
13、f new medical technologies is increasing medical costs. Sixty-five percent of insurers thought this was among the three most significant causes, with a further 48% identifying profit motive of providers as a main cause. While there is fear about the rising incidence of large scale claims affecting t
14、he insurance industry, only 15% identified it as among the three leading causes of higher costs. Few surprises come with the identification of the top three conditions that cause the highest incidence of claims and the highest cost of claims in medical client portfolios. Circulatory, musculoskeletal
15、 and cancer are the leading causes, with 54% of respondents worldwide identifying circulatory conditions as the leading cause and 49% identifying musculoskeletal conditions as the leading cause a dramatic rise from preceding years. Cancer was identified by 42% of respondents as causing the most clai
16、ms. Cancer continues to be the most expensive condition in each of the four regions. The lowest figure was the 68% of insurers in the Americas who placed it among the top three conditions and the highest was 82% for the Middle East and Africa, in excess of the figures for circulatory conditions, the
17、 second placed in the hierarchy. There were 67% of insurers in the Asia Pacific region who rated circulatory conditions among the top three most costly conditions, the highest total for non-cancer related illnesses. While cardiovascular conditions and cancer are generally expected to cause the highe
18、st incidence of claims around the world, excluding maternity, the incidence of mental and behavioral disorders are expected to increase over the next five years. In Europe, 44% of About the survey The Willis Towers Watson Global Medical Trends Survey was conducted from July through September 2018, w
19、ith responses received from 307 leading insurers from 77 countries. Global results presented here have been weighted using GDP per capita. The U.S. medical trend data are drawn from other Willis Towers Watson research on this highly developed market with unique characteristics. Figure 1. Participant
20、 prole Americas Asia Pacic Europe Middle East and Africa 22% 37% 24% 16% insurers identified mental disorders as being among the top three conditions in the next five years, with 33% of insurers globally agreeing. This perhaps reflects that symptoms are not yet widely recognized by medical professio
21、nals and that many insurers do not cover mental disorders. From a cost perspective, there should be no change in the top conditions. Seventy-nine percent of insurers globally expect cancer to be the most costly health condition, with circulatory conditions somewhat behind on a global average of 59%
22、and musculoskeletal conditions further behind at 50%.4 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? 0% 20% 40% 60% 80% 100% Middle East and Africa Europe Asia Pacic Americas Global 1 4 45 44 5 2 65 29 5
23、 9 2 44 43 4 2 3 1 42 49 5 35 48 12 Signicantly lower Higher Lower Signicantly higher About the same Medical trend by region and country Over half of health insurers in all regions are anticipating higher or significantly higher medical trends over the next three years. The global trend is that 44%
24、of insurers are predicting higher costs over this period and 5% are predicting significantly higher costs. In the Americas, just 34% predict higher costs, while in the Middle East and Africa this figure is altogether higher, with 60% expecting an increase the highest total of any region, by some dis
25、tance. Asia Pacific The region continues to see countries experiencing increases far in excess of the projected average of 7.8% for 2019. China. While there has been a significant growth in the number of private health care providers, providing potentially more capacity and competition, this has not
26、 reduced the continued upward movement in medical trend. Indeed, many employees are reducing use of public hospitals due to lower government subsidies. The advance of medical technology, the rise of the middle class and greater health care awareness drives increased demand for treatment all of which
27、 results in a higher average cost for that treatment. We do see increasing government intervention through better or broader health care policies; although, in the short term we expect the medical inflation trend to continue to rise, especially with the impact of increased lifestyle-related chronic
28、conditions. 4 2018 Global Medical Trends Survey Report 5 Figure 3. Global average medical trend rates by country, 2017 2019 Gross cost trend Net cost trend (net of general inflation) 2017 2018 2019 2017 2018 2019 Global 6.7 7.1 7.6 4.6 4.6 5.2 Asia Pacific 7.1 7.0 7.8 5.5 5.0 5.8 Australia 4.9 4.6 4
29、.6 2.9 2.4 2.2 China* 9.0 10.1 10.7 7.5 7.6 8.1 Hong Kong* 7.0 8.0 8.6 5.5 5.8 6.5 India 7.6 9.2 10.6 4.0 4.2 5.6 Indonesia* 11.1 10.9 10.8 7.3 7.4 7.4 Malaysia* 9.0 11.4 13.1 5.2 8.2 10.7 New Zealand 6.9 5.4 5.4 5.1 3.7 3.3 Philippines* 8.8 10.3 11.5 5.6 6.1 7.7 Singapore* 8.3 8.8 9.1 7.7 7.6 8.1 S
30、outh Korea* 6.0 1.4 3.4 4.1 0.3 1.5 Taiwan* 7.2 7.8 9.3 6.5 6.5 8.0 Thailand* 6.4 7.0 8.5 5.7 5.6 7.9 Vietnam* 11.0 15.0 16.3 7.5 11.2 12.3 Europe 4.4 5.0 5.0 2.7 3.2 3.1 Belgium 3.9 4.0 4.4 1.7 2.4 2.6 Bulgaria 5.0 5.0 5.0 3.8 3.0 2.9 Cyprus 10.0 10.0 5.0 9.3 9.6 3.4 Denmark 3.9 5.5 4.3 2.7 4.1 2.6
31、 France* 1.9 2.5 2.5 0.7 1.0 0.9 Germany 4.3 4.0 3.0 2.5 2.4 1.3 Greece 4.3 4.5 4.5 3.1 3.8 3.4 Hungary 0.0 10.0 15.0 2.4 7.3 11.7 Ireland 3.4 3.9 4.7 3.2 2.9 3.4 Italy* 1.8 1.7 2.1 0.5 0.6 0.8 Norway 5.4 5.3 6.0 3.5 3.4 4.0 Poland 3.0 5.0 5.0 1.0 2.5 2.5 Portugal* 3.4 2.9 3.0 1.9 1.3 1.4 Romania 8.
32、8 7.5 9.3 7.4 2.8 6.2 Russia 6.3 6.7 8.0 2.7 3.9 4.3 Serbia 10.0 10.0 8.0 6.9 7.3 5.0 Spain* 3.0 4.0 4.0 1.1 2.2 2.4 Switzerland 5.0 4.0 4.0 4.5 3.3 3.0 Turkey 10.9 14.2 18.2 0.3 2.8 7.7 Ukraine 10.6 11.3 13.3 3.8 0.2 5.3 United Kingdom* 5.7 6.9 6.3 3.0 4.2 4.2 Latin America 11.1 10.8 10.6 6.7 6.3 7
33、.1 Argentina 30.0 24.6 23.5 4.4 1.9 8.1 Barbados and East Caribbean 10.0 10.0 10.0 5.6 4.6 7.1 Brazil* 17.4 15.0 15.3 14.0 11.5 11.1 Chile* 6.3 7.1 8.1 4.1 4.7 5.1 Colombia* 6.6 6.8 6.5 2.3 3.3 3.0 Costa Rica 12.0 12.0 12.0 10.4 9.2 9.0 Dominican Republic 10.0 10.0 10.0 6.7 5.6 6.5 Dutch Antilles 10
34、.0 10.0 10.0 Gross cost trend Net cost trend (net of general inflation) 2017 2018 2019 2017 2018 2019 Ecuador 12.0 15.0 12.0 11.6 14.1 10.6 El Salvador 10.0 10.0 10.0 9.0 8.3 8.1 Guatemala 10.0 10.0 10.0 5.6 5.8 6.3 Honduras 13.0 11.0 11.0 9.1 6.3 6.5 Mexico* 10.7 10.9 11.4 4.6 6.5 8.2 Nicaragua 12.
35、0 12.0 12.0 8.1 5.8 4.8 Panama 15.0 12.0 12.0 14.1 9.8 9.5 Peru* 4.6 6.4 6.6 1.8 4.8 4.6 Puerto Rico 5.2 6.6 5.8 3.3 4.4 5.0 Trinidad and Tobago 10.0 10.0 10.0 8.1 7.3 7.9 Middle East and Africa 8.5 9.9 12.4 5.9 5.7 9.0 Algeria 10.0 18.3 20.0 4.4 10.9 12.4 Benin 3.0 5.0 8.0 2.9 2.1 5.1 Cameroon* 5.3
36、 5.1 7.7 4.6 3.9 6.4 Central African Republic 0.0 10.0 0.0 3.8 13.5 3.2 Congo (Republic of) 3.0 5.0 5.0 2.5 3.5 3.4 Cote dIvoire 18.5 15.0 20.0 17.7 13.3 18.0 Egypt 23.3 14.3 11.3 0.2 5.8 1.6 Gabon 15.0 20.0 30.0 12.0 17.2 27.5 Ghana 7.0 8.0 9.0 5.4 0.7 1.0 Kenya 10.0 11.8 12.5 2.0 6.9 7.5 Madagasca
37、r NR 10.0 20.0 NR 2.2 13.2 Mozambique 21.0 11.0 9.0 5.7 4.3 3.3 Niger 4.5 4.5 4.5 2.1 0.6 2.5 Nigeria 18.5 17.5 13.5 2.0 3.5 1.3 Oman 5.5 7.0 9.0 3.9 4.5 5.5 Saudi Arabia 4.0 10.0 15.0 4.9 6.3 13.0 Senegal 9.0 4.5 7.0 7.6 3.0 5.5 South Africa* 7.6 7.7 7.4 2.4 2.5 2.1 Togo 13.1 6.8 13.1 13.9 6.4 11.9
38、 Uganda 5.0 5.0 5.0 0.6 1.4 0.7 United Arab Emirates 9.7 10.3 11.0 7.7 6.2 8.5 Zambia 14.0 11.0 9.0 7.4 2.8 1.0 Zimbabwe 3.0 2.0 3.0 1.7 3.2 3.3 North America 11.0 11.4 11.1 9.2 9.1 8.9 Canada 12.7 12.7 12.7 11.1 10.5 10.5 United States* 7.5 8.7 7.9 5.4 6.1 5.5 *Countries with significant participat
39、ion *U.S. data are from various years of the Willis Towers Watson National Trend Survey. Notes: Global and regional trend rates are weighted averages based on GDP per capita. No response is indicated by NR. Global average medical trend rates by country, 2017 2019 (continued) 6 India. The increase in
40、 chronic illness and lifestyle-related conditions continue to drive the use of medical facilities and services. These factors, along with a lack of access to treatment as well as delays in receiving service, result in the rise in medical trend. Insurers are striving to improve underwriting and prici
41、ng controls for medical policies, which is helping to correct some claim loss ratios. But in many instances we still see an underpricing of medical programs in relation to the actual loss ratios. Malaysia. The availability and adoption of new medical technologies and equipment is part of the reason for medical cost being driven upward to 11.4% in 2018, and a projected 13% in 2019. We continue to observe medical service providers recommending potentially unnecessary treatment/diagnostic procedures resulting in higher overall bill
