2021年全球医学趋势调查报告.docx

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1、Given that 2020 was an extraordinary 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.Figure 1: Participant profileAbout the surveyWillis Towers Watson conducts the Global Medical Trends Su

2、rvey every year between 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 Tre

3、nd Survey research. AmericasAsia Pacific Europe Middle EastAnd AfricaOverviewCOVID-19 has undoubtedly had a major impact on projected medical trends for 2020 and 2021. Given that 2020 was an extraordinary year globally due to the pandemic, most countries are seeing a decrease in trend from 2019 to 2

4、020. 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 delayed especially between March and August. In turn, these delays created a need for some private fa

5、cilities 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 whether or not a vaccine becomes available early in the year, who pays for it and the extent of its availa

6、bility. 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 medical trend lies ahead in future years as we start to see the true impact of delayed treatment in 2020 a

7、nd 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 help to offset those potentialrlllistowerswahigher costs and provide a more efficient way for insureds

8、 to access and use health care in the future. It may also, of course, increase utilization due to ease of access.IllllllllllllllllllllllllllllllllllllllllllllOverall, we expect projected global trend to drop to below 6% in 2020 before rebounding back to above 8% for 2021 due to the catchup on delaye

9、d treatment potentially leading to worsening health conditions and some unexpected cost increases coming through, such as those for personal protective equipment (PPE).i%Asia Pacific11%49%39%Figure 2: How do you expect the medical trend in your overall book of business to change over the next three

10、years compared to current rates?9 Asia PacificThe 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.China. COVID-19 has not had os much impact on cost or utilization in China as it has in other countries. The costs of

11、 medical care continue to increase for treatments, particularly those outside the scope of social security coverage.The central government is planning to eliminate the individual medical account and at the same time offer coverage for outpatient expenses under social security. The initiative was ann

12、ounced 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 variation in government funding at the provincial level.Hong Kong. The low util

13、ization 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 dropped due to the travel restrictions and social unrest in Hong Kong.1%

14、Europe21%71% 6%Figure 3: Global average medical trend rates by country, 2019 - 2021CountryGross cost trendNet cost trend (of general inflation)201920202021201920202021GlobalA7.165.888.125.134.606.17Latin AmericaA10.838.9713.635.756.6211.17North America5.552.767.133.652.155.50Asia Pacific7.476.228.50

15、5.885.106.78Europe5.584.245.764.023.274.15Middle East/Africa8.658.6610.017.396.946.98Latin AmericaArgentina*56.9947.2960.503.4428.8547.75Barbados and East Caribbean10.0010.0010.005.905.548.39Brazil*11.969.38118.235.828.21Chile*4.883.184.072.63-0.191.14Colombia*6.276.896.922.753.383.71Costa Rica*7.00

16、8.009.254.906.467.00Ecuador12.0012.0012.0011.7312.0110.84El Salvador*7.4310.007.717.359.947.11Guatemala*8.008.8311.804.307.0010.02Honduras*6.177.989.671.804.836.69Mexico*9.3011.5011.715.668.808.93Nicaragua10.0012.0015.004.627.5311.04Panama*10.6711.009.4011.0211.918.90Peru5.006.008.002.864.296.21Puer

17、to Rico5.00-6.0018.004.27-4.4517.36Trinidad and Tobago10.0010.0010.009.0011.008.72Venezuela85.00150.00250.00-19821.02-14850.00-14750.00North AmericaCanada4.170.137.032.22-0.485.76United States#7.917.247.306.106.625.06Asia PacificAustralia6.506.006.004.894.574.18China*8.689.109.325.786.066.77Hong Kon

18、g*8.166.246.685.304.244.18India*7.8012.0010.003.268.666.38Indonesia*10.339.9712.007.517.109.06Malaysia*10.6410.8212.559.9710.719.75New Zealand5.60-2.0020.003.98-3.2218.62Philippines*7.758.508.825.276.785.94Singapore*7.677.678.177.107.847.65South Korea7.005.004.006.624.733.55Sri Lonka5.005.005.000.70

19、0.340.35Taiwan*4.004.004.003.463.502.50Thailand7.007.508.006.298.567.44Vietnam*12.9310.1310.1510.136.936.25CountryGross cost trendNet cost trend (of general inflation)201920202021201920202021EuropeBelgium2.002.503.000.752.251.91Cyprus5.000.001.004.44-0.700.00Denmark5.506.504.504.775.803.30France4.17

20、1.032.302.870.751.60Germany5.007.007.003.656.685.82Greece4.504.504.753.984.963.74Hungary Ireland10.004.4710.001.4310.008.336.633.596.661.036.836.63Norway*5.275.996.433.103.594.23Poland*5.856.507.333.543.284.75Portugal*Romania*3.7912.62-1.8310.333.9711.503.498.79-1.638.092.6210.05Russia7.2510.0011.00

21、2.786.918.01Serbia7.507.5015.005.656.0613.06Spain2.851.934.752.152.234.10SwedenSwitzerland9.004.006.001.507.501.007.303.645.541.895.970.40Turkey23.2517.5016.008.075.504.00United Kingdom5.676.336.503.885.154.96Middle East and AfricaBahrain7.007.007.006.004.404.50Burkina Foso0.5015.0010.003.7311.807.9

22、0Cameroon*3.506.254.001.053.451.75Cote dIvoire15.0015.6718.3314.1914.4716.93Egypt* Gabon12.1319.5010.8821.5012.3325.00-1.7417.485.0218.504.1022.00Ghana12.1714.6717.174.965.018.62Guinea10.005.003.000.53-3.50-5.00Jordan Kenya7.008.500.006.504.009.006.703.30-0.201.402.404.00Kuwait5.007.5010.003.907.007

23、.70Madagascar25.0020.0030.0019.3814.5023.50Mozambique7.005.005.004.22-0.19-0.71Nigeria Oman17.334.5014.674.5018.675.505.944.371.273.506.302.10Saudi Arabia10.0010.0012.0011.219.1310.04Senegal10.0015.0015.008.9813.0013.08South AfricaTogo6.505.006.008.006.0010.002.374.313.576.002.848.00Uganda20.0010.00

24、15.0017.136.0610.15Uniled Arab Emirates9.008.008.0010.939.006.50Zambia15.0020.0025.005.206.6012.95Countries with significant (5+) participation.ADue to the hyperinflationary nature of the Venezuelan economy, Venezuela has been excluded from Latin America regional and global totals.#United States dat

25、a is from various years of the Willis Towers Watson National Trend Survey.Global Medical Trend 5Asia Pacific (continued)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

26、 situation with low claim frequency and average cost 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 cha

27、llenge. The government did, however, take some small measures to issue guidelines around pricing for COVID-19 tests and treatmentSz 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 t

28、o normal levels; however, we also may see an increased 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 In

29、donesia ore projected to be slightly lower in 2020, 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 ongoin

30、g costly treatments. This allows insurers to split 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 deman

31、d for private health core.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 h

32、as caused the overall trend to decrease. During this period, many elective surgeries were postponed. For outpatient care, there has been a big drop in specialist care visits; at the primary care level, there has been a drop in less acute visits, with patients turning to telemedicine. For patients wi

33、th chronic conditions, the level of visits has been largely maintained, os these are generally uunavoidable.HAll of this means that there is a pause in 2020 trend compared with 2019, but an uptick is expected in Q4 2020 and in 2021 to catch up on delayed procedures.Global Medical TrendPhilippines. P

34、rivate medical care in the Philippines is largely dominated by an HMO model which accounts for 80% of plans. While the frequency of inpatient and outpatient claims has definitely decreased in 2020, the average amounts per inpatient and outpatient claims are rising. In addition, various physician org

35、anizations negotiated with HMO associations and were granted a 50% increase in fees commencing May 27, 2020, ostensibly to cover the cost of PPE. This cost increase is expected to remain in place for the duration of the pandemic. Physician fees are roughly 30% of total spend.Overall this helps expla

36、in why trend rotes in the Philippines have edged up for 2020 to 8.5% from 7.8% in 2019 and are projected to continue increasing for 202L although continued delay in treatment in 2020 could mean an even larger increase in 2021 than projected.Singapore. Insurers have taken quite a conservative view on

37、 medical inflation for 2020 and 2021, mainly due to delayed elective surgical procedures and an employer focus on mental health, wellbeing and virtual solutions. Overall trend is still hovering in the 7% to 8% range for 2020 and 2021.Wellbeing solutions include ensuring employees are able to work ef

38、fectively from home, and quality telehealth has become one of the key priorities that employers are keen to introduce to their work-from-home employees. Some medical providers are offering home health screenings and vaccinations to employees as well as their dependents.Q EuropeMedical trend in Europ

39、e has decreased to 4.2% for 2020, but a rebound is expected in 2021 to a trend rate close to the 2019 level of 5.8%.France. A significant drop in utilization and medical claims in 2020 can be attributed to the April lockdown period. Although utilization has started to rise again, overall we expect a

40、 reduction of 5% in medical claims by the end of 2020. This is reflected in the decrease in medical trend from 4.2% in 2019 to 1% in 2020. Nevertheless, insurers project that this rate will start to increase in 2021, rising to 2.3%.Utilization is expected to rise in 2021 due to the impact of delayed

41、 services and procedures in 2020. In addition, other factors are potentially driving an increase in 2021 medical trend, including the introduction of a COVID-19 tax, which the government has decided insurers should pay as a new additional tax. This tax of 2.6% for 2020 and 1.3% for 2021 is based on

42、claims paid in these two years. We expect insurers will want employers to finance this tax, which could lead to further premium increases in 2021. There is also the impact of Uportability/B which allows dismissed employees to maintain their medical coverage for 12 months after leaving a company. Thi

43、s is a legal arrangement financed by active workers, which could lead to increased contributions. Lastly the so-called h100%Sante legal change (eliminating out-of-pocket costs for dental, optical and auditory care) was implemented on January b 2020, and will be deployed within the next several month

44、s for hearing aids. This will lead to an increase in claim reimbursement and a potential increase in trend.Norway. Medical trend in Norway continues to edge upward for 2020 and 2021. In part, this is driven by use of more expensive treatments and overuse of care. Otherwise we see a rising use of psy

45、chological services with the increasing awareness of mental and behavioral health conditions.However, there is hope that the growing use of digital solutions and online services will help mitigate some of the future increase in trend. In addition, some of the insurers in the Norwegian market are considering offering dif