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Survey Report

Global average medical trends by country, 2020 – 2022

2022 Global Medical Trends Survey Report

Benefits Administration and Outsourcing Solutions|Health and Benefits
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November 15, 2021

The 2022 survey tracks medical costs from a global network of 209 insurers in 61 countries. Explore key findings and trends at a glance.

Asia Pacific

China. The medical industry is working toward establishing post-pandemic routines for daily medical treatment to support the Chinese people’s everyday needs. With close to 1.1 billion of its people vaccinated — almost 80% of the population — China’s healthcare market and medical facilities are trending back to the typical pre-COVID-19 state, both in terms of capabilities and capacity.

Medical inflation is expected to increase in 2022 to pre-pandemic levels, following significant stagnation in 2020. Besides highlighting life and medical coverage needs, the pandemic is elevating wellbeing awareness and the adoption of wellbeing initiatives by employers. Physical safety and mental health are becoming high-priority topics in the China market, and employers are seeking support to implement approaches targeting these issues.

India. While hospital utilization trends have stabilized after showing a large spike during parts of 2021 (especially during wave two of the pandemic between April and July), India is currently in a situation where non-COVID-19 deferred claims are rising and the average cost of procedures is gradually increasing due to the impact of providers implementing COVID-19 protocols.

From a provider management perspective, the Indian government is still at an early stage of implementing regulations on the treatment and pricing protocol of medical care. While hospital billing practices continue to pose a challenge, the government is trying to address this issue through guidelines around pricing for COVID-19 tests and treatments.

In 2022, we expect to see a similar level of trend as in 2021, that is, in excess of 20%; however, we also may see an increased awareness and a rising utilization of prevention strategies and wellbeing initiatives.

Malaysia. The vaccination rate among Malaysian adults is trending upward in 2021, and with this comes the lifting of the interstate travel ban together with a host of economic activities. This is expected to bring a large degree of normalcy back into everyday life, including the rescheduling of elective medical procedures previously postponed due to the pandemic.

Medical tourism is also expected to pick up again once the international travel ban is lifted, largely expected by early 2022. It is with these expectations that medical trend is projected at a much higher rate for 2022, with the medical industry catching up after an almost two-year hiatus.

Singapore. Insurers in Singapore have projected a slightly higher medical inflation for 2022, mainly due to the higher utilization of services. This includes the residual impact of delayed elective surgical procedures, largely performed at private hospitals given the surge in COVID-19 cases in Singapore government hospitals. Overall trend is hovering at the higher range from 8% in 2021 to 9% in 2022.

The mental wellbeing of employees continues to be a key employer focus. The healthcare system has also pivoted to include virtual mental wellbeing support, largely to ensure that employees receive the quality telehealth support they need as they continue to work from home. Employers are reviewing how wellbeing solutions, in general, can be incorporated as a core benefit item, seeking support from insurers.

Vietnam. Most of the insurance companies participating in the survey predict that medical costs in Vietnam will increase next year to about 9% compared with 7% in 2021 and 5% in 2020. COVID-19 has been the main driver of this, but 2022 is still showing a level of trend below that of 2019; however, this situation will not last long, as we expect utilization to return to normal gradually, especially in 2022 and 2023.

Healthcare providers enhanced their services by providing tele-consultation services to meet the needs of patients during the pandemic as they switched to remote working. Consequently, insurers are considering the inclusion of telemedicine services and diagnosis/consultation in their coverage, but it is still limited to certain specific clients in 2021. We expect this trend to develop further in 2022 and beyond.

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Europe

France. The expected trend for 2021 in France is highly influenced by the impact of delayed medical services that were postponed in 2020 along with the full-year impact of the legislative reforms that went into effect in 2019 that increased minimum thresholds of coverage (i.e., 100% Santé). Additional services such as telehealth and wellbeing are increasing costs in the short term with prevention expectations over the longer term.

Spain. Similar to other countries, the delayed medical services in 2020 caught up in 2021, and we have seen lengthier hospital stays (inpatient claims) than in other years. Medical groups are consolidating in Spain resulting in higher prices (and less choice). Careful attention must be paid to policy terms, as we are seeing some insurance companies attempting to exclude coverage due to pandemics.

Netherlands. As of January 1, 2023, insurers will no longer be allowed to discount premiums on the collective medical plan (basic insurance). This is expected to reduce the attractiveness of collective medical plans, and premiums are expected to rise. Companies are advised to review this and consider alternatives in 2022 ahead of this change.

U.K. The U.K. has seen routine and elective medical treatments delayed for much of 2020 and the first half of 2021. At the end of Q2 2021, claims were suppressed by around 5% to 10% against expected corporate norms. Although during Q3 2021, claims returned to near pre-pandemic levels, much uncertainty remains regarding how much of these deferred claims will come through in late 2021 or into early 2022.

We expect to see the pandemic continue to have an adverse impact on medical trend in the following areas:

  • Claims incidence rates could be affected as the state National Health System (NHS) deals with record waiting lists for routine and elective treatments, prompting more employees to use private/corporate programs.
  • Delayed diagnoses and treatments could mean disease progression could affect average claim costs. This applies not only to more routine treatments, such as musculoskeletal, but also to serious and high-cost illnesses, such as cancer.
  • The effects of long COVID-19 are still unclear but could affect claim incidence rates both in the short and medium term.
  • Increasing claims around both musculoskeletal and mental health, due to changes in both work and social habits, are likely to be a key claims driver.

However, some impacts of COVID-19 are expected to positively affect medical trend:

  • Changing working behaviors and a move to permanent hybrid working could mean more treatments are delivered regionally and outside of more costly city centers.
  • The continued use of telehealth, remote consultations and therapies should positively affect claim costs given the efficiencies around delivery.
  • The development of digital pathways provides the opportunity for more consistency as well as the ability to optimize the patient journey and remove inappropriate treatments.
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Latin America

Argentina. High inflation and the devaluation of the Argentine currency against the U.S. dollar continue to be among the key factors driving medical trend in Argentina. In addition, healthcare salary growth and the increase of the list of mandatory treatments that medical plans must cover are two factors that have a marked impact on medical costs. The projected 2022 medical cost trend reflects the impact of the expected increase in medical services utilization as COVID-19 cases decrease and people resume elective treatments as well as all other treatments that were delayed during 2020 and 2021.

Brazil. Medical trend in Brazil is expected to return to pre-pandemic levels in 2022 after a drop during the past two years. The key reasons are the return of patients for elective hospitalizations and elective treatments that had been postponed due to COVID-19 (e.g., orthopedic surgeries, digestive tract, otorhinolaryngology, gynecology). We are also seeing increased medical plan utilization deriving from use of therapies for the treatment of post-COVID-19 symptoms related to mental health, such as occupational therapy, physiotherapy and psychiatry. Telehealth continues to be utilized and is expected to increase in popularity, as people got used to having access to this service during 2020. This is an element that will help contain medical inflation, preventing it from returning to its highest levels.

Chile. The increase in healthcare costs for 2022 is projected to continue at 4%. While elective treatments are resuming, Chile is benefiting from having one of the most efficient vaccination campaigns in Latin America, with 84% of its population vaccinated with at least one dose in 2021. Other factors helping to manage trend include the acceleration of technology developments for insurers, improving self-service tools (e.g., via apps) for reimbursement processes, digital enrollment and subscription. We are also seeing further development of wellbeing programs focused on mental health benefits, telemedicine and the incentive to use preferred providers for outpatient and hospital services.

Colombia. Medical trend is projected to increase for 2022 to 4.3% due to slight increase in utilization. Containment of medical trend is helped by competitive pressures in the insurance market, with many insurers seeking to increase their market share. At the same time medical providers are focusing their efforts on developing their technology further, and there is an increase in wellbeing and utilization of telemedicine, all of which should help to contain medical trend in the coming years.

Mexico. Overall, the medical trend rate in Mexico is projected to continue in 2022 at a similar level to 2021, maintaining a double-digit trend. The depreciation of the Mexican peso versus the U.S. dollar continues to affect costs of imported medical devices and hospital supplies, which continue to drive trend. In addition, demand for private healthcare remains high, particularly as the public health system has been besieged by COVID-19 cases and also because of a shortage of medicines in the public sector.

There is a trend to redesign medical programs and underwriting processes in an effort to reduce costs. The main features include the incorporation of wellbeing services and telemedicine programs, which are expected to reduce the severity of medical cases and decrease utilization levels in hospitals. Underwriting analysis with geographical differentiation by region is being implemented to capture the differentiated impact that COVID-19 had across the country. Finally, insurance companies are considering including a COVID-19 factor for medical insurance policies, which will affect the medical cost trend in the coming years.

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Middle East and Africa

Africa. In 2021, we are seeing claims returning to normal pre-pandemic levels in many countries. We are also observing COVID-19 claims being paid by medical insurers in some countries (e.g., Egypt, South Africa), which is expected to lead to a high trend in many countries in Africa. Significant variations in levels of trend are expected across the continent depending on the rate of general inflation and amounts of medical supplies being imported. We also observed a new trend to offer telemedicine facilities (Nigeria and Egypt); however, we have not yet seen a high utilization of this service.

Saudi Arabia. Trend is projected to be the same in 2022 as in the past two years, holding steady at 10%. We are expecting that demand for healthcare services will continue to rise in 2022; costs will also rise due to the scope of cover required within the mandated plan design. Nationalization in the healthcare sector (i.e., mandated employment of local nationals in key roles) may also be an inflationary factor.

South Africa. COVID-19 has led to lower-than-average medical cost increases over the past three years. This results in part from the decline in non-COVID-19 healthcare claims seen during the course of the pandemic. (Elective surgeries/procedures were deferred during this period.) The Council for Medical Schemes recommended that medical aid schemes limit contribution increases to 4.2% or less in 2022, but some schemes have maintained that the uncertainty of future COVID-19 claims has made it hard to do so, and so we are seeing a higher projected medical trend for 2022 of 8.5%.

U.A.E. The projected trend numbers in the U.A.E. are a little lower than expected. As in other countries, we are seeing an uptick in trend for 2022 based on delayed services or demand for healthcare services that had been suspended during the pandemic. We have also seen increased use of telehealth services in the Emirates. There is an expectation of higher cost of materials coming through in 2022, with the expanding scope of coverage in relation to mental health conditions, increased capability to treat complex medical conditions locally and ongoing high prevalence of chronic/lifestyle-related conditions.

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North America

Canada. Medical trend in Canada is expected to slow slightly in 2022 compared with 2021. Nevertheless, employers continue to be concerned about COVID-19’s impact on mental health and disability needs. Day care subsidization across provinces has made an impact, supporting the return to work. Pharmacy costs remain a concern in Canada with progress on a national pharmacare plan still awaited.

U.S. COVID-19 has cost employers more in 2021 than in 2020 with the upward trend expected in the second half of 2021. The delta surge and vaccine hesitancy has defined the national landscape. Other delayed medical services continue to resume gradually with the results that 2022 trend continues to edge upward from 2021 to an expected 7.6%. Pharmacy costs continue to be a large contributor to trend in the U.S. For employers, there is a focus on wellbeing programs (with an increase on digital vendors) as well as support for family/caregivers and newer healthcare delivery strategies.

Download the report for data by country.

Next section: Update on telehealth

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