What’s Making Us Sick: Insurers’ Most Common Pay-outs by Condition
Corporate health insurance can be a huge asset to companies seeking to recruit and retain the very best talent, but it can also be a potential liability if it is not well-structured, well-managed and well-administered. Of course, it’s also a mandatory requirement for employers in Dubai and Abu Dhabi.
Part of the process of maintaining excellent corporate health insurance is keeping accurate actuarial tables of risk and claim prevalence. Studies such as the Global Medical Trends Survey are a crucial source of capturing data which informs risk management of healthcare benefit cost trends, incidence of claims related to specific conditions, restrictions on insured coverages and the development of new technologies such as telehealth, supporting the construction of dynamic actuarial databases, across territories.
This year’s Survey identified trends from 209 participating insurers across 61 countries, to give a global snapshot of how corporate health policies are used by the insured individuals.
The Survey was truly global, covering the Americas, Europe, Asia Pacific, and Middle East & African territories. The data was received between July and September 2021.
The Continual Rise of Healthcare Costs
Following a dip during the height of the COVID-19 pandemic, during which fewer people attended hospitals for routine procedures and check-ups, the global average cost of healthcare has risen significantly from 2020 to 2021 (8.12 %), and this was anticipated to continue in 2022.
When surveyed, a full three quarters of health insurance providers said they expected costs to continue to rise over the next three years. A factor significantly contributing to this was the rising cost of hospital visits across ALL territories, no doubt exacerbated by the financial fallout from the global COVID-19 pandemic.
Respondents also pointed to other trends contributing to the sharp rise in costs, including overprescribing, lack of preventative care, and poor health habits of policy members.
In terms of how individual healthcare costs increased, 55% of respondents pointed to the development of new technologies as a significant contributing factor to cost increases, , despite showing high effectiveness. The profit motives of providers and COVID-19 costs were also frequently cited.
What Conditions Contribute the Most to Health Insurance Pay-outs?
Across all territories, the following three conditions were the most prevalent in triggering corporate health insurance claims:
Musculoskeletal and Connective Tissue Conditions
Cardiovascular Conditions
Respiratory Conditions
The order of prevalence per territory was not consistent, however, and other conditions were common in specific regions. For example, gastrointestinal issues were common in Asia Pacific (the primary claim cause) and Latin American countries (the second most prevalent condition) but did not feature significantly in the Middle East and Africa.
Within the MENA region, the top five conditions by prevalence were:
Respiratory Conditions
Diabetes, Endocrine, Nutritional and Metabolic Conditions
COVID-19 Treatments
Musculoskeletal Ailments
Mental and Behavioural Disorders
Diabetes, Endocrine, Nutritional and Metabolic Conditions have been a recent addition to many healthcare programs in the region, in addition to other well-being provisions, reflecting greater awareness of the debilitating effect of such conditions on workers’ fitness and performance.
Cardiovascular Issues were consistently one of the top three conditions worldwide, apart from the Middle East and Africa. It is likely that a range of factors contributed to these differences, including diet, lifestyle, climate, hygiene infrastructure and the types of diseases and ailments covered by locally available corporate insurance policies.
Interestingly, COVID-19 only formed a significant portion of health insurance claims in a couple of regions, including the Middle East and Africa. It is likely that African countries that did not have large-scale vaccination programs suffered from a prevalence of COVID-19 related claims.
The Middle East region is highly vaccinated, however, and thus probably generated fewer COVID-related claims. For a vivid demonstration of the differential rates of vaccination, visit the following data aggregation site, which keeps tallies of COVID-19 vaccination and disease incidence worldwide: Our World in Data.
Most Claimed Conditions by Cost
While the above figures reveal the most claimed conditions, when the analysis is filtered by the cost of treatment, a different picture emerges. Here were the top five conditions claimed at the end of 2022 for the Middle East and Africa:
Cardiovascular
Cancer (Neoplasms)
Diabetes, Endocrine, Nutritional & Metabolic Diseases
COVID-19
Gastrointestinal conditions
The survey also predicts Diabetes and other related metabolic conditions becoming the fastest-growing conditions upon which claims would be made in the next 18 months.
However, in terms of cost, the largest contributing conditions were predicted to be cardiovascular care, then diabetes and metabolic conditions, with cancer care in third place. Viewed globally, cancer care continues to be the costliest condition for predicted claims over the next 18 months.
The Middle East and Africa buck the trend for musculoskeletal conditions to be a significantly costly claim item since these conditions don’t feature in the top five of predicted high-cost ailments within the region.
Summary: Regional Differences within Global Trends
The 2022 Survey is instructive for corporate insurance providers. It makes clear that, although there are relatively universal conditions which continue to contribute to rising health insurance costs (such as cancer and cardiovascular care), there are also regional differences which mean that actuarial analyses need to be tailored to specific territories.
Within the Middle East and Africa, additional care should be taken to factor in the higher prevalence and consequent cost of diabetes, endocrine and other metabolic and nutritional conditions, for instance.
The 2023 survey is yet to be conducted and analysed. With preventive and containment measures being implemented aggressively, the trends of the previous year may differ by greater margins, with the consideration of reduced Covid-19 claims.
