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Global Benefits 2018 Global Medical Trend Rates2 2018 Global Medical Trend Rates Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Key Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Medical Plan Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Medical Plan Employee Cost Sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Medical Plan Financing Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Alternative/Innovative Delivery Mechanisms . . . . . . . . . . . . . . . . . . . . . . . 7 Call to Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Average Medical Trend Rate Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Most Important Elements of Medical Plan Cost . . . . . . . . . . . . . . . . . . . . 13 Key Reported Conditions Driving Adverse Medical Claim Experience . . 14 Risk Factor Driving Supplementary Medical Plan Costs . . . . . . . . . . . . . . 15 Mitigation Initiatives to Control Medical Plan Cost Escalation . . . . . . . . . 16 Levels of Claims Information Available from Carriers . . . . . . . . . . . . . . . . 17 Prevalence of Medical and Derivative Benefits . . . . . . . . . . . . . . . . . . . . . 18 Summary of Modal Practices per CountryEmployee Cost Sharing . . . . 19 Regional Summary of Practices on Employee Cost Sharing on Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Regional Summary of Country Practices on Employee Cost Sharing on Claim Outlays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Global Wellness and Health Promotion Initiatives . . . . . . . . . . . . . . . . . . 21 Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Contacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table of Contents Aon | Survey Report 1 Introduction Aon is pleased to present the results of its 2018 survey of average medical trend rates from countries around the world . The survey was conducted among 98 Aon offices that broker, administer, or otherwise advise on employer-sponsored medical plans in each of the 98 countries covered in this report . The survey responses reflect the medical trend expectations of the Aon professionals, clients, and carriers represented in the portfolio of Aon medical plan business in each country . The trend rates presented in this report do not include any allowances for potential employer countermeasures such as cost-containment plan amendments or the potential impact of any attendant employer negotiations with carriers . Aon has conducted this survey in order to help multinational companies: Budget premium costs for medical plan renewals Understand the factors driving medical cost increases Devise wellness and cost-containment initiatives to respond to the challenges The trend rate figures shown in this report represent the percentage increases in medical plan (insured and self-insured) unit costs that are anticipated to be technically required to address projected price inflation, technology advances in the medical field, plan utilization patterns, and cost shifting from social programs in each covered country . Care should be taken in interpreting the information presented here . The medical trend rates provided are not meant to represent an overview of each countrys health care costs as a whole . Neither are they necessarily indicative of the health care situation of each countrys population overall . This survey covers several separate themes: Estimated medical trend rates for 2018 Risk factors that are expected to drive medical cost inflation in the future Cost elements that could be mitigated through medical plan adjustments Wellness and health promotion initiatives being undertaken by employers to deal with spiraling medical cost increase trends The most common (modal) employer practices in each covered country around medical plan prevalence, design, funding, and administration Qualitative responses to provide greater context to medical plans globally As a reference, we have also included the projected general inflation rates for 2018 published by the International Monetary Fund (IMF) that have been adopted as a proxy for the expected domestic retail inflation level in each country for 2018 . The trend rate figures, risk factors, and cost elements in this report relate to employer-sponsored plans and their participants with aggregate premiums managed by Aon in the vicinity of USD154 billion . The global and regional medical trend rate averages reflect the following technical procedures: A weighting process based on each countrys average private health care insurance expenditure per person A geometric averaging mechanism Due to the hyperinflation environment prevailing in Venezuela, we have left this country out of the regional and global medical trend rate averaging mechanism for 2018 . Aon intends to issue annual survey updates in the future . We expect that as the global demand for medical plan benefits extends to more countries, the number of participating countries in our published reports will increase over time . In this report, we cover 98 countries . We hope you will find this report useful . We welcome any feedback you may wish to provide .2 2018 Global Medical Trend Rates Key Highlights The prevalence of employer-sponsored medical plans is increasing in all countries covered by the survey . Furthermore, the scope of the provisions offered by these medical plans is expanding as well (e . g . , larger maximum lifetime benefits, larger allowances for maternity benefits, fewer exclusions from plan coverage, more types of medical procedures covered by the plan . ) This report provides detail on the growing practice of requiring employee cost sharing in medical plan costs . The report summarizes the most typical (modal) practices in each covered country in this regardemployee sharing in medical premium costs, or in medical claim outlays . The nominal global medical trend average continues to increase, while the real global average medical trend rate experienced a modest decrease . For 2018, the gap between the average medical trend rate and the average general inflation rate is expected to modestly decrease to 5 . 3 percentage points from the corresponding 5 . 4 figure in 2017 . The average nominal medical trend rate is expected to increase 0 . 2 percentage points: For 2018, the global average medical trend rate was 8 . 4% and the average general inflation rate was 3 . 1% . 1 In 2017, the global average medical trend rate was 8 . 2% and the average general inflation rate was 2 . 8% . 2 Aon expects further medical cost escalation due to global population aging, overall declining health, poor lifestyle habits becoming pervasive in emerging countries, continuing cost shifting from social programs, and increasing utilization of employer- sponsored plans . 1 IMF World Economic Outlook Database April 2017; 2 IMF World Economic Outlook Database April 2016 Exhibit 1: Double-digit margins between 2018 medical trend rates and domestic inflation levels were found in the following countries: Lithuania Slovakia Egypt Lebanon Pakistan Malaysia Vietnam Venezuela Brazil Costa Rica Indonesia Honduras Aon | Survey Report 3 Exhibit 3: Differentials by geographic region among the primary medical conditions that were reported to generate adverse claim experience are: United States Canada Asia-Pacific (APAC) Europe Latin America (LATAM) Middle East/Africa (MEA) Musculoskeletal/Back Mental Health Cardiovascular Cardiovascular Cancer/Tumor Growth High Blood Pressure Cardiovascular Cardiovascular Cancer/Tumor Growth Cancer/Tumor Growth Diabetes Diabetes Diabetes Diabetes Gastrointestinal High Blood Pressure Cardiovascular Respiratory Noncommunicable diseases (NCDs) are the biggest contributors to the adverse experience driving high medical inflation . NCDs are directly linked to modern lifestyles, and their incidence can be significantly reduced through modification of individual behaviors . Influencing these behaviors presents both a challenge and an opportunity for employers . Key Highlights Exhibit 2: The top-reported conditions giving rise to adverse claim experience around the world are: Cancer/Tumor Growth 68 Cardiovascular 66 High Blood Pressure 54 % of countries responding Exhibit 4: The key reported global risk factors that are expected to drive future claims are: High Blood Pressure 78 Physical Inactivity 49 Obesity 48 % of countries responding4 2018 Global Medical Trend Rates Key Highlights Exhibit 5: Differentials by geographic region among the risk factors that are expected to generate future claims are: United States Canada APAC Europe LATAM MEA Physical Inactivity Aging High Blood Pressure High Blood Pressure High Blood Pressure High Blood Pressure Bad Nutrition Physical Inactivity Obesity/Physical Inactivity Poor Stress Management Bad Nutrition Physical Inactivity Obesity Obesity High Cholesterol/Bad Nutrition Obesity/Physical Inactivity/SmokingObesity/High Cholesterol Bad Nutrition/High Cholesterol Exhibit 7: Differentials by geographic region among the cost elements are: United States Canada APAC Europe LATAM MEA Hospitalization Biologic Immunomodulators Hospitalization Hospitalization Hospitalization, Prescription Drugs and Clinics/Labs Hospitalization and Clinics/Labs Physician Services Prescription Drugs Physician Services Clinics/Labs and Physician Services Physician Services Prescription Drugs Prescription Drugs Preventive Care Clinics/Labs Dental Maternity Physician Services Exhibit 6: The most impactful elements of medical plan costs around the world are: Hospitalization 86 Clinics/Labs 74 Physician Services 73 % of countries responding Aon | Survey Report 5 Key Highlights Exhibit 9: The cost-mitigation methods most commonly reported by geographic region are: United States Canada APAC Europe LATAM MEA Cost Containment Cost Containment Cost Containment Cost Containment Wellness Initiatives Wellness Initiatives Plan Design Changes Wellness Initiatives Wellness Initiatives Wellness Initiatives Cost Containment Cost Containment Access and Delivery Restrictions Plan Design Changes Access and Delivery Restrictions Provider Networks Access and Delivery Restrictions Access and Delivery Restrictions Exhibit 10: The most common wellness and health promotion initiatives being undertaken by progressive employers globally are: Wellness Programs Commonly Provided Detection 83 Education Programs 72 Wellness Interventions 69 % of countries responding Exhibit 8: The methods most commonly reported for mitigating the increase in the costs of a medical plan are: Wellness Initiatives 71 Cost Containment 69 Access and Delivery Restrictions 49 % of countries responding6 2018 Global Medical Trend Rates Medical Plan Features This year we surveyed our offices to canvass the prevalence of medical programs in each country . A summary of the replies is as follows: Key Highlights Exhibit 11: Medical Plan Features Hospitalization 90 Outpatient 86 Vision 60 Dental 63 Prescription Drugs 72 Preventive Medicine 62 % of countries reporting strong or moderate prevalence General Practices As employee cost sharing is often a very important element of a companys medical cost-mitigation strategy, we have investigated the prevalence of employee cost-sharing practices in each country covered from two perspectives: Employees sharing the cost of medical premiums Employees sharing in claim outlays The figures below represent the percentages of Aon offices reporting countrywide modal practices in employee cost sharing in the medical plan premiums and claims in their respective regions . Exhibit 12: Employee Cost Sharing Global APAC Europe LATAM MEA Share of Medical Premiums 78 68 94 90 52 Share of Medical Claims 85 95 65 86 100 % of countries responding Medical Plan Employee Cost Sharing Aon | Survey Report 7 Medical Plan Financing Media The reported prevalence of financing approaches typical within each country was as follows: 0 20 40 60 80 100 APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global Insurance Pre-Paid Services Self Insured Mixed Company OwnedYes No Exhibit 13: Prevalence of Financing Approaches (%) Key Highlights Notes: “Prepaid Services” refers to the financing of medical coverage via set fees per participant which are community rated and which are assessed by the provider network “Direct Provision Through Company-owned Facility” refers to company owned (or rented) clinics or medical dispensary (a generalist physician or nurse and basic prescription drugs) generally available on-site . Alternative/Innovative Delivery Mechanisms Aon offices reported prevalence of the following delivery mechanisms supporting medical benefit plans: 0 20 40 60 80 100 APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global APAC Europe LATAM MEA Global Company In House Clinic Medical Cash Allowances Second Medical Opinions Health Tourism EAPYes No Exhibit 14: Delivery Mechanisms Supporting Medical Benefit Plans (%)8 2018 Global Medical Trend Rates The findings addressed in this report suggest that employers need to accelerate their efforts in helping employees to both understand their own health risks and begin to take steps to improve their health . Rising costs and the increased prevalence of chronic conditions are global phenomenaand regardless of the underlying medical insurance system, employers will experience added organizational cost and lost workforce productivity if these trends continue . The wellness initiative summaries in this report should be useful in understanding wellness and cost mitigation efforts being undertaken by employers . However, the underlying causes of illness and risk factors vary greatly by region, country, company sector, etc . It is therefore important to carefully target employer initiatives to the specific situation surrounding each medical plan . Call to Action Aon | Survey Report 9 Survey Results Average Medical Trend Rate Tables 2017 2018 Exhibit 15: Region (Avg %) Annual General Inflation Rate Annual Medical Trend Rates Annual General Inflation Rate Annual Medical Trend Rates Gross Net Gross Net Global 2.8 8.2 5.4 3.1 8.4 5.3 North America 1 . 6
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