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2021年全球醫(yī)學(xué)趨勢調(diào)查報告

發(fā)布時間:2020-11-21 來源: 工作總結(jié) 點(diǎn)擊:

 G iv en

 tha t

 2 0 2 0

 w as an

 e x tr aordinar y

 y ear

 globally

 due

 to

 the

 pandemic,

 mos t

 coun tries ar e

 seeing

 a

 decrease

 in

 tr end

 fr om

 2 0 19

 to

 2 0 2 0 .

 S ome

 coun tries

 ar e

 e v en

 e xpecting

 a nega tiv e

 tr end

 f or

 2 0 2 0 .

 About the

 sur v e y

 Willis

 T o w ers

 W a ts on

 conducts

 the

 Global

 Medic al

 T r ends Surv e y

 ev ery

 y ear

 be t w een

 July and

 Sep t ember .

 T w o

 hundr ed and

 eigh ty -s ev en

 leading

 insur ers

 r epr es en ting

 7 6

 coun tries participa t ed

 in

 our

 20 21

 surv e y .

 Global

 r esults

 pr es en t ed

 her e ha ve

 been

 weigh t ed

 using

 GDP

 per

 c apita.

 The

 U . S .

 medical tr end

 da ta

 ar e

 dr a wn

 fr om

 the

 Willis

 T o w ers

 W a ts on

 Na tional T r end

 Surv e y

 r es ear ch.

  Figur e

 1:

 P ar ticipan t

 pr o file

 Ov er vie w

 CO VID- 19

 has

 undoub t edly

 had

 a

 major

 impact

 on

 pr oject ed medical

 tr ends

 f or 2020

 and

 20 21.

 Given

 tha t

 2020

 w as an

 e xtr aor dinary

 y ear

 globally

 due

 t o

 the

 pandemic,

 mos t coun tries

 ar e

 s eeing

 a

 decr eas e

 in

 tr end

 fr om

 20 19

 t o 2020 .

 Some

 coun tries

 ar e

 ev en

 e xpecting

 a

 nega tiv e tr end

 f or 2020 .

  Man y

 insur ers

 and

 emplo y ers

 ar e

 r eporting

 a

 decr easing tr end

 in

 claims

 r a tio

 in

 2020 ,

 as mos t

 nonur gen t

 tr ea tmen ts and

 sur geries w er e

 dela y ed

 especially

 be t w een

 Mar ch

 and

 A ugus t .

 In

 turn,

 thes e

 dela y s

 cr ea t ed

 a

 need

 f or s ome priv a t e

 f acilities

 t o

 mak e

 up

 f or los t

 r ev enue

 in

 2020 .

 The Willis

 T o w ers

 W a ts on

 CO VID- 19

 claims

 modeler

 sugges ts signific an t

 vola tility

 in

 20 21

 r esults,

 which

 ar e

 dependen t on

 the

 impact

 o f

 CO VID- 19

 and

 whe ther

 or no t

 a

 vaccine becomes

 a v ailable

 early

 in

 the

 y ear ,

 who

 pa y s

 f or it

 and the

 e x t en t

 o f

 its

 a v ailability .

 In

 addition,

 ther e

 is

 uncertain ty about

 how

 CO VID- 19

 t es ting

 and

 tr ea tmen t

 cos ts

 f or 20 21 will con tinue

 t o

 be

 split

 be t w een

 gov ernmen t ,

 insur ers

 and

 emplo y ers.

  F urther uncertain ty

 ar ound

 medical

 tr end

 lies

 ahead

 in

 futur e y ears as w e

 s tart

 t o

 s ee

 the

 true

 impact

 o f

 dela y ed

 tr ea tmen t in

 2020

 and

 the

 long-t erm

 e ff ects

 on

 thos e

 who

 con tr act ed CO VID- 19 .

 Ne v ertheless, ther e

 is

 a

 silv er lining

 her e ,

 as CO VID- 19

 has

 gr ea tly

 acceler a t ed

 the

 adop tion

 and

 us e

 o f t elehealth,

 which,

 in

 turn,

 could

 help

 t o

 o ff s e t

 thos e

 po t en tial

 2

 willis to w ers w a t son. com

  higher

 cos ts

 and

 pr ovide

 a

 mor e

 e fficien t

 w a y

 f or insur eds t o

 access

 and

 us e

 health

 c ar e

 in

 the

 futur e .

 It

 ma y

 als o ,

 o f cours e ,

 incr eas e

 utiliza tion

 due

 t o

 eas e

 o f

 access.

 A sia

 P acific

  Ov er all,

 w e

 e xpect

 pr ojected

 global

 tr end

 to dr op

 to

 belo w

 6%

 in

 2 0 2 0

 be f or e

 r ebounding back

 to

 abo v e

 8%

 f or

 2 0 2 1

 due

 to

 the

 c a tch- up

 on

 dela y ed

 tr ea tmen t ,

 po ten tially

 leading to

 worsening

 health

 conditions and

 some unexpected

 cos t

 incr eases coming

 thr ough, such as those

 f or

 personal pr o tectiv e equipmen t

 (PPE).

  Figur e

 2:

 How

 do

 y ou

 e xpect

 the

 medic al

 tr end

 in

 y our

 o v er all book

 o f

 busines s

 to

 change

 o v er

 the

 ne x t

 thr ee

 y ears

 compar ed to

 curr en t

 r a tes ?

  0

  Global

  China .

 CO VID- 19

 has

 no t

 had

 as much

 impact

 on

 cos t

 or utiliza tion

 in

 China

 as it

 has

 in

 o ther

 coun tries.

 The

 cos ts

 o f medical

 c ar e

 con tinue

 t o

 incr eas e

 f or tr ea tmen ts,

 particularly thos e

 outside

 the

 s cope

 o f

 s ocial

 s ecurity

 cov er age .

  The

 cen tr al

 gov ernmen t

 is

 planning

 t o

 elimina t e

 the

 individual medical

 accoun t

 and

 a t

 the

 s ame

 time

 o ffer cov er age

 f or outpa tien t

 e xpens es

 under

 s ocial

 s ecurity .

 The

 initiativ e

 w as announced

 in

 Sep t ember

 2020 ,

 with

 mor e

 de tails

 t o come

 on

 cov er age .

 This

 is

 e xpect ed

 t o

 impact

 the

 cos t

 o f tr ea tmen t

 in

 the

 futur e;

 how ev er ,

 it

 will pr obably

 tak e

 a

 while f or the

 initiativ e

 t o

 be

 fully implemen t ed

 given

 the

 v aria tion

 in gov ernmen t

 funding

 a t

 the

 pr o vincial

 le v el.

  Hong

 K ong.

 The

 lo w

 utiliza tion

 o f

 medical

 s ervices

 during

 the pandemic

 and

 the

 r ecession

 f or ec as t ed

 b y

 the

 gov ernmen t ar e

 the

 t w o

 main

 driv ers

 o f

 the

 slo w do wn

 in

 medical

 tr end

 f or

 Latin

 Americ a

 Asia

 P acific

 Europe

 Middle

 East and

 A fric a

 1%

 3%

 1%

 Significantly

 lowe r

 4%

  1%

  2%

  L owe r

 About

 the

 same

 2020

 and

 20 21.

 Demand

 f or medical

 t ourism fr om

 mainland China

 has

 als o

 dr opped

 due

 t o

 the

 tr a v el

 r es trictions

 and s ocial

 unr es t

 in

 Hong

 K ong.

 Higher

 Significantly

 higher

 54%

 Global

 Medic al

 T r end

  3

 30%

 63 %

 37 %

 71%

 21 %

 6%

 39%

 49%

 11%

 11%

 87%

 The

 r egion

 sho w s

 a

 signific an t

 dr op

 in

 tr end

 t o

 6 .2 % in

 2020 ,

 but

 this

 will spring back

 abo ve

 the

 20 19

 tr end t o

 a

 pr oject ed

 8.5 %

 in

 20 21.

 %

 20%

 40%

 60%

 80%

 100%

 3%

 4%

 Figur e

 3: G lobal

 a v er age

 medic al

 tr end

 r a tes

 b y

 coun tr y ,

 2 0 19

 – 2 0 2 1

  C oun tr y

 G r os s

 cos t

 tr end

 Ne t

 cos t

 tr end

 (o f

 gener al

 in flation)

  2 01 9

 2020

 2 02 1

 2 01 9

 2020

 2 02 1

 Global^

 7 .1 6

 5.88

 8. 12

 5. 13

 4. 60

 6 .1 7 La tin

 Americ a^

 10 .83

 8 .97 13. 63

 5 .7 5

 6. 62

 11. 17

 North

 Americ a

 5.55

 2 .7 6

 7 .1 3

 3. 65

 2. 15

 5.50

 A sia

 P acific

 7. 4 7 6 .22 8.50

 5.88

 5. 10

 6. 78

 E ur ope

 5.58

 4.2 4

 5 .7 6

 4 .0 2

 3.27

 4. 15

 Middle

 Eas t/ A fric a

 8. 65

 8. 66

 1 0.0 1

 7 .39

 6 .9 4

 6 .9 8

 L a tin

 Americ a

 Ar gen tina *

 56 . 99

 4 7 .29

 60 .50

 3. 44

 28.85

 4 7. 7 5

 Barbados

 and

 Eas t

 Caribbean

 1 0.0 0

 1 0.0 0

 1 0.0 0

 5. 90

 5.54

 8.39

 Br azil*

 11. 96

 9 .38

 11.5 1

 8.23

 5.82

 8.21

 Chile*

 4.88

 3. 18

 4 .07

 2. 63

 -0 . 19

 1. 14

 Colombia *

 6 .27

 6. 89

 6. 92

 2 .7 5

 3.38

 3. 71

 Cos ta

 Ric a *

 7. 00

 8. 00

 9 .25 4. 90

 6 .4 6

 7. 00

 E cuador

 12. 00

 12. 00

 12. 00

 11. 73

 12. 0 1

 10 .84

 El

 Salv ador *

 7. 4 3

 1 0.0 0

 7. 7 1

 7 .35

 9. 94

 7 .1 1

 Gua t emala *

 8. 00

 8.83

 11.8 0

 4.30

 7. 00

 1 0.0 2

 Hondur as *

 6 .1 7 7. 9 8

 9 .67 1.8 0

 4.83

 6. 69

 Me xico *

 9 .30

 11.50

 11. 71

 5. 66

 8.8 0

 8. 93

 Nicar agua

 1 0.0 0

 12. 00

 15. 00

 4 .6 2

 7 .53

 11. 04

 P anama *

 1 0 .67 11. 00

 9 .4 0

 11. 0 2

 11. 91

 8. 90

 P eru

 5. 00

 6 .0 0

 8. 00

 2.8 6

 4.29

 6 .21

 Puert o

 Rico

 5. 00

 -6 . 00

 18. 00

 4.27

 -4. 45

 17 .36

 T rinidad

 and

 T obago

 1 0.0 0

 1 0.0 0

 1 0.0 0

 9 .0 0

 11. 00

 8. 72

 V ene zuela

 85. 00

 150 . 00

 250 . 00

 - 19821. 0 2

 - 14850 . 00

 - 14 7 50 . 00

 Nor th

 Americ a

 Canada

 4. 17

 0 .1 3

 7. 0 3

 2.22

 - 0.4 8

 5 .7 6

 Unit ed

 Stat es#

 7. 9 1

 7. 2 4

 7 .30

 6 .1 0

 6. 62

 5. 06

 A sia

 P acific

 A us tr alia

 6 .50

 6 .0 0

 6 .0 0

 4.8 9

 4.5 7 4. 18

 China *

 8. 68

 9 .1 0

 9 .32

 5 .7 8

 6 .0 6

 6 .7 7 Hong

 K ong*

 8. 16

 6 . 24

 6 .6 8

 5.30

 4.2 4

 4. 18

 India *

 7. 8 0

 12. 00

 1 0.0 0

 3.26

 8. 66

 6 .38

 Indonesia*

 10 .33

 9 .97 12. 00

 7. 5 1

 7 .1 0

 9 .0 6

 Mala y sia *

 10 . 64

 10 .82

 12.55

 9 .97 10 . 71

 9 .7 5

 Ne w

 Z ealand

 5. 60

 - 2. 00

 2 0.0 0

 3. 98

 -3.22

 18. 6 2

 Philippines *

 7. 7 5

 8.50

 8.82

 5.27 6. 78

 5. 94

 Singapor e *

 7. 6 7 7. 6 7 8. 17

 7 .1 0

 7 .84

 7. 6 5

 South K or ea

 7. 00

 5. 00

 4. 00

 6. 62

 4. 73

 3.55

 Sri

 Lank a

 5. 00

 5. 00

 5. 00

 0 .7 0

 0 .34

 0 .35

 T aiw an *

 4. 00

 4. 00

 4. 00

 3. 46

 3.50

 2.50

 Thailand

 7. 00

 7 .50

 8. 00

 6 .29

 8.56

 7. 44

 Vie tnam *

 12. 93

 10 . 13

 10 . 15

 10 . 13

 6 .9 3

 6 .25 4

 willis to w ers w a t son. com

 C oun tr y

 G r os s

 cos t

 tr end

 Ne t

 cos t

 tr end

 (o f

 gener al

 in flation)

  2 01 9

 2020

 2 02 1

 2 01 9

 2020

 2 02 1

 E ur ope

 B elgium

 2. 00

 2.50

 3. 00

 0 .7 5

 2.25

 1. 91

 Cyprus 5. 00

 0.0 0

 1. 00

 4. 44

 - 0 .7 0

 0.0 0

 Denmark

 5.50

 6 .50

 4.50

 4 .7 7 5.8 0

 3.30

 F r ance

 4. 17

 1. 03

 2.30

 2.8 7 0 .7 5

 1. 60

 German y

 5. 00

 7. 00

 7. 00

 3. 65

 6 .6 8

 5.82

 Gr eece

 4.50

 4.50

 4 .7 5

 3. 98

 4. 96

 3 . 74

 Hungary

 1 0.0 0

 1 0.0 0

 1 0.0 0

 6 .6 3

 6 .6 6

 6 .83

 Ir eland

 4 .47 1. 43

 8.33

 3.5 9

 1. 03

 6 .6 3

 Norw a y *

 5.27 5. 99

 6 .4 3

 3. 10

 3.5 9

 4.23

 P oland*

 5.85

 6 .50

 7 .33

 3.54

 3.28

 4 .7 5

 P ortugal*

 3 .7 9

 - 1.83

 3 .97 3. 49

 - 1. 63

 2 .6 2

 R omania *

 12. 6 2

 10 .33

 11.50

 8 .7 9

 8 .0 9

 1 0.0 5

 Russia

 7.25 1 0.0 0

 11. 00

 2 .7 8

 6 .9 1

 8 .0 1

 Serbia

 7 .50

 7 .50

 15. 00

 5. 65

 6 .0 6

 13. 06

 Spain

 2.85

 1. 93

 4 .7 5

 2. 15

 2.23

 4. 10

 S w eden

 9 .0 0

 6 .0 0

 7 .50

 7 .30

 5.54

 5 .97 S witz erland

 4. 00

 1.50

 1. 00

 3. 64

 1.8 9

 0.4 0

 T urk e y

 23.25

 17 .50

 16 . 00

 8 .07

 5.50

 4. 00

 Unit ed

 Kingdom

 5 .67 6 .33

 6 .50

 3.88

 5. 15

 4. 96

 Middle

 Eas t

 and

 A fric a

 Bahr ain

 7. 00

 7. 00

 7. 00

 6 .0 0

 4. 40

 4.50

 Burkina F as o

 0 .50

 15. 00

 1 0.0 0

 3. 73

 11.8 0

 7. 9 0

 Camer oon *

 3.50

 6 .25 4. 00

 1. 05

 3. 45

 1 .7 5

 Co t e

 d"Iv oir e

 15. 00

 15. 6 7 18.33

 14. 19

 14. 4 7 16 . 93

 E gyp t*

 12. 13

 10 .88

 12.33

 -1 . 7 4

 5.0 2

 4. 10

 Gabon

 19 .50

 21.50

 25. 00

 17 . 48

 18.50 22. 00

 Ghana

 12. 17

 14. 6 7 17 . 17

 4. 96

 5.0 1

 8 .6 2

 Guinea

 1 0.0 0

 5. 00

 3. 00

 0 .53

 -3.50

 -5. 00

 Jor dan

 7. 00

 0.0 0

 4. 00

 6 .7 0

 -0 .20

 2. 40

 Ke n y a

 8.50

 6 .50

 9 .0 0

 3.30

 1. 40

 4. 00

 K uwait

 5. 00

 7 .50

 1 0.0 0

 3. 90

 7. 00

 7. 7 0

 Madagas c ar

 25. 00

 2 0.0 0

 3 0.0 0

 19 .38

 14.50

 23.50

 Mo zambique

 7. 00

 5. 00

 5. 00

 4.22

 -0 . 19

 -0 . 71

 Nigeria

 17 .33

 14. 6 7 18. 6 7 5. 94

 1.27

 6 .30

 Oman

 4.50

 4.50

 5.50

 4.3 7 3.50

 2. 10

 Saudi

 Ar abia

 1 0.0 0

 1 0.0 0

 12. 00

 11.21

 9 .1 3

 1 0.04

 Senegal

 1 0.0 0

 15. 00

 15. 00

 8. 98

 13. 00

 13. 0 8

 South A fric a

 6 .50

 6 .0 0

 6 .0 0

 2.3 7 3.5 7 2.84

 T ogo

 5. 00

 8. 00

 1 0.0 0

 4.31

 6 .0 0

 8. 00

 Uganda

 2 0.0 0

 1 0.0 0

 15. 00

 17 . 13

 6 .0 6

 10 . 15

 Unit ed

 Ar ab

 Emir a t es

 9 .0 0

 8. 00

 8. 00

 10 . 93

 9 .0 0

 6 .50

 Z ambia

 15. 00

 2 0.0 0

 25. 00

 5.20

 6 .6 0

 12. 95

 * Coun tries

 with

 signific an t

 (5+)

 participa tion.

 ^Due

 t o

 the

 h yperin fla tionary

 na tur e

 o f

 the

 V ene zuelan

 econom y ,

 V ene zuela

 has

 been

 e x cluded

 fr om

 La tin

 Americ a

 r egional

 and

 global

 t o tals.

 #Unit ed

 Sta t es

 da ta

 is

 fr om

 v arious y ears o f

 the

 Willis

 T o w ers

 W a ts on

 Na tional

 T r end

 Surv e y .

 Global

 Medic al

 T r end

  5

 A sia

 P acific

 ( con tin u ed)

 India .

 India

 has

 no t

 s een

 the

 s ame

 r eduction

 in

 tr end

 as o ther coun tries

 ha ve

 f or 2020 .

 While

 utiliza tion

 decr eas ed

 during part

 o f

 the

 y ear

 (April

 t o

 July ),

 India

 is

 curr en tly

 in

 a

 situa tion with

 lo w

 claim

 fr equency

 and

 a v er age

 cos t

 o f

 pr ocedur es incr easing

 ( due

 t o

 the

 cos t

 impact

 o f

 CO VID- 19

 pr ec autions on

 non-CO VID- 19

 claims).

 A t

 the

 s ame

 time ,

 the

 tr ea tmen t and

 pricing

 pr o t ocol

 o f

 medical

 c ar e

 is

 no t

 r egula t ed

 in

 India, and

 hospital

 billing

 pr actices

 con tinue

 t o

 pos e

 a

 challenge .

 The

 gov ernmen t

 did,

 how ev er ,

 tak e

 s ome

 small

 measur es t o

 issue

 guidelines

 ar ound

 pricing

 f or CO VID- 19

 t es ts

 and

 tr ea tmen ts,

 which

 helped

 with

 cos t

 managemen t

 t o

 an

 e x t en t .

  The

 y ear

 20 21

 could

 s ee

 an

 incr eas ed

 r a t e

 o f

 tr end,

 higher than

 pr o visionally

 r eport ed,

 as utiliza tion

 s tarts

 t o

 r e turn t o

 normal

 le v els;

 how ev er ,

 w e

 als o

 ma y

 s ee

 an

 incr eas ed a w ar eness

 in

 the

 ar eas

 o f

 pr ev en tion

 and

 w ellbeing,

 and a

 rising

 tr end

 in

 f a v or o f

 home

 c ar e

 r a ther

 than

 immedia t e hospitalization

 f or medical

 tr ea tmen ts,

 which

 could

 help mitiga t e

 a

 lar ger

 po t en tial

 incr eas e .

  Indonesia .

 Medic al

 tr end

 r a t es

 in

 Indonesia

 ar e

 pr oject ed

 t o be

 sligh tly

 lo w er in

 2020 ,

 no t

 only

 bec aus e

 o f

 the

 impact

 o f CO VID- 19

 on

 r educed

 electiv e

 pr ocedur es

 but

 als o

 due

 t o v arious o ther

 f act ors,

 including

 the

 incr eas ed

 utiliza tion

 o f BP JS

 K es eha tan

 ( univ ers al

 health

 insur ance)

 especially

 f or chr onic / critic al

 illness es

 and

 ongoing

 cos tly

 tr ea tmen ts.

 This allow s

 insur ers

 t o

 split

 their

 risk

 with

 the

 gov ernmen t

 and

 will help

 s tabiliz e

 futur e

 medical

 tr end

 r a t es. The

 BP JS

 K es eha tan als o

 pr o vides

 cov er age

 o f

 all

 medical

 tr ea tmen ts

 r ela t ed

 t o CO VID- 19 ,

 which

 helps

 t o

 s tabiliz e

 the

 tr end

 r a t es

 despit e

 the e xpect ed

 con tinued

 demand

 f or priv a t e

 health

 c ar e .

  Mala y sia .

 Medic al

 tr end

 in

 Mala y sia

 is

 e xpect ed

 t o

 con tinue its

 ris e

 albeit

 a t

 a

 slo w er pace

 compar ed

 with

 pr e vious y ears.

 F or 2020 ,

 the

 number

 o f

 doct or visits

 and

 admissions dr opped

 signific an tly

 during

 Mar ch

 and

 April

 due

 t o

 the

 gov ernmen t -impos ed

 lock do wn

 (MCO),

 which

 has

 c aus ed

 the o v er all

 tr end

 t o

 decr eas e .

 During

 this

 period,

 man y

 electiv e sur geries w er e

 pos tponed.

 F or outpa tien t

 c ar e ,

 ther e

 has been

 a

 big

 dr op

 in

 specialis t

 c ar e

 visits;

 a t

 the

 primary

 c ar e le v el,

 ther e

 has

 been

 a

 dr op

 in

 less

 acute

 visits,

 with

 pa tien ts turning

 t o

 t elemedicine .

 F or pa tien ts

 with

 chr onic

 conditions, the

 le v el

 o f

 visits

 has

 been

 lar gely

 main tained,

 as thes e

 ar e gener ally

 “una voidable .”

  All o f

 this

 means

 tha t

 ther e

 is

 a

 paus e

 in

 2020

 tr end compar ed

 with

 20 19 ,

 but

 an

 up tick

 is

 e xpect ed

 in

 Q4 2020 and

 in

 20 21

 t o

 c a t ch

 up

 on

 dela y ed

 pr ocedur es.

  6

 willis to w ers w a t son. com

 Medic al

 tr end

 in

 E ur ope

 has

 decr eas ed

 t o

 4.2 %

 f or 2020 ,

 but

 a

 r ebound

 is

 e xpect ed

 in

 20 21

 t o

 a

 tr end r a t e

 clos e

 t o

 the

 20 19

 le v el

 o f

 5.8%.

 Philippines .

 Priv a t e

 medical

 c ar e

 in

 the

 Philippines

 is

 lar gely domina t ed

 b y

 an

 HMO

 model,

 which

 accoun ts

 f or 8 0%

 o f plans.

 While

 the

 fr equency

 o f

 inpa tien t

 and

 outpa tien t

 claims has

 de finit ely

 decr eas ed

 in

 2020 ,

 the

 a v er age

 amoun ts

 per inpa tien t

 and

 outpa tien t

 claims

 ar e

 rising.

 In

 addition,

 v arious ph ysician

 or ganiza tions

 nego tia t ed

 with

 HMO

 ass ocia tions and

 w er e

 gr an t ed

 a

 50%

 incr eas e

 in

 f ees

 commencing

 Ma y 27 ,

 2020 ,

 os t ensibly

 t o

 cov er the

 cos t

 o f

 PPE .

 This

 cos t incr eas e

 is

 e xpect ed

 t o

 r emain

 in

 place

 f or the

 dur a tion

 o f

 the pandemic.

 Ph ysician

 f ees

 ar e

 r oughly

 30%

 o f

 t o tal

 spend.

  Ov er all

 this

 helps

 e xplain

 wh y

 tr end

 r a t es

 in

 the

 Philippines ha ve

 edged

 up

 f or 2020

 t o

 8.5 %

 fr om

 7 .8%

 in

 20 19

 and

 ar e pr oject ed

 t o

 con tinue

 incr easing

 f or 20 21,

 although

 con tinued dela y

 in

 tr ea tmen t

 in

 2020

 could

 mean

 an

 ev en

 lar ger incr eas e

 in

 20 21

 than

 pr oject ed.

  Singapor e.

 Insur ers

 ha ve

 tak en

 quit e

 a

 conserv a tiv e

 vie w

 on medical

 in fla tion

 f or 2020

 and

 20 21,

 mainly

 due

 t o

 dela y ed electiv e

 sur gic al

 pr ocedur es

 and

 an

 emplo y er f ocus

 on men tal

 health,

 wellbeing

 and

 virtual

 s olutions.

 Ov er all

 tr end

 is s till

 ho v ering

 in

 the

 7 %

 t o

 8%

 r ange

 f or 2020

 and

 20 21.

  W ellbeing

 s olutions

 include

 ensuring

 emplo y ees

 ar e

 able t o

 w ork

 e ff ectiv ely

 fr om

 home ,

 and

 quality

 t elehealth

 has become

 one

 o f

 the

 k e y

 priorities

 tha t

 emplo y ers

 ar e

 k een t o

 in tr oduce

 t o

 their

 w ork -fr om-home

 emplo yees.

 Some medical

 pr o viders ar e

 o ff ering

 home

 health

 s cr eenings

 and v accina tions

 t o

 emplo y ees

 as w ell

 as their

 dependen ts.

  E ur ope

 F r ance.

 A

 signific an t

 dr op

 in

 utiliza tion

 and

 medical

 claims

 in

 2020

 c an

 be

 a t tribut ed

 t o

 the

 April

 lock do wn

 period. Although

 utiliza tion

 has

 s tart ed

 t o

 ris e

 again,

 o v er all

 w e e xpect

 a

 r eduction

 o f

 5 %

 in

 medical

 claims

 b y

 the

 end

 o f 2020 .

 This

 is

 r e flect ed

 in

 the

 decr eas e

 in

 medical

 tr end

 fr om 4.2 %

 in

 20 19

 t o

 1%

 in

 2020 .

 Ne v ertheless, insur ers

 pr oject tha t

 this

 r a t e

 will s tart

 t o

 incr eas e

 in

 20 21,

 rising

 t o

 2.3%.

 Utiliza tion

 is

 e xpect ed

 t o

 ris e

 in

 20 21

 due

 t o

 the

 impact

 o f dela y ed

 s ervices

 and

 pr ocedur es

 in

 2020 .

 In

 addition,

 o ther f act ors

 ar e

 po t en tially

 driving

 an

 incr eas e

 in

 20 21

 medical tr end,

 including

 the

 in tr oduction

 o f

 a

 CO VID- 19

 tax,

 which

 the

 gov ernmen t

 has

 decided

 insur ers

 should

 pa y

 as a

 ne w additional

 tax.

 This

 tax

 o f

 2. 6%

 f or 2020

 and

 1.3%

 f or 20 21

 is bas ed

 on

 claims

 paid

 in

 thes e

 t w o

 y ears.

 W e

 e xpect

 insur ers will w an t

 emplo y ers

 t o

 finance

 this

 tax,

 which

 could

 lead

 t o further pr emium

 incr eas es

 in

 20 21.

 Ther e

 is

 als o

 the

 impact

 o f

 “portability ,”

 which

 allow s

 dismiss ed

 emplo y ees

 t o

 main tain their

 medical

 cov er age

 f or 12

 mon ths

 af t er lea ving

 a

 compan y . This

 is

 a

 legal

 arr angemen t

 financed

 b y

 activ e

 w orkers,

 which could

 lead

 t o

 incr eas ed

 con tributions.

 Las tly

 the

 s o-c alled “ 100%

 San t é ”

 legal

 change

 ( elimina ting

 out -o f -pock e t

 cos ts f or den tal,

 op tic al

 and

 audit ory c ar e)

 w as implemen t ed

 on January

 1,

 2020 ,

 and

 will be

 deplo y ed

 within

 the

 ne x t

 s ev er al mon ths

 f or hearing

 aids.

 This

 will lead

 t o

 an

 incr eas e

 in

 claim r eimburs emen t

 and

 a

 po t en tial

 incr eas e

 in

 tr end.

  Nor w a y .

 Medic al

 tr end

 in

 Norw a y

 con tinues t o

 edge

 up w ar d f or 2020

 and

 20 21.

 In

 part ,

 this

 is

 driv en

 b y

 us e

 o f

 mor e e xpensiv e

 tr ea tmen ts

 and

 o v erus e

 o f

 c ar e .

 Otherwis e

 w e s ee

 a

 rising

 us e

 o f

 ps y chologic al

 s ervices

 with

 the

 incr easing a w ar eness

 o f

 men tal

 and

 beha vior al

 health

 conditions.

  Ho w ev er ,

 ther e

 is

 hope

 tha t

 the

 gr o wing

 us e

 o f

 digital s olutions

 and

 online

 s ervices

 will help

 mitiga t e

 s ome

 o f

 the futur e

 incr eas e

 in

 tr end.

 In

 addition,

 s ome

 o f

 the

 insur ers

 in the

 Norw egian

 mark e t

 ar e

 considering

 o ff ering

 diff er en tia t ed pr oducts

 t o

 diff er en t

 age

 gr oups

 t o

 mee t

 the

 challenge

 o f o v erus e

 o f

 s ervices

 in

 certain

 age

 gr oups.

  P or tugal.

 Ther e

 is

 a

 signific an t

 dr op

 in

 utiliza tion

 in

 P ortugal driv en

 b y

 CO VID- 19 ,

 with

 a

 lar ge

 majority

 o f

 the

 cov er ed popula tion

 de f erring

 doct or consulta tions, tr ea tmen ts

 and e x ams.

 This

 is

 r esulting

 in

 a

 nega tiv e

 tr end

 r a t e

 in

 2020 .

 Ne v ertheless, medical

 tr end

 is

 e xpect ed

 t o

 r e turn t o

 20 19 le v els

 in

 20 21,

 as cov er ed

 emplo y ees

 r es chedule

 dela y ed pr ocedur es

 and

 tr ea tmen ts.

 The

 po t en tial

 e xis ts

 f or health complic a tions

 and

 incr eas ed

 cos ts

 in

 futur e

 y ears due

 t o

 the dela y ed

 tr ea tmen ts

 and

 ther apies.

  T urk e y .

 A side

 fr om

 the

 impact

 o f

 CO VID- 19 ,

 the

 loc al curr ency

 r emains

 w eak .

 E conomic

 indic a t ors

 pr edict con tinued

 incr eas e

 in

 gener al

 in fla tion

 and

 fluctua tion

 in curr ency

 r a t es. This

 has

 a

 dir ect

 e ff ect

 on

 medical

 s ervices pricing

 and

 could

 mean

 the

 actual

 tr end

 is

 higher

 than

 wha t

 is being

 r eport ed.

  Global

 Medic al

 T r end

  7

 This

 r egion

 has

 the

 highes t

 medical

 tr end

 numbers f or 2020

 and

 20 21.

 E v en

 e x cluding

 the

 en vir onmen t o f

 h yperin fla tion

 in

 V ene zuela,

 w e

 s ee

 pr oject ed

 tr end numbers

 o f

 9 . 0%

 f or 2020

 and

 a

 lar ge

 jump

 t o

 13. 6% in

 20 21.

  T elemedicine

 f or outpa tien t

 c ar e

 w as implemen t ed

 b y a

 f e w

 big

 insur ers

 during

 the

 pandemic.

 CO VID- 19

 w as initially

 e x cluded

 fr om

 health

 insur ance

 policies;

 how ev er , af t er the

 gov ernmen t

 declar ed

 the

 priv a t e

 hospitals as pandemic

 hospitals in

 April

 and

 insur ers

 made

 the

 decision t o

 cov er CO VID- 19

 tr ea tmen ts

 a t

 priv a t e

 hospitals ( as a complemen tary

 cov er age

 t o

 s ocial

 s ecurity ),

 T urkish

 citiz ens with

 priv a t e

 health

 insur ance

 policies

 s tart ed

 using

 the

 priv a t e hospitals f or tr ea tmen t .

 A s

 o f

 July 2020 ,

 the

 gov ernmen t

 has now

 paus ed

 the

 us e

 o f

 priv a t e

 f acilities

 in

 this

 w a y ;

 how ev er ,

 it

 is

 e xpect ed

 tha t

 the

 gov ernmen t

 ma y

 r eimplemen t

 this appr oach.

  With

 pr o fit -sharing

 in

 place ,

 man y

 clien ts

 could

 r eceive dividends

 or e xperience

 r a ting

 r e funds

 f or the

 2020

 policy y ear .

 Some

 insur eds

 ar e

 looking

 t o

 add

 additional

 bene fits

 lik e limit ed

 ps y chologic al

 ther ap y

 s essions

 or die tician

 s ervices; how ev er ,

 thes e

 additions

 will need

 t o

 be

 balanced

 agains t po t en tial

 utiliza tion

 incr eas es

 in

 20 21.

  U .K .

 Medic al

 tr end

 in

 the

 U .K .

 con tinues t o

 edge

 up w ar d despit e

 the

 impact

 o f

 CO VID- 19

 in

 2020 .

 Con tributing

 f act ors include

 a

 ma turing

 insur ed

 demogr aphic

 and

 aging

 w orkf or ce as w ell

 as incr eas ed

 demand

 f or priv a t e

 health

 c ar e

 as a r esult

 o f

 challenges

 with

 accessing

 the

 na tional

 health

 s ervice (NHS).

 In

 addition,

 w e

 ar e

 s eeing

 the

 impact

 o f

 high-cos t tr ea tmen ts,

 such

 as ne w

 gener a tion

 c ancer

 drug

 ther apies and

 wider

 a v ailability

 o f

 mor e

 comple x

 medical

 tr ea tmen ts.

  The

 impact

 o f

 CO VID- 19

 on

 bo th

 c apacity

 and

 demand

 in 2020

 and

 the

 an ticipa t ed

 c a t ch-up

 in

 20 21

 r emain

 unclear . It

 is

 e xpect ed

 tha t

 con tinued

 pos tponemen t

 o f

 nonur gen t tr ea tmen ts

 and

 gr o wing

 waiting

 lis ts

 ar e

 possible in

 the NHS ,

 r esulting

 in

 incr eas ed

 utiliza tion

 o f

 priv a t e

 health

 c ar e pr o viders and

 plans.

 A dditional

 CO VID- 19

 cos ts

 s till

 t o

 be

 consider ed

 include

 PPE

 cos ts,

 additional

 cleaning

 pr ocedur es and

 higher

 sur gic al

 cos ts

 per

 tr ea tmen t

 t o

 o ff s e t

 the

 r educed number

 o f

 pr ocedur es

 perf ormed

 in

 2020 .

 L a tin

 Americ a

  Ar gen tina .

 High

 in fla tion

 con tinues t o

 be

 one

 o f

 the

 k e y f act ors

 driving

 medical

 tr end

 in

 Ar gen tina.

 In

 addition,

 the de valua tion

 o f

 the

 Ar gen tine

 curr ency

 agains t

 the

 U . S .

 dollar and

 health

 c ar e

 s alary

 gr o w th

 ar e

 t w o

 o ther

 f act ors

 tha t

 ha ve had

 a

 mark ed

 impact

 on

 the

 incr eas e

 in

 medical

 cos ts

 during the

 pas t

 f e w

 y ears.

  The

 es tima t ed

 2020

 medical

 tr end

 is

 lo w er than

 20 19 and

 pr oject ed

 20 21,

 r e flecting

 the

 impact

 o f

 CO VID- 19

 on utiliza tion

 in

 2020

 as w ell

 as the

 slo wing

 o f

 s ome

 o f

 the health

 c ar e

 s alary

 incr eas es

 due

 t o

 economic

 challenges in

 2020 .

  Br azil. Similar

 t o

 o ther

 coun tries,

 ther e

 w as a

 signific an t r eduction

 in

 the

 utiliza tion

 o f

 health

 r es ources

 in

 2020

 due

 t o CO VID- 19 ,

 i. e .,

 f e w er electiv e

 appoin tmen ts

 and

 emer gency r oom

 visits,

 ther apies,

 e x ams

 and

 hospitaliza tions. This

 r esults in

 a

 single-digit

 tr end

 number

 o f

 9 . 4 %

 f or 2020 ,

 s ome thing tha t

 has

 no t

 been

 s een

 in

 a

 long

 while

 in

 Br azil.

 Insur ers

 ha ve

 been

 r equir ed

 b y

 the

 ANS

 (Health

 Na tional

 A gency )

 t o cov er cos ts

 r ela t ed

 t o

 CO VID- 19

 and

 t o

 apply

 a

 fr ee z e

 t o

 an y pr emium

 adjus tmen ts

 fr om

 Sep t ember

 2020

 un til

 the

 end

 o f

 2020 .

  It

 is

 pr oject ed

 tha t

 the

 tr end

 will r e turn t o

 double

 digits in 20 21

 as demand

 and

 utiliza tion

 incr eas e;

 how ev er ,

 the

 r a t e

 o f tr end

 is

 no t

 e xpect ed

 t o

 r each

 the

 s ame

 le v els

 as prior y ears

  8

 willis to w ers w a t son. com

 This

 r egion

 w as the

 only

 one

 no t

 t o

 sho w

 a

 major decr eas e

 in

 medical

 tr end

 f or 2020

 compar ed

 with

 20 19 . The

 tr end

 f or 2020

 is

 e xpect ed

 t o

 be

 8.7 %,

 the

 s ame

 as f or 20 19 .

 F or 20 21

 w e

 e xpect

 an

 incr eas e

 t o

 10%.

 due

 t o

 s ev er al

 f act ors.

 One

 f act or is

 the

 economic

 r ecession and

 ano ther

 is

 the

 in tr oduction

 o f

 t elehealth.

 Appr o v ed

 as a t empor ary

 pr o vision this

 y ear ,

 t elehealth

 is

 e xpect ed

 t o

 be made

 permanen t

 and

 impr o ve

 utiliza tion

 and

 access

 f or s ome while

 helping

 manage

 cos ts.

 One

 o ther

 f act or is

 tha t

 the

 ANS will be

 r e vie wing

 the

 minimum

 obliga t ory cov er ages

 in

 medical plans,

 which

 ma y

 impact

 tr end.

  Chile.

 The

 incr eas e

 in

 health

 c ar e

 cos ts

 f or 20 21

 is

 pr oject ed a t

 4. 1%.

 This

 r epr es en ts

 a

 lo w er tr end

 than

 tha t

 obs erv ed

 in 20 19

 ( 4. 9%)

 and

 higher

 than

 the

 2020

 tr end

 wher e

 medical cos ts

 ha ve

 been

 signific an tly

 aff ect ed

 b y

 the

 CO VID- 19 pandemic.

  F or 2020 ,

 f ace-t o-f ace

 medical

 and

 den tal

 consulta tions

 ha ve

 decr eas ed,

 with

 a

 50%

 dr op

 in

 the

 fr equency

 o f

 thes e activities

 compar ed

 with

 the

 s ame

 period

 in

 20 19 .

 A dditionally , certain

 lo w -risk

 hospital

 pr ocedur es

 w er e

 pos tponed, especially

 in

 the

 firs t

 mon ths

 o f

 the

 pandemic.

 Mor eov er , t elehealth

 s ervices

 and

 online

 men tal

 health

 s ervices

 ha ve

 incr eas ed.

  Ho w ev er ,

 f or 20 21,

 it

 is

 e xpect ed

 tha t

 the

 incr eas e

 in

 medical cos ts

 will r e turn t o

 20 19

 le v els. This

 r e flects the

 an ticipa t ed impact

 o f

 adv ances

 in

 medical

 t echnology

 and,

 in

 particular , the

 e xpect ed

 pr o vision o f

 an

 e ff ectiv e

 vaccine

 agains t CO VID- 19 .

  Me xico .

 Me xico

 has

 no t

 y e t

 s een

 the

 full

 e ff ect

 o f

 CO VID- 19 on

 medical

 tr end.

 This

 ma y

 come

 in

 the

 firs t

 mon ths

 o f

 20 21. Ov er all,

 the

 medical

 tr end

 r a t e

 is

 s till

 pr oject ed

 t o

 incr eas e in

 2020

 compar ed

 with

 20 19 .

 The

 number

 o f

 pa tien ts

 using hospital

 s ervices

 has

 decr eas ed

 sligh tly

 in

 20 20;

 how ev er , the

 depr ecia tion

 o f

 the

 Me xic an

 pes o

 v ersus

 the

 U . S .

 dollar signific an tly

 aff ect ed

 cos ts

 o f

 import ed

 medical

 de vices

 and hospital

 supplies,

 which

 con tinue

 t o

 driv e

 tr end.

  In

 addition,

 demand

 f or priv a t e

 health

 c ar e

 r emains

 high, particularly

 as the

 public

 health

 s y s t em

 has

 been

 besieged

 b y CO VID- 19

 c as es

 and

 als o

 bec aus e

 o f

 a

 shortage

 o f

 medicines in

 the

 public

 s ect or .

 A gr eemen ts

 ha ve

 been

 made

 t o

 allow s ome

 pa tien ts

 fr om

 the

 public

 s y s t em

 t o

 r eceive

 medical a tt en tion

 in

 priv a t e

 hospitals due

 t o

 the

 lack

 o f

 a v ailable

 beds in

 public

 hospitals.

 A s

 a

 r esult ,

 cos ts

 and

 tr end

 in

 the

 priv a t e health

 s ect or con tinue

 t o

 incr eas e

 and

 ar e

 e xpect ed

 t o

 ris e

 t o double

 digits in

 2020

 and

 20 21.

 Middle

 Eas t

 and

 A fric a

  E gyp t .

 E gyp t’ s

 tr end

 r emains

 in

 the

 double

 digits.

 While 2020

 sho w s

 a

 slight

 r eduction

 in

 tr end

 compar ed

 with

 20 19 , it

 is

 no t

 as lar ge

 as tha t

 o f

 s ome

 o ther

 coun tries

 tha t

 ar e s eeing

 a

 decr eas e

 in

 tr end

 due

 t o

 the

 impact

 o f

 CO VID- 19 . The

 E gyp tian

 gov ernmen t

 has

 es tablished

 a

 fund

 t o

 cov er CO VID- 19 ,

 which

 limits

 the

 e ff ects

 o f

 the

 pandemic

 on

 medical tr end.

 Ins t ead,

 gener al

 in fla tion

 con tinues t o

 be

 the

 major f act or driving

 medical

 tr end.

 While

 the

 economic

 situa tion

 is s tabilizing,

 it

 is

 s till

 pr oject ed

 tha t

 tr end

 will r e turn t o

 a

 r a t e

 in e x cess

 o f

 12 %

 f or 20 21.

  Gulf

 coun tries

 (Gulf

 C ooper a tion

 C ouncil

 coun tries : B ahr ain,

 K uw ait ,

 Oman,

 Saudi

 Ar abia ,

 United

 Ar ab Emir a tes).

 While

 medical

 tr end

 in

 the

 Gulf

 coun tries

 has decr eas ed,

 w e

 e xpect

 t o

 s ee

 a

 gr ea t er impact

 fr om

 CO VID- 19 due

 t o

 suspension o f

 electiv e

 sur geries in

 2020 ,

 f ollo w ed

 b y

 a

 higher

 r ebound

 in

 20 21,

 particularly

 in

 the

 Kingdom

 o f Saudi

 Ar abia

 (K S A)

 and

 Bahr ain.

 W e

 do

 e xpect

 an

 incr eas e

 in hospital

 unit

 cos ts

 in

 20 21

 due

 t o

 CO VID- 19

 e xpens es

 r ela t ed t o

 PPE

 supplies,

 ne w

 pr ocedur es

 and

 the

 need

 t o

 oper a t e

 a t

 lo w er c apacity

 as a

 r esult

 o f

 s ocial

 dis tancing.

 The

 us e o f

 t elehealth

 has

 incr eas ed

 in

 the

 r egion,

 which

 ma y

 help

 t o o ff s e t

 s ome

 o f

 the

 unit

 cos t

 incr eas es.

 Other

 f act ors

 t o

 consider

 going

 f orw ar d

 include

 whe ther or no t

 the

 gov ernmen ts

 will absorb

 the

 cos t

 o f

 CO VID- 19 s cr eening,

 diagnosis,

 tr ea tmen t

 and

 v accines.

 The

 U . A .E . gov ernmen t

 had

 initially

 abs orbed

 the

 cos t

 o f

 CO VID- 19

 tr ea tmen t ,

 but

 in

 s ome

 c ases, it

 is

 now

 passing

 this

 cos t

 on

 t o insur ers,

 whereas

 the

 K S A

 gov ernmen t

 is

 curr en tly

 abs orbing all

 tr ea tmen t

 cos ts.

 Other

 signific an t

 legislativ e

 initiativ es

 t o w a t ch

 include

 the

 de tails

 and

 timing

 o f

 the

 planned

 launch

 o f manda t ory medical

 insur ance

 in

 Bahr ain

 and

 Oman

 as w ell

 as the

 lik ely

 con tinued

 ev olution

 o f

 manda t ory medical

 insur ance in

 the

 U . A .E .

 ( specific ally

 in

 Abu

 Dhabi

 and

 Dubai

 with

 the possible addition

 o f

 o ther

 Emir a t es)

 and

 K S A .

 Finally ,

 ther e

 is the

 e xpect ed

 legislation

 in

 K S A

 on

 the

 dispensing

 o f

 generic

 drugs.

  Global

 Medic al

 T r end

  9

 A fric a

 — Anglophone

 coun tries .

 B ec aus e

 Nigeria

 and

 Ghana ha ve

 fluctua ting

 curr encies

 and

 do

 import

 medical

 supplies or drugs,

 w e

 s ee

 a

 tr end

 driv en

 lar gely

 b y

 gener al

 in fla tion

 and utiliza tion

 changes.

 F or Nigeria

 and

 K en y a,

 w e

 ar e

 s eeing

 a utiliza tion

 decr eas e

 in

 2020

 due

 t o

 CO VID- 19 ,

 which

 driv es medical

 tr end

 do wn

 fr om

 20 19

 le v els. But

 tr end

 r ebounds

 t o ev en

 higher

 le v els

 in

 20 21:

 18. 7 %

 in

 Nigeria

 and

 9%

 in

 K en y a. Ghana

 does

 no t

 sho w

 the

 s ame

 decr eas e

 in

 medical

 tr end

 f or 2020

 but

 r a ther

 a

 con tinued

 incr eas e

 fr om

 20 19

 t o

 20 21.

 W e ha ve

 als o

 s een

 an

 acceler a tion

 in

 us e

 o f

 t elehealth

 in

 Ghana, Nigeria

 and

 Uganda

 in

 2020 .

 It

 is

 s till

 early

 da y s

 f or t elehealth in

 thes e

 coun tries,

 but

 w e

 e xpect

 t o

 s ee

 mor e

 and

 mor e o fferings and

 pr o viders.

  A fric a

 — F r ancophone

 coun tries .

 In

 the

 F r ancophone coun tries

 (Camer oon,

 Cô t e

 d’Iv oir e ,

 Gabon,

 Guinea, Madagas c ar ,

 Senegal

 and

 T ogo )

 w e

 don ’t

 y e t

 obs erv e widespr ead

 us e

 o f

 t elehealth.

 Nor ha ve

 w e

 s een

 the

 s ame le v el

 o f

 r eduction

 in

 tr end

 f or 2020

 in

 thes e

 coun tries

 as in

 s ome

 o ther

 A fric an

 coun tries.

 Camer oon,

 Cô t e

 d’Iv oir e , Gabon

 and

 Senegal

 sho w

 incr eas es

 in

 medical

 tr end

 fr om 20 19

 t o

 2020 .

 In

 Camer oon

 medical

 tr end

 is

 slo wing

 f or 20 21,

 perhaps

 r e flecting

 a

 dela y

 in

 the

 impact

 o f

 CO VID- 19 . In

 addition,

 Camer oon

 has

 s ome

 o f

 the

 lo w es t

 medical

 claim cos ts

 in

 the

 r egion

 (pr obably

 link ed

 t o

 the

 r ange

 o f

 s ervices a v ailable

 in

 coun try )

 and

 a

 tr end

 r a t e

 o f

 only

 4 %

 t o

 6%.

  Nor th

 Americ a

 f or 20 19 ,

 this

 r esults

 in

 a

 high

 e xpect ed

 y ear -o v er - y ear

 tr end v alue

 when

 the

 e xpect ed

 20 21

 cos t

 is

 compar ed

 with

 the e xpect ed

 2020

 cos t .

  A f t er normalizing

 f or the

 e ff ects

 o f

 CO VID- 19 ,

 health

 c ar e cos ts

 in

 Canada

 ha ve

 con tinued

 t o

 incr eas e

 a t

 a

 r a t e

 gr ea t er than

 the

 r a t e

 o f

 gener al

 in fla tion.

 Some

 k e y

 f act ors

 driving cos ts

 up w ar d

 include

 the

 ongoing

 emer gence

 o f

 high-cos t biologic s/ specialty

 drugs and

 r apid

 adv ancemen ts

 o f

 health c ar e

 t echnologies

 (i. e .,

 pharmacogenomic s).

 Thes e

 up w ar d f or ces

 ma y

 be

 mitiga t ed

 b y

 implemen ting

 e fficien t

 drug...

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