2030年及以后的英国私人医疗保险

MILLIMANWHITE PAPER UKprivate medical insurancein 2030 and beyond Assessing the relevance and financialsustainability of the current proposition Joanne Buckle, FIASomya BansalCameron Kinnick,FSA An important caveat is that our analysis assumes nofundamental change with the current National Health Service(NHS)/private payer structure of healthcare in the UK.Essentially, we assume that the NHS carries on in its’currentform, as a tax-funded service available to the entire population,largely free at point of use, but without a clearly defineduniversal benefit package. Designing supplemental orcomplementary PMI products with mass market appeal isdifficult under the existing system, as there isa limiteddesignated role for privately funded healthcare within thecurrent NHS infrastructure. TheUKprivate medical insurancemarket hasundergone significanttransformation over the last few yearsandseen a boostincovered livessince2021. We examinesome current trendsand discuss our analysis demonstratingthefundamental challengesthat remainaround affordability. Trend 1: Extension of the PMIbenefit package Prior to early 2020, at the start of the worldwide COVID-19pandemic,the individual UKprivate medical insurance(PMI)market hadbeenshrinking in overall enrollmentfor manyyears, while the employer-paid market hadbeenmostlystatic.In2021, approximately11%1of the UK population was coveredby PMI, with significant concentration in London and the SouthEast of England and in more affluent segments of thepopulation. Circa three out of every four people with PMI havetheir premiums paid for by their employers,while the remainderpay their own premiums for individual (retail) policies. Post-COVID-19, the market has seen some topline growth withexpansions in all segments, including retail, small and mediumgroups and large corporate. However, the numbers are stillrelatively small in terms of percentage of population covered byPMI. In addition, a substantial part of the increase in enrollmentin the corporate sector has come from existing corporate PMIschemes broadening eligibility to a wider range of employees,rather than new corporates starting to offer PMI benefits. While the apparent UK PMI benefit package and propositionhave remained similar (typically faster access to electivesurgery and diagnostics coverage in private facilities), the mixof claims seen by the industry has altered materially in the twodecades leading up to COVID-19. Cancer claims, generallyless than 1% of claims cost 20 years ago, have, in manyportfolios, become increasingly significant, with increases inboth the frequency and average cost of claims. In 2014, only3% of cancer patients accounted for approximately one-third ofclaims costs2and earlier analysis showed that a significantproportion of these claims (approximately 75%) was directlydue to the cancer treatment.3This is mainly due to theincreasing availability of new and expensive specialty drugs,which have helped move cancer from a chronic condition,largely not covered by PMI insurers, to an “acute” condition. In the wake of COVID-19, the claims cost mix has changed again,with materially higher mental health utilisation, higher frequenciesof diagnostic services and significantly higher usage of what wereonce peripheral and scarcely used benefits, such as online andtelephone general practitioner (GP) and counselling services. Atthe same time, well-documented NHS access problems4havedriven a greater proportion of people to use their PMI coveragewhere perhaps once they would have accessed the NHS forhealth needs in the first instance. The increases in utilisation seemunlikely to keep accelerating at the recent elevated rates,butequally it seems unlikely that the level of claims for diagnostics,mental health and primary care services will fall back to pre-pandemic norms. In this paper, we examine key trends in the UK PMI market andoffer thoughts on the direction of these trends. The purpose ofthis paper is to highlight considerations around the futurestrategic direction of the UK PMI market to help product andproposition development. We consider what these trends meanfor the benefit design, customer service proposition and futureaffordability for both companies and individual/retail customers.We present the results of a series of interviews we carried outwith experts in the industry to supplement our insights into thefuture direction of trends and drivers shaping the industry, aswell as our affordability analysis. We conducted around circa20 interviews with market stakeholders, including providers,established insurers and underwriters, technology providersand start-ups. In discussing the potential future benefit packages withstakeholders, we identified several drivers for benefitpackage trends: Trend 2: PMI insurers become “risk-poolers” again Increasing lack of accessto NHS primary careIncreasing concern about lack of access tourgent/emergency careUrgentemployer needto reassure employees of a “healthsol