2021年全球醫(yī)學(xué)趨勢調(diào)查報(bào)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

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         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

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         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

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         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

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         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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