2018 Global Medical Trends
Survey Report
2 willistowerswatson
Executive summary
The cost of medical care continues to rise across the globe.
Insurers responding to the 2018 Willis Towers Watson Global
Medical Trends Pulse Survey see no light at the end of the
tunnel. While medical trend is slowing or even falling back
slightly in some countries, the trend in most countries is
signi cantly upward and above general levels of economic
in ation.
Keyndings
to be 7.2% in 2018, compared with an average of 6.8% in
2017. This continues to far exceed the average general
in ation rate in respondent countries, which is projected
at 2.5% in 2018 (International Monetary Fund weighted
cost rises: 11.4% in 2018 driven largely by persistent double-
digit increases in Argentina, Brazil and Mexico.
health insurers globally expect the upward trend to be
greater or signi cantly greater over the next three years.
About the survey
This is a shorter edition of our more comprehensive Global
Medical Trends Survey, which we run on a biennial basis.
Willis Towers Watson’s Global Medical Trends Pulse
Survey was conducted in September and October 2017,
and re ects responses from 201 leading medical insurers
operating in 60 countries. To lessen the e ect of market
size and currency factors, we have weighted global trend
rates, using GDP. Most participants have at least a 10%
share of the group medical insurance market in their
respective home countries. The U.S. marketplace, which
is covered by other Willis Towers Watson research, is not
included in this survey.In this survey, Americas responses
are from Canadian and Latin American insurers
(Figure 1)
.
Figure 1.
Participant prole
Americas
Asia Pacic
Europe
Middle East/Africa
34%
29%
27%
10%
2018 Global Medical Trends Survey Report 3
Figure 2. Global average medical trend rates by country, 2016 – 2018
Gross cost trendNet cost trend (net of general in ation)
201620172018 (expected)201620172018 (expected)
Asia Paci c
Australia6.76.67.15.44.54.9
China6.610.710.64.68.98.2
Hong Kong7.86.87.25.24.85.0
India10.511.311.36.07.56.4
Malaysia11.812.613.29.78.810.3
New Zealand6.16.16.15.43.94.1
Philippines7.67.98.65.84.85.6
Singapore7.67.69.28.26.77.9
Taiwan11.59.29.110.18.27.7
Thailand8.010.08.87.89.47.8
Europe
Belgium4.44.44.62.62.13.2
Bulgaria5.06.07.06.34.95.6
Cyprus5.04.04.06.23.23.3
Czech Republic3.03.05.02.30.73.2
Denmark2.74.33.52.53.32.1
France1.62.52.31.31.31.0
Germany3.55.05.33.23.43.7
Greece2.52.92.52.51.61.2
Ireland9.07.58.09.27.16.5
Italy1.51.61.81.60.20.6
Netherlands5.02.24.84.90.93.4
Norway3.72.44.50.20.32.5
Poland1.02.04.01.60.11.7
Portugal2.03.52.71.41.90.7
Romania10.311.013.311.99.99.9
Russia10.58.48.93.54.25.0
Serbia10.012.015.08.98.612.0
Spain2.72.53.12.90.51.6
SwedenNRNR4.0NRNR2.4
Turkey10.010.011.72.2–0.92.3
Ukraine13.914.313.90.01.64.0
United Kingdom5.05.06.04.32.43.4
Latin America
Argentina40.333.627.4NR6.79.5
Barbados and East Caribbean7.59.510.56.24.54.7
Brazil17.816.814.49.113.210.4
Chile6.16.76.82.44.44.1
Colombia9.48.58.41.94.25.1
Costa Rica9.09.09.09.07.36.2
Dominican RepublicNRNR10.0NRNR6.7
Ecuador10.015.015.08.314.314.3
El Salvador8.08.07.57.47.25.3
Guatemala8.08.08.33.63.64.8
Honduras6.06.06.03.32.02.0
Mexico12.115.114.49.39.210.7
4 willistowerswatson
Gross cost trendNet cost trend (net of general in ation)
201620172018 (expected)201620172018 (expected)
Netherland Antilles5.09.011.0NRNRNR
Nicaragua6.06.06.02.52.0-1.2
Panama11.711.08.710.99.46.5
Peru6.07.06.52.43.94.2
Trinidad and Tobago12.010.010.08.96.86.8
Venezuela233.3466.7633.3–21.1–186.0–1715.9
Middle East and Africa
Bahrain5.86.76.73.05.73.2
Jordan5.010.015.05.86.713.5
Kuwait5.0NR4.01.5NR1.3
Lebanon5.75.86.86.52.84.3
Oman7.08.39.85.95.16.6
Qatar5.05.55.52.34.60.7
Saudi Arabia5.06.09.51.56.24.5
South Africa9.98.88.83.63.43.4
United Arab Emirates12.512.010.510.79.97.6
North America
Canada12.312.312.310.910.710.5
Note: No response is indicated by NR.
Global average medical trend rates by country, 2016 – 2018
(continued)
Medical trend by country
More than half of health insurers globally expect the upward
cost trend to be higher or signi cantly higher over the next
three years
(Figure 3).
Figure 3.
How do you expect the medical trend in your
overall book of business to change over the next three years
compared with current rates
0%20%40%60%80%100%
Middle East/Africa
Europe
Asia-Pacic
Americas
Global
339516
241507
348417
536544
33598
Signicantly
lower
HigherLowerSignicantly
higher
About
the
same
2018 Global Medical Trends Survey Report 5
Asia Pacific
The rise in average medical costs in Asia Paci c is driven by
China, India, Malaysia and Singapore
(Figure 4)
.
In China, we expect the gross trend to continue at or above
10% in the near future, attributed to increased demand for
private care and heightened by easier access to private
plans for the newly established wealthy middle class. There
is also rapid expansion in the deployment of new medical
technology, the costs of which are directly passed through to
the consumer in higher charges. In addition, growing medical
labor costs have resulted in the government increasing
consulting fees in public hospitals.
India’s medical cost trend continues to be impacted by poor
underwriting and pricing discipline in the past, which has
led to the underpricing of medical risk. Moreover, low health
awareness among the population often delays treatment
resulting in the aggravation of insured members’ medical
conditions. When treatment occurs, private practitioners are
prone to use unnecessary surgery and related procedures.
There is also an increased prevalence of lifestyle disorders,
which lead to chronic ailments, such as stress.
Malaysia has experienced a consistent increase in medical
costs since 2016, resulting in the largest growth of all
surveyed Asia Paci c countries. As in other Asian countries,
there is increased use of expensive new technologies and
equipment with costs being passed directly onto patients.
There is also increasingly more medical tourism from middle/
upper-class foreign visitors, which has driven up utilization
and the prices of medical providers.
Singapore’s slower medical cost trend in recent years
appears to have run its course. Specialists in government
hospitals are overwhelmed by the number of cases they
handle, resulting in patients turning to private hospitals.
Increases in chronic diseases and the wider use of new
medical technologies are also contributing to the rising cost
trend.
Figure 4.
Average gross medical cost trends in Asia Pacic,
2016 – 2018
201820172016
0%2%4%6%8%10%12%14%
Thailand
Taiwan
Singapore
Philippines
New Zealand
Malaysia
India
Hong Kong
China
Australia
7.1
6.6
6.7
10.6
10.7
6.6
7.2
6.8
7.8
11.3
11.3
10.5
13.2
12.6
11.8
6.1
6.1
6.1
8.6
7.9
7.5
9.2
7.6
7.6
9.1
9.2
11.5
8.8
10.0
8.0
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