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iPMI Market Sizing With Ian Youngman, Author, International Health Insurance 2021 Featured

iPMI Market Sizing With Ian Youngman, Author, International Health Insurance 2021

Global, national and company IPMI figures are more an art than a science.

Many reports claim to have figures but they are either so ancient as to be useless, or guestimates.

There are NO official IPMI figures anywhere – but I have only been looking for 30 years!

Country figures

In most countries health insurance is not a separate sector so country health insurance figures are often estimates by insurance associations rather than state statistics,

There are a few exceptions.

Even where they exist they mix PMI with IPMI and health cash and supplemental health – and sometimes other sectors such as critical illness, accident and short-term income protection,

Company figures

Very few insurers now publish country-by-country statistics on health insurance

Even where they exist they mix PMI with IPMI and health cash and supplemental health – and sometimes other sectors such as critical illness, accident and short-term income protection- and in one major case life insurance.

There are many reasons why the figures are not published.

The three key ones are commercial confidentiality that most companies may struggle to separate out IPMI by country, and currency/tax.

In the last five years of massive currency fluctuations, companies have learnt to massage the figures to look the best they can.

Global insurers also seek to minimise local and own country taxes and ‘ avoid” paying more than they have to- so they move real and book money around. Round and round the money goes – where it stops nobody knows. Amazon and Google are not the only global companies that do the magic money trick.

For insurers there are rules on offshore and onshore- so many countries only allow business to be placed in the country itself and with rules that it may have to be placed via a local insurer and/or broker- then there are rules on how much money an insurer can take out of a country.

So a simple IPMI product with a major insurer originating from a major broker may have the parent company, the local subsidiary, a local associate, the global broker location, the broker local subsidiary and a local associate- then confused further into where the insurer’s regional processing centre is.

Then – many insurers sell IPMI via MGAs- so you then add another mix of where the MGA is based and where the local office is!

So you may have choice of up to 8 countries as to where the premium for one simple IPMI policy can be placed- even before the insurer starts moving it around in practice or theory to minimise currency and tax and legal issues,


For IPMI most business is not direct with customers but via agents, independent agents, banks, employers, brokers and MGAs.

This adds a wonderful element of obfuscation on tracking country figures or even global ones!  

Another way

Insurers are falling over each other to tell us their strategies on coal, environment, equality, diversity, employee involvement and other soft issues. As company reports are filled up with this PR stuff, actual produced figures get less and less. I have often to check investor briefings and other stuff not aimed at the public to get the figures I have.

The reports provide what information there is on countries and companies but if you are looking for country by country IPMI figures then split down by insurer- these have not existed for many years and detail gets less each year.

Adjusted figures

In most weeks I read a few detailed financial reports from insurers.

In most weeks this drives me to need a drink.

The latest phrase is  “ adjusted” – to seek to give a better comparison with previous figures.

The longer the explanation for the adjustments, the more complex the adjustment of sales, costs and profits.

Every company seeks to put the best spin on their results.


I have lost count of the number of people who suggest that I should be able to estimate global or national IPMI figures as they have read of reports that claim to have these figures.

To make an estimate you need decent baseline figures.

Many estimates are the equivalent of betting that horse A will win the next race.

At least 90% of any figures or facts on anything on the web are rubbish.

If I used or believed much of the "information" I read daily then I would confidently say that Trump is still president, Germany won WW2, 20 years in Afghanistan was not a disaster and that politicians always tell the truth.

The future

I can analyse trends but the cut and paste boiler-plate reports that say country x will see health insurance premium will grow by 20% a year, or IPMI will grow by X % a year by the next decade – are the insurance equivalents of all those adverts that promise to reverse hair loss, make you more attractive, or will make you wealthy.

Events can cause even simple future estimates to be rubbish- such as tourism figures for 2020 and 2021 that the pandemic turned to farce.

Analysing historic figures to predict future numbers is very dangerous- as the investment warning that also applies to any sports team goes "Past performance is no guarantee of future results".

International Health Insurance (IPMI) 2021 Report

There are now 80 million expatriates, 5 million international students, 4 million temporary foreign workers, and 18 million high net worth individuals of which 2.7 million are ultra high net worth. All of these are targets for international private medical insurance.

International health insurance for expats, third country nationals, domestic nationals and global nomads is a 3 volume iPMI market report updated in 2021 with even more companies and more countries.


Expats and local workers of global companies and HNW individuals may no longer have the option of flying home or another country for medical treatment so may have to rely on local healthcare.

Global insurers have national and international healthcare networks that have a better capability for telemedicine than local insurers.

In almost every country the state healthcare network is under never before experienced pressure so access to private healthcare is increasingly essential. In some countries, expats will be at the back of the queue for state healthcare. In some countries, even access to private healthcare may be strained and hospitals may have to prioritise healthcare for long-term partners such as insurance companies over one-time private patients.

An increasing number of insurers are moving from being health insurers to healthcare providers protected by health insurance. With a linked move to Artificial Intelligence and teleconsultation, the world of IPMI is changing.

The fragile and volatile state of global stock markets is of concern to insurers who may already be vulnerable while offering opportunities to potential buyers of insurers and health insurance books of business. The environment for mergers and acquisitions among health insurers remains favourable as they continue to seek out diversification and growth opportunities.

Read International Health Insurance (IPMI) 2021 Report, click here.


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