In a Closed Door Exclusive Round Table Business Forum, iPMI Magazine will speak with C-Suite Industry Leaders from the International Medical Cost Containment Market about International Medical Cost Containment Strategies For Global Medical Payors And Providers.

Although international risks have changed, the cost of healthcare around the world remains a key concern for the international private medical insurance market.

This exclusive round table will define the complex nature of international medical cost containment and how medical payors and providers may leverage cost containment strategies to improve the access and standard of care, whilst reducing the bottom line to the payor.

Talking Points

• Real-time cost containment and medical case management;
• Managing the costs in the advancements of new medical procedures and pharmaceuticals;
• Discrepancies in pricing across global hospital networks;
• iPMI Plan design to manage costs before emergency;
• The use of technology to improve healthcare access and reduce the bottom line;
• The financial pressures of COVID-19;
• Combating international medical insurance fraud;
• Provider network management and negotiations;
• The challenges of cross-border regulatory and legal developments;
• The future of medical cost containment and medical case management.

iPMI Magazine Cost Containment Network

• Athens Assistance
• Charles Taylor Assistance
• Global Excel
• GMMI
• Healix International
• MDabroad
• New Frontier Group
• Roy Medical Assistance
• StandbyMD
• UnitedHealthcare Global

Related Reading:

International Medical Cost Containment Strategies 2018

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To apply for a seat at the table, please write to Christopher Knight, CEO, iPMIM: ceo[at]ipmimagazine.com

About iPMI Magazine Round Tables

Leaders learn from leaders, and by invite only, iPMI Magazine Executive Round Table Business Forums feature leading C-Suite Executives from the world of iPMI. Limited in numbers and distributed to over 40,000 readers in 120+ countries, iPMI Magazine round tables are an educational, executive, and exclusive event.

That's according to Griselle Chernys, CEO, at Wellaway, who took an executive seat on a recent iPMI Magazine round table business forum.

Although global risks have changed dramatically, medical inflation and the cost of employee benefits continues to cause concern. In the most recent iPMI Magazine Round Table Business Forum we spoke with leading C-Level executives from the world of International Private Medical Insurance about the rising cost of healthcare and medical inflation.

An AON report report shows that in 2015, medical costs are expected to increase by 10.15 percent before plan design changes and vendor negotiations—6 percentage points higher than the average inflation rate. In 2014, the global average medical trend was 10.34 percent. While the global average medical trend is expected to decline, three regions--Asia Pacific, Europe and Latin America--are projected to see an uptick in rates for 2015.

Talking to the IPMI round table group about the Aon Hewitt report Griselle Chernys, CEO, at Wellaway told us, “I think that the data is pertinent and probably correct. Healthcare is a commodity that providers will control and deliver as they want, especially in the private sector with IPMI coverage. Hospitals and physicians have the upper hand in the delivery and pricing, thus the need for integrated services. As I heard a physician administrator in a hospital say once, during some insurance pricing negotiation, “this is our price and if you do not like it, I would like to see you admit and deliver the medical care the member needs." As long as the relationship of providers and insurance is antagonistic, a solution will not be able to achieved. More and more hospitals and physicians will develop and deliver health plans via their medical facilities and I predict that the multi-hospital system will develop internationally as it has happened in the USA or as we see with Hospiten and the like.

Insurance companies and products as we know them today will have to evolve.”

ANDREW APPS, HEAD OF GLOBAL HEALTHCARE, BELLWOOD PRESTBURY added, “Competition between iPMI insurers is intensifying and will continue to do so as new entrants dip their toe into the market and dream of taking a slice of the ever expanding market. Price cutting particularly amongst the employer-sponsored plans is inevitable as the larger players jockey for position and greater market share, all of which is good for the employer in the short term at least. As the saying goes, there is always someone out there who will take the risk. But there has to come a point where underwriters have to make a return on their investment. At this point premiums have to rise and with the relationship between insurers and medical service providers becoming all the more strained as medical treatment fees increase, that day is not too far away. This makes the job of the adviser /broker all the more important."

ROMAN BEILHACK, CEO, GLOBALITY HEALTH said, “Employers are operating in an environment where they need to provide high levels of healthcare for their employees, sometimes due to statutory requirements and other times due to the natural tendency of employers to look after the well being of their workforce. Employers are typically under pressure to keep their operating costs low and when they review their budgets during their annual business planning cycles they will aim to minimise the cost of employee benefits. Due to these cost pressures, there may be situations where employers will downgrade the insurance coverage so that they can afford a plan rather than removing the plan altogether. Globality seeks to find solutions for their clients in these situations.

The global average inflation rate is interesting for comparing one year to the next. However, when it comes to employer-sponsored plans then the specific features of those plans should be considered. This means considering the locations of the insured members, the benefit levels, the treatment providers and network access. Referring to a single global average can be misleading for many employers.”

One of the most common questions we hear within the IPMI industry is: how will the cost of international private medical insurance rise in the next 5 years?

ROMAN BEILHACK, CEO, GLOBALITY HEALTH told us, “Costs are expected to continue to rise at levels above general price inflation. There are continual advances in medical science with new treatments and medicines being developed all the time. It is normal that insured members will demand the best treatments and services available, particularly for expatriates. In order for insurers to offer these new treatments then there will inevitably be premium increases.

However, insurers should not use this as an excuse to increase premiums beyond what is necessary. As can be seen recently, Globality is holding 2016 rates at 2015 levels for many categories of its business."

ARJAN TOOR, MANAGING DIRECTOR, CIGNA GLOBAL IPMI added, “Medical inflation is driven by unit cost, i.e. the price of each service; and utilization, that is how many and what type of services are used. As the world’s health care standards continue to rise and the range of treatment facilities and breadth of treatment options available continues to increase, it is without doubt that both unit cost and utilisation will also continue to increase.

It’s our job as the insurer to understand these risks and continually evolve our proposition to protect our customers from the impacts of medical inflation as far as possible. We’re continually working on initiatives to help minimize the impact of inflationary volatilities including investments in expanding our medical network and claims teams globally, meaning we can counteract medical inflation spikes to a certain extent as we build long-term relationships with hospital groups. It’s a lot about experience as well - it’s imperative that our claims advisors know the expected cost of a hip operation in Singapore, for example, and can ask the right questions to ensure the costs are appropriate.

Ultimately, it’s impossible to say exactly how premium costs will rise over a 5 year period, but our focus will continue to be on driving forward our mission of helping the people we serve improve their health, well-being and sense of security.”

ANDREW APPS, HEAD OF GLOBAL HEALTHCARE, BELLWOOD PRESTBURY commented, “If I had a crystal ball, it would be easy to answer this; however, the reality is that no one really knows to what extent iPMI premiums are going to rise over the next few years. What is certain is that premiums will continue to increase due to the rising cost of medical treatment along with the ever popular demand for private medical treatment.

That said, increased competition amongst the iPMI providers has, to some degree, helped to keep premiums palatable for most policyholders (putting to one side the notion that nobody likes to see their premiums increase), with average year on year increases running between 5-10% depending upon where a person is living and working. How long this will continue is anyone’s guess, but the market is hotting up with yet more new provider entrants trying their hand.”

GRISELLE CHERNYS, CEO, WELLAWAY added, “The cost of international private medical insurance will rise dramatically and this will be driven by the development and demand for new treatments, pharmaceuticals and technology. Longevity is also playing a role in the inflation and utilization of medical services which creates more demand and demand will drive costs.”

TO READ THE COMPLETE ROUND TABLE, THE RISING COST OF GLOBAL HEALTHCARE, CLICK HERE.

Welcome to the most recent International Private Medical Insurance Magazine (iPMI Magazine) exclusive iPMI round table business forum. In this exclusive discussion we talk to leading providers of iPMI about medical inflation and the rising cost of global healthcare. Featuring Bellwood Prestbury, Cigna Global iPMI, Globality Health and Wellaway.

Welcome to the most recent International Private Medical Insurance Magazine exclusive air ambulance medical transportation round table business forum. In this exclusive debate we talk about the international medical transportation sector of the business. With a focus on fleet capabilities, on-board technology, medication and payor-provider relations the round table takes a closer look at the global providers assisting iPMI insurers and insureds.

Exclusive C-Suite executive commentary from FAI, Jet Executive, MedcareProfessional and Tyrol.

In a recent International Private Medical Insurance Magazine executive round table business forum, we spoke with leading C-Level executives about the major differences between international private medical insurance plans and local insurance plans.

As expatriate hot spots around the world continue to mandate insurance cover for expatriate employees, under various visa and employment laws, questions from the business community continue to be raised. Issues focus around how new laws will help and assist expatriates and what levels of cover they may expect from local insurance plans.

GREGOR SCHULTE Globality Health: At their heart, international health insurance plans are designed to cover all costs of high quality medical care regardless of the location of the insured person and the standard of local health services. Whereas a local plan is designed to provide cover primarily in a single country, taking into account the insurance practice and requirements of that country, access to state healthcare provisions and treatment costs in local hospitals only.

Of course international plans offer cover that transcends borders and generally include benefits specifically applicable to expatriates, such as repatriation and evacuation cover, assistance services and benefits, portability and freedom to choose the healthcare provider. The result is that iPMI usually provides far higher levels of benefits than those available from ‘local’ schemes, although this is dependent on which country is considered.

ANDREW APPS ALC Health*: Superficially there are many similarities between a local and international private medical (iPMI) plan. The fundamental difference is the target audience for each of these two very different products.

An iPMI plan is designed to cover a policyholder, usually an expatriate, for practically any health-related matter they may encounter, a local scheme does not have the same mandate, being designed with the local population in mind and most often acting as a support to local, often staterun facilities. This means that the features of each of these plans are markedly different.

The most noticeable difference is that an international plan usually offers a wider, more comprehensive range of benefits and with much higher benefit limits. For example, with an iPMI plan there can be generous cover for items such as GP visits, full chronic conditions cover, routine pregnancy and childbirth cover, evacuation and repatriation cover, and usually overall sum insured amounts that can be ten or twenty times higher than those of a local scheme.

Typically, an iPMI plan will also be portable, and not restricted to their country of residence, allowing the geographically mobile policyholder full access to all of their benefits wherever they are, in their chosen area of cover. Some iPMI plans also do not require their insured members to seek treatment within a network. The policyholder has the freedom to choose where they wish to receive treatment.

Naturally local schemes are usually less expensive than international plans, but correspondingly, the benefits are far less comprehensive, with low benefit limits (sometimes the benefits are blatantly only a contribution towards the total cost of treatment), out-of-network penalties, co-pay benefits, none or very limited out-of-country coverage. Most local schemes also do not offer 24 hour support.

Similarly by their very nature, local schemes are very much tailored to the local population with policy documentation available only in the local language and the benefits tailored to the audience the plan is designed for. The unwary expatriate with local cover may well find that he either has to make do with low levels of cover, or more likely will have to self-pay at least part of his treatment.

PHIL AUSTIN Cigna: International Health Insurance plans by their nature are better suited to expatriate life than local plans. They usually provide cover worldwide, meaning that wherever the individual happens to be in the world, they will be able to receive treatment.

Local plans on the other hand will normally only provide cover in a single country. This means that when the expatriate is making a trip back home, or is spending time in another country, they are potentially ineligible for treatment.

Moving to a new country often brings about basic challenges like language barriers and cultural adjustments. An international health insurance plan helps the expatriate remove a lot of this uncertainty as they will be dealing with a provider with experience in working with expats and experience in global healthcare. This means that often a language barrier can be removed by speaking to the insurer who can communicate directly with the hospital, and the expat can seek advice about local customs and peculiarities.

Finally and perhaps most importantly, expatriates who are not permanent residents or citizens of the country they are moving to may be ineligible for a local plan.

SHIRLEY PUCCINO GeoBlue: Local plans are designed to deliver coverage and services inside the host county and tend to incorporate underlying government health programs, networks, and delivery systems reflecting local languages, customs, business practices and provider relationships. International health insurance plans strive to provide more comprehensive global cover and an optimal experience globally, while to the extent possible, allow for local nuances in plan administration, delivery and practices.

READ THE COMPLETE ROUND TABLE, CLICK HERE.

*At the time of round table publication Andrew was working at ALC Health.

The Maritime Labour Convention 2006 was adopted at a Maritime session of the International Labour Conference in 2006 and came into force on 20 August 2013. To date, 56 ILO Member States have ratified the Convention, representing more than 80 percent of the world’s gross tonnage of ships.

There are more than 1.5 million seafarers in the world. A majority of these seafarers now have a right to be protected through national laws and practices applying the MLC, 2006 to the ships on which they work. Title 4 of the MLC covers Health Protection, Medical Care, Welfare and Social Security Protection. From August 20th 2013 all vessels over a certain size have to comply with a new labour convention known as the Maritime Labour Convention (MLC) 2006.

We hope you enjoy this important round table discussion. 

• 94 large ships lost worldwide in 2013, down 20% from last year, with foundering most common cause.
• Piracy focus shifts away from Somalia to new hotspots: Indonesia and West Africa.
• Indonesia attacks up 700% in five years. Evolving piracy tactics present new challenges.
• Mega ships, Arctic shipping and alternative fuels create new industry risks.

Shipping losses continued their downward trend with 94 losses reported worldwide in 2013, coming in below 100 for only the second time in 12 years.

Losses declined by 20 percent from 2012 when there were 117 reported losses. The 2013 accident year also represents a significant improvement on the previous 10-year loss average with total worldwide shipping losses declining 45 percent since 2003.

“More than 90 percent of global trade is carried by sea so the safety of international shipping vessels and routes is critical to the health of the global economy,” said Tim Donney, Global Head of Marine Risk Consulting. “While the long-term downward trend in shipping losses is encouraging, there is more work to be done to improve the overall safety of these vessels as well as their cargo, crew and passengers, especially in Asian waters. As an insurer we are always concerned about recognized issues such as training and safety management, - human error is not something we can ignore and lack of skilled workforce is still an issue - but we also need to be alert for new risks as the industry continues to develop.”

Asia saw highest number of marine losses and continues to be an area of focus According to the report, more than a third of 2013’s total losses were concentrated in two maritime regions. As in 2012, the South China, Indo China, Indonesia and the Philippines region saw the highest number of losses (18 ships), closely followed by the seas around Japan, Korea and North China (17 ships).

More than two years after the Costa Concordia disaster, improving passenger ship safety continues to be a priority, with 2014 likely to see the 100th loss of a passenger vessel since 2002. Asia remains a hotspot for passenger shipping losses, especially for smaller passenger vessels and ferries as demonstrated by the sinking of the ferry St. Thomas of Aquinas as a result of a collision with another vessel off Cebu in the Philippines in August 2013, with the loss of at least 116 lives.

“We have to ask how some Asian ship operators measure safety and quality, particularly when speaking about domestic trade shipping in South East Asia,” said Captain Jarek Klimczak, Senior Marine Risk Consultant at AGCS. “The understanding of quality and standards can sometimes appear 50 years behind Europe – maybe even more.”

Around the world, more than a third of the vessels lost were cargo ships with fishery and bulk carriers the only other type of vessels to record double-digit losses. The total loss of two bulk carriers in Asian waters in 2013, Harita Bauxite and Trans Summer, highlighted the importance of proper cargo handling and stowage of bulk cargoes. AGCS experts believe high moisture content and subsequent liquidization, leading to free flowing instabilization of the cargo to be the primary cause of the accidents. The most common cause of losses in the past year was foundering (sinking or submerging), often driven by heavy weather, accounting for almost 75 percent of all losses, which was a significant increase from both 2012 (47 percent) and the previous 10-year average (44 percent).

For the first time the report includes not only total losses but also the total number of shipping casualties by region. The East Mediterranean and Black Sea region is shown to be a casualty hotspot, responsible for 464 casualties (18%) out of a worldwide total of 2,596 during 2013, including the year’s oldest ship to be a total loss:

the 108 year old Hantallar which grounded off Tekirdag, Turkey. This region combines busy shipping routes and a reputation for weaker safety management practices with a regional fleet that has a higher proportion of lower quality older vessels. The report also shows that over the past decade the British Isles have been the location of the most casualties, while January is the worst month for all casualties (including total losses) in the Northern Hemisphere.

In the Southern Hemisphere it is July. Piracy attacks still a concern – different models pose new challenges In 2013, piracy attacks declined 11 percent to 264 reported incidents worldwide according to International Maritime Bureau statistics - 106 of these occurred in Indonesia, which has seen a 700 percent increase in attacks since 2009.

Most of these attacks remain low level opportunistic thefts carried out by small bands of individuals but one third of incidents in these waters were reported in the last quarter of 2013, and there is potential for such attacks to escalate into a more organized piracy model unless they are controlled.

An emerging piracy hotspot with more organized crime is the Gulf of Guinea with 48 incidents in 2013, accounting for 18 percent of all attacks worldwide. Piracy attacks in Somalia have declined dramatically with only seven incidents in 2013 compared with 160 attacks in 2011. The report suggests the piracy model could be broken in Somalia in a couple of years if naval patrols continue.

Emerging Risks

An increasingly difficult operating climate for ship operators has forced a number of innovations, including larger ship sizes to capitalize on economies of scale, the use of alternative fuels and changes in ship designs. At the same time, more economical trading routes are fast appearing in Arctic regions during the summer months, but these present their own set of challenges.

Emerging risks identified include:

Vessel size: Last year marked the arrival of the largest container vessel on record, over 400 meters long and boasting capacity in excess of 18,000 teu. This trend is set to continue. AGCS estimates capacity grows by around 30 per cent every four to five years, meaning the arrival of 24,000 teu carriers can be anticipated around 2018.

“The claims arising out of maritime emergencies of these ‘mega ships’ can be huge. For example, just think of the business interruption of ports and terminals if an accident was to block the entrance,” said Dr. Sven Gerhard, Global Product Leader, Hull & Marine Liabilities, AGCS. “In addition, salvage might require unprecedented efforts and complex operations – in some cases it may take many months, or possibly a year or longer, to remove all the containers, particularly if the accident were to happen in a remote location. The large loss potential has increased for events which are not extraordinary on these big ships. And these are unchartered waters for salvors.”

Rise of LNG[1]-fueled vessels: Use of liquefied natural gas to power ships is expected to dramatically increase by 2020. There are safety concerns however, as the industry will see the rise of ports that have never previously handled LNG providing bunkering stations on dock.

“We need to ask what risks LNG-fueled ships will present to the industry. The concern is storing the LNG as fuel and handling it onboard. LNG expertise is not easily available – there needs to be a change in mindset and training,” said Capt. Rahul Khanna, Senior Risk Consultant, Marine, AGCS. Arctic trading routes: Shipping casualties in Arctic Circle waters have increased to an average of 45 per year during 2009-2013 from only 7 during 2002-2007. Damage to machinery caused a third of these incidents, higher than the average elsewhere, reflecting the harsher operating environment.

The Maritime Labour Convention (MLC) is an International Labour Organization convention established in 2006 as the Fourth pillar of international maritime law and embodies "all up-to-date standards of existing international maritime labour Conventions and Recommendations, as well as the fundamental principles to be found in other international labour Conventions".

Title 4 of the MLC covers Health Protection, Medical Care, Welfare and Social Security Protection.

Medical care on board ship and ashore: Seafarers should be covered for and have access to medical care while on board; in principle at no cost and of a quality comparable to the standards of health care on shore. Countries through which territory a ship is passing should guarantee treatment on shore in serious cases.

Shipowners' liability: Seafarers should be protected from the financial effects of "sickness, injury or death occurring in connection with their employment". This includes at least 16 weeks of payment of wages after start of sickness.

Health and safety protection and accident prevention: A safe and hygienic environment should be provided to seafarers both during working and resting hours and measures should be taken to take reasonable safety measures.

Access to shore-based welfare facilities: Port states should provide "welfare, cultural, recreational and information facilities and services" and to provide easy access to these services. The access to these facilities should be open to all seafarers irrespective of race, sex, religion or political opinion.

Take Your Seat At The Round Table - APPLY HERE.

DNV GL, announced the launch of its guideline "Subsea power cables in shallow water renewable energy applications" (DNV-RP-J301), which provides a comprehensive review of subsea power cable practice and advice for managing the risk commonly associated with the cables.

The recommended practice, which is free to download from www.dnvgl.com/rules-standards/default.aspx#2, is the most comprehensive of its type in the industry. Technical guideline covers entire lifecycle of subsea power cables, from concept development to decommissioning, and is a comprehensive resource of project guidance.

Many existing offshore wind farms have faced subsea power cable problems caused by underestimation of complexities and interrelationships Guideline will become essential tool for stakeholders involved in renewable energy projects, improving safety and lowering costs for the wind industry Problems with subsea cables have affected many offshore wind farms and damage to cables has been identified as a major insurance risk for the offshore wind industry.

Cable related problems are costly and most often arise from inadequate risk identification, lack of planning, sub-standard design and deficiencies in how procedures are applied. To date, cabling failures have cost millions of euros in delays and numerous legal disputes.