When it comes to runaway medical costs, the United States isn’t the only country with a problem. In a survey conducted by Watson Wyatt involving 85 insurers to global employers throughout Asia, Africa, Europe, and the Americas, 71 percent of respondents said they expect higher or significantly higher medical costs over the next five years, and 81 percent report that medical costs eclipsed the general rate of inflation in their country. The countries with the highest expected increases are in Asia, Africa, and South America.

Pharmacy directors and medical directors will need to adjust plan design and premiums accordingly, says Francis Coleman, senior international consultant at Watson Wyatt. “They can take some of the managed care techniques learned in the United States and adapt them to local countries and cultures.” Premium sharing, like member coinsurance, appears to be the most widely used form of cost-sharing arrangement globally.

Global medical costs (% change from previous year)
  2006 costs minus inflation 2007 medical costs (projected) 2008 medical costs (projected) Compared to current rates, expectations over the next 5 years
Above median
(yellow shading)
Top quartile
(orange shading)
     
Asia and Africa
Bangladesh −2.2 13.0 13.0 Higher
China 12.3 21.2 19.6 Higher
Egypt 2.6 15.0 17.5 Higher
Hong Kong 6.8 8.8 9.1 Higher
India 16.7 25.0 30.0 Significantly higher
The Philippines 6.5 11.4 11.5 About the same
Russia −2.8 13.7 15.7 Higher
Saudi Arabia −2.8 13.3 16.3 Higher
Singapore 5.3 6.5 7.5 About the same
Europe
France 3.7 6.6 7.3 Higher
Netherlands 4.5 5.2 6.0 Higher
Switzerland 2.4 7.5 6.0 Higher
United Kingdom 3.6 8.0 8.0 Higher
Italy 3.7 11.0 11.3 Higher
Americas
Brazil 4.9 5.9 7.2 About the same
Canada 10.0 11.5 12.0 Higher
Chile −5.9 6.5 7.1 About the same
Mexico 7.5 12.8 12.6 Higher
United States 5.4 8.0 11.0 Higher
Venezuela 14.4 25.0 25.0 About the same
Source: Watson Wyatt. Global Medical Trends: 2008 Survey of Medical Insurers

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.