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Recently, many major American insurers have looked to international markets for new customers.  Thus far, major insurers have primarily targeted the booming expatriate market as their source for international customers, often times establishing field offices to better serve them.  A prime example of this trend is in China, where household names such as Aetna, UnitedHealth Group and Wellpoint have all recently established field offices.

The main reason for a growing expatriate segment in China is that various multi-national corporations are setting up shop to take advantage of China’s booming economic growth.  According to Martha Temple, president of Aetna global benefits, China is “…a real hotbed place for large U.S. multinational or multinational corporations [from other nations] to open or expand their offices.”  As a result, Insurance companies are cashing in by aggressively targeting expatriates.

However, with the slowdown of the US economy, and China experiencing social changes such as a booming middle and upper class, insurers are now pondering the decision of whether or not to offer insurance to Chinese citizens.  More and more Chinese are looking for western “luxuries” such as private health insurance as they experience and enjoy their newfound wealth.  Even though China has a basic national health insurance plan, many of the middle class and well-to-do nationals would opt to supplement the national insurance plan with private insurance to have a wider range of coverage.  And with a population over 4 times the size of the United States, China may be a much needed supplement to insurer’s US business.

Interestingly, foreign insurers within China must have a field office open in the country for two years before it may start selling its products, as required by the Chinese government.  Aetna, which only recently opened its China office, needless to say, will have a lot to think about in this period.  Possibilities of what to sell are diverse.  Insurers could opt to sell non-insurance products such as wealth management plans, or offer abbreviated services such as case management or diseases management insurance.  In any case, the outcome of these insurers’ decision will be an interesting one.

The Health Insurance Industry Convention is currently well underway in San Francisco this week and even though its only been one day record numbers of protesters are showing up to rally against the current healthcare system in the USA. This is occurring in the same week as the American Medical Association released its health insurance report card to individual insurers. All in all, it’s been a difficult week for American insurance companies.

Among the insurers rated by the report are companies like Aetna, Anthem BCBS, CIGNA, Coventry, Health Net, Humana, United Healthcare (UHC), and Medicare; and while the report has no ‘grades’ per-se, it does reveal some interesting facts about some of the country’s top insurance providers. The major focus of the report is with relation to how quickly doctors are receiving payment form insurers for services rendered to policyholders and the consensus is that most insurers are too slow.

According to some AMA members physicians are spending approximately 14% of their annual income simply to receive payment from insurance companies. And in the current economic climate, this is simply an issue that will not stand with the AMA. Paying out claims is a key issue, and failure to complete payments in a timely and efficient manner is resulting in a large amount of unrest among primary caregivers.

According to the AMA the worst offender when it comes to paying claims at the contracted rate is United Healthcare (UHC), with only 62% of all claims being paid, while Medicare was the best with a 98% completion record. While some insurers are able to follow through on Doctors payments with limited hassle many insurance companies are simply dropping the ball.

This is leading to a number of Doctors starting ‘boutique’ medical clinics in an effort to remove themselves from the world of insurance. With boutique clinics patients will typically pay a monthly, or annual, retainer under which they are entitled to 24/7 access to their caregiver. In addition to this Boutique medical practices are focusing on a more personalized form of medicine by only working with a limited number of patients, something which is paying off as many people in the USA are jumping ship and leaving the traditional system of healthcare.

There is a problem though, Boutique practices, due to the level of attention and care provided are only accessible by patients who are relatively wealthy, meaning that the majority of the American population is unable to use these services, which brings us back to the insurance companies. As mentioned previously, the Health Insurance Industry Convention has been rocked by large numbers of protesters clamoring for a single payer healthcare system. Single payer healthcare was supported by a number of politicians running in the presidential primary elections, most notably Senator Hillary Clinton, however with John McCain and Barrack Obama sealing their relative party nominations this proposal has a very limited chance of being established.

With the presidential election coming up in November the issue of healthcare is becoming ever more important to the American Public. With a number of proposals being floated to address the current problems in the system it is clear that there will have to be a fairly radical reassessment of healthcare in the US. According to the AMA this reassessment process should start with the insurance companies rather than with healthcare providers or the system as a whole.

With a number of insurers failing to meet their requirements towards primary healthcare providers it is clear that something must be done to address the system. When the domestic insurer who has the best record in settling claims is the one that is administered by the government then maybe it is worth looking at initiatives that would see the government prop up the local market. All that remains clear at the moment is that this crisis of care will not end anytime soon and that everyone in the American healthcare industry needs to be looking at viable options for the future. Whether this is in regards to improved claims handling, better insurance policy coverage, subsidies for prescribed medicines, or simply looking to lower the cost of healthcare, something must be done, otherwise there may not be the standard of quality healthcare that exists in the USA today.

You know it’s going to be a bad day in the healthcare industry when the chairman of the Federal Reserve, Bernard S. Bernanke, is predicting a massive rise in the cost of healthcare in the USA unless some serious measures to tackle the problem are introduced. At the same time as the Fed is struggling to come to grips on this ever worsening issue the Democratic and Republican presidential candidates are also starting to focus in on current healthcare policies and ways to change the present situation.

With the primaries over, and the presidential elections just round the corner, Barack Obama and John McCain are going to have to convince the voting public that they will be able to address the current healthcare crisis, and it may not be as easy as you think. Both these candidates know that their ability to offer a suitable solution may be the difference between winning and loosing a state. With that in mind we’re going to give you a brief rundown of the options and what they could mean if implemented.

The two main options on the table are:

Barack Obama’s Proposal

1.           A move to a paperless healthcare system where all patient records and health insurance documents would exist only in electronic form. This would be implemented along with quality disease prevention (as opposed to disease management), and ensuring portability of health insurance should a policyholder loose their job, and consequently their coverage.

John McCain’s Proposal

2.           Create tax breaks of up to $2,500 for individuals, and $5000 for families, who have purchased private health insurance. These tax breaks will occur each year, and while this would have a relatively limited impact on the number of uninsured individuals in the USA, it would create an incentive for private citizens to obtain their own health insurance rather than relying on their employer.

These two proposals aim to solve the current healthcare and insurance crisis in radically different ways. By removing paper from the healthcare industry Obama aims to eliminate one of the major sources of spending (namely paper) by moving everything to an electronic format. It’s easy to see how this simple proposal would save quite a bit of money, but there is a problem.

Electronic conversion is moving at a snails place in the USA; as it turns out, people like doing business on paper. In addition to this the amount of money being saved (an estimated $ 77 billion a year) is based off one survey, of which industry experts are not convinced about the accuracy. Disease prevention is always going to be less costly that disease management, but overhauling the current system to institute these reforms will be costly, and there is no guarantee that the implementation will have any effect at all.

By far the most promising part of this proposal, at least in the eyes of the American public, is the issue of health insurance portability should an individual loose his job, and subsequently their employment backed insurance. However, it is important to note that with the HIPPA and COBRA legislations the US government has already attempted, albeit not very successfully, to address this issue. Creating legislation to guarantee portability and renewability will always be an uphill battle, and may be harder than Obama realizes.

Citing immediate results may get Obama votes on this issue, but analysts are warning that even if these proposals are accepted by the government, the earliest changes to the system will happen approximately 5 years after the institution of the plan. This means that the USA would only see the benefit from these changes 1 year after the presidential term, and with the state of the healthcare system, this may be too long to ask of the average voter.

In terms of immediate impact the winner is clearly the tax break initiative proposed by John McCain. Creating a system whereby individuals would receive tax credit for any health insurance policy that they have purchased could be instituted immediately, which could give strength to the proposal in the eyes of the voting public. In addition to this McCain is not planning on upsetting the current free market system of healthcare in the USA, which would allow healthcare businesses to continue business as normal.

Critics of the McCain plan claim that this proposal would seriously undermine the American public’s ability to access healthcare as the policy would involve the removal of employer backed health insurance coverage. However, this is not the case at all. Under the tax break system suggested by McCain employees would still be entitled to job-sponsored insurance and this initiative would simply give a dollar for dollar tax rebate to any individual who had purchased medical insurance.

This would, in McCain’s eyes, give the American public an incentive to go out and buy health insurance, which would in turn reduce corporate spending, and improve the overall quality of health insurance plans which in turn would increase the availability of healthcare. If there truly was a free and open market for health insurance established in the USA, rather than the fairly closed system that currently exists, then obviously consumers would choose to obtain the best plan at the best price, forcing the insurance industry to adjust accordingly by increasing the quality of the products that they supply. However, critics are unsure and claiming that this rebate proposal would continue to isolate sick Americans who at present are unable to obtain private insurance unless they are covered by their employer.

Both arguments have their critics and supporters, and both proposals recognize that there is a fundamental problem in the American healthcare system. With rapid medical inflation, millions of uninsured and underinsured citizens and pharmaceutical prices skyrocketing this is an issue that may play a very important role in the upcoming elections. But it’s up to the voting public to inform themselves and understand the subject. Is one of these plans the way forwards for healthcare and insurance in the USA? Only time will tell.

The United Kingdom is often cited by supporters of universal healthcare coverage as being the epitome of a national healthcare service, and while it is true that Great Britain is able to provide British citizens with quality healthcare services for little to no cost, the picture is not as rosy as it may seem at first glance.

While the National Health Service still has the biggest share of the healthcare services in Britain, there is an increasing trend of individuals choosing to separate themselves from the government services by obtaining private medical insurance. One of the more staggering statistics, for a country with an internationally lauded healthcare service, is that the number of individuals who have private health insurance has exceeded 6 million for the first time in 5 years.

This comes as the British government is considering tax reforms that would see young British workers contribute to a new social security initiative benefiting the nation’s elderly. Following on from this comes the fact that a growing number of young professionals in the UK are moving ever further away from government provided services, choosing instead to obtain private medical coverage and insurance.

 

 

So what’s going on?

Younger people in the UK are beginning to become disenfranchised with the current system. Poor response times, large amounts of paper work, and a general all pervading sense of bureaucracy have served to disillusion large amounts of the population away from this previously ‘lauded’ system.

According to the Association of British Insurers (ABI) more companies than ever before are taking out private medical insurance in a bid to offer competitive benefits packages to prospective employees, and if the national service was all that it is cracked up to be, then this would not be a serious issue.

However, the fact that BUPA, the UK’s largest provider of health insurance, recognized 20% growth in sales during 2007 should attest to the fact that no longer can the UK simply rely on the medical service as it exists today.

In addition to the NHS’ bureaucracy there is a serious lack in qualified medical professionals, such as nurses, large amounts of overcrowding, poorly maintained treatment facilities and a virtual mountain to climb for treatment access. Is it any wonder that more and more individuals are choosing to go private over this public behemoth? And the situation won’t improve for the NHS, especially if a proposed imitative to give tax credit to organizations that provide private medical coverage to their employees goes through; a proposal remarkably similar to one made by Representative Ron Paul in the USA.

And all of this comes at the same time as politicians on the other side of the Atlantic are becoming increasingly vocal about the need for the implementation of a Universal healthcare system.

There are no hard and fast answers when considering health. However the trends in recent years, especially in countries like the UK which provide free medical treatment, are worth following.

According to a recent New York Times article, America has an estimated 48 million uninsured citizens and this number may soon increase due to the economic downturn being felt across the country right now. Not only is this downturn pushing people out of being insured, but it is also dramatically affecting the insured population.

An increasing reality for many of the 158 million citizens that are insured through their employers is that medical costs are becoming unaffordable. Rising prices for food and gasoline are making many Americans think twice about their spending on health care. From another perspective, rising insurance premiums, narrower coverage, and bigger deductible and co-pay requirements are pushing health care prices through the roof. It follows that many insured Americans are not financially prepared for the costs of emergency room visits and necessary surgeries. They are choosing to pay for food and gasoline over necessary doctor visits.

According to consulting and accounting firm Deloitte, nearly one fifth of the average household’s spending goes to health care. Since 2001, health care premiums for families have risen to $3,300 from $1,800 while incomes have not increased enough to cover this change. Another survey by Deloitte points out that less than 10% of American feel they are financially prepared for their future health care needs.

Employers are also feeling the effects of a soft economy. Expenses for health care are skyrocketing and as a result, many employers are passing on these increased costs to their employees. Many have begun pushing for consumer-driven plans where lower premiums come in the form of higher annual deductibles. According to the New York Times article, nearly 6 million Americans are now enrolled in such plans.

With Presidential Elections coming later this year, it should be very interesting to see what remedies each candidate puts for and how the nation responds.

In recent years, China has been facing a health care crisis in its rural regions. During China’s great Cultural Revolution and the several decades following it, rural health care was in prime form. Nine out of ten country people had access to subsidized health clinics run by government sponsored doctors. From 1952 to 1982, the infant mortality rate fell from 200 per 1,000 live births to only 34. Average life expectancy increased nearly doubled from 35 years of age to 68 years of age.

However, after an age of great development in health care, progress in rural China seems to be reversing. China’s nationwide push towards capitalist ideals has been a large cause of this. While China’s cities are developing at incredible speeds, rural China is being left in the dust. But ignoring these rural areas may end up hurting China as a whole if not dealt with soon.

Today, 79% of rural residents have little or no health insurance. With new capitalistic ideals, China’s hospitals have been told that they now need to finance a larger portion of their expenses themselves (previously, hospitals were heavily subsidized by the government). To cope with this, hospitals are increasing fees for their patients. It follows that out-of-pocket spending for country residents on health care is sky-high.

It is no doubt that China’s economy has been booming. A look at almost any economic measure shows significant progress. For the past 20 years, average annual GDP growth has been a stunning 9.7%. According to the World Bank, China has lifted 400 million people out of poverty in the past two decades.

The trends in economic prosperity and health insurance coverage are on a crash course and it looks as if China’s health care problems could overpower China’s economic growth. Many rural residents who fall ill choose not to seek necessary medical attention. This choice is dangerous and often lethal. Oftentimes, many residents who do chose to seek medical care do so at the expense of living above the poverty line. In other words, the out-of-pocket expenses the rural residents pay, when ill, put them back below poverty. There have been numerous reports of rural citizens using education, food, and living expenses towards medical bills.

Furthermore, the traditional Chinese way of borrowing money from friends and family to pay for expensive medical conditions could become difficult. The working population, alike much of the developed world, is ageing fast and according to some predictions, China will have only two working people per person over 60 years old in 2040 – in other words, there will be fewer working people to borrow from. Currently there are 6.4 people for every person over 60 years old. According to a report by the Centre for Strategic and International Studies, China may be the first country to grow old before it becomes rich.

These obstacles have nation-wide, and even global, health implications too. Many epidemics such as SARS, Bird Flu, and HIV are not easily contained in rural China directly because these areas lack proper health care. In a worst case scenario, it is imaginable that these diseases could become more widespread internationally as a result of poor containment in rural China.

The most effective way to curb this dilemma is to offer affordable health insurance in rural China. Increases in national economic prosperity and development can only take China so far. Full development into a mature and well-developed country requires a comfortable lifestyle for all of its citizens, or at least accessibility to it. The inability for so many residents to pay for their own health care and well being does not make for a comfortable lifestyle. Thus providing adequate healthcare to all of its citizens is one area China will need to master before it can be labeled well-developed.

 

One of the biggest issues facing modern America is the fact that large portions of the population are underinsured, an no where is this more evident than within the nation’s tertiary student community. In fact, it’s not just underinsurance that is an issue; it’s the total lack of health insurance within 20%, almost 1.7 million individuals, of the American student population that is so worrying.

Even among those college students that are covered by some form of health insurance the prevalence of underinsurance is staggering. 31% of part time students (those attending college for less than 8 hours a week) and 18% of full time students in the USA have insurance coverage that is less than comprehensive. To illustrate, many colleges and universities in the United States obtain plans for their students that have relatively low coverage limits; Ohio University, for instance, provides a plan with a maximum benefit of US$ 50,000 per medical condition per year. This is in a country with the highest average medical costs in the world, so it doesn’t take much of an imagination to see that a coverage limit of $ 50,000 isn’t going to go very far in the event of an individual developing a serious condition, such as cancer.

Of course the schools say that they’re not to blame, and that the problem is in the fact that insurance premiums (especially with domestic American insurers) tend to get more expensive each year, and that by obtaining these lower coverage limits the educational institution is actually helping their students by saving them money. In this regards many schools have these group policies, but it is up to the individual students as to whether they purchase it (the only variation to this rule is with regards to international students who are forced to obtain a university insurance plan prior to starting classes). Only 30% of the 4,182 tertiary education institutes in the USA require full time students to obtain health insurance, and just over half these institutions actually have any student healthcare plan at all.

Where colleges and universities in the US actually do have health insurance plans in place these often provide only the most essential coverage. Exclusions placed on pre-existing conditions, emergency evacuation, specialist consultations, and even out-patient treatments in some cases lead to high priced (US$ 918 per year at Ohio University) plans that afford students very little in the way of actual medical protection. On top of this is the issue that if a student does develop a serious medical condition that would require them to reduce their course load, they will no longer be provided, in the majority of cases, with the full time student plan, even though, through no fault of their own, they were a full time student prior to the sickness or injury.

That however, is a situation that may change. Senate Bill 1168 has been passed with the aim of providing ‘full time coverage’ to seriously sick students who are unable to attend classes full time for up to 12 months after the condition originally emerges. Known as Michelle’s law, the bill is aiming to support this large portion of the US population that is currently deemed to be ‘high risk’. However, there needs to be a reassessment of the American healthcare system as a whole and not just in regards to the student population. Outside of this fairly separated community millions of Americans are either uninsured or underinsured leading to the fact that medical treatment and sickness are the number one cause for an individual claiming personal bankruptcy in the USA.

There are other options, especially with regards to foreign students in the country. With the emergence of a strong international health insurance industry (as opposed to the local/domestic market) many major insurers have come to the realization that students deserve quality protection as much, and possibly even more, as the rest of society. This has lead to the creation of specialized ‘international health insurance student plans’ giving individuals around the world the security that they need in order to get the education that they deserve.

Despite this development of customized international student plans however, and the creation of senate bill 1168 the US is facing a serious crisis. It is a situation that needs to be examined further.

Hong Kong, a city internationally renowned for its high standard of living, quality social services, and its attraction as a global tourism destination, is facing a crisis when it comes to the provision of local healthcare services. This issue is this; Hong Kong is one of the most expensive places to seek medical treatment in the world, in fact according to many insurance companies Hong Kong is tied with Israel for second place in terms of most expensive healthcare costs, just behind the USA. Offering high quality public healthcare services that are heavily subsidized by the government has allowed this reputation to continue in recent years, yet the Government of the SAR is starting to feel the pressure on the budget with billions of dollars being spent on healthcare every year, with the actual figure of healthcare expenditure set to rise by 2011 to HK$ 48 billion (US$ 6.15 billion).

This is a serious issue for Hong Kong, and contributing to an already grim situation is the fact that the number of elderly persons in the city is expected to double by 2028, couple this with the elderly’s increased need for healthcare and general medical inflation around the world and it becomes fairly obvious that this is a situation that needs addressing. In fact, when examined closer it seems that the problems that Hong Kong is experiencing are running along the same lines as those associated with the American healthcare system, namely that large amounts of money are being spent for little or no return while the overall cost of medical services and treatment continues to rise at the fastest rate ever.

The solutions being proposed in the most recent public consultation on healthcare in Hong Kong are extremely varied. Ranging from purely out-of-pocket payment to personal healthcare reserve, the 6 options all have their pros and con’s and a number of these choices sound like some of the ones being thrown around by American political parties in the primary elections. Below is a brief outline of the various options being suggested in Hong Kong:

• Out of Pocket Payments

This option, as the name suggests, is fairly straight forward. An out-of-pocket healthcare scheme would force all but the poorest Hong Kong residents to pay for their treatment out-of-pocket. However, under this option the government would continue to subsidize public healthcare services and slightly raise the prices associated with all treatments. So while members of the public would see medical costs rise, the overall cost of medical treatments would still remain relatively low.

• Social health insurance

A social, or national, health insurance scheme would force members of the work force to contribute a pre-determined percentage of their monthly salary towards the public healthcare system. This is an initiative that is already in place in a number of other countries and one that has experienced a large amount of success around the world. However the major complaint the Hong Kong population has with this proposal is that it would be in addition to a number of taxes already in effect. Currently middle class citizens in Hong Kong have to pay a 15% income tax and a 5% mandatory provident fund tax (forced retirement fund). The introduction of a social health insurance scheme would see an additional monthly tax of 5%, bringing the annual middleclass tax rate up to 25%, an extremely large amount for a place with a worldwide reputation for relatively low taxes.

The major benefit with this proposal however, would be with regards to the fact that medical costs will continue to remain low, and people will not have to delve into their personal finances in order to receive quality treatment.

• Medical Savings Account

This option would work along the lines of a disaster relief fund. A specific portion of the Hong Kong population (namely the lower and middle classes) would be required to contribute money into a specially created fund in order to meet any future medical costs. People with these accounts will have the option to invest the money that they save, much along the lines of the Mandatory Provident Fund scheme, and all monies accrued in the fund can be used to pay insurance premiums, so in actuality this type of proposal is extremely flexible and comprehensive. However it does not address the issue that many employees in Hong Kong receive health insurance coverage through their job, so an enforced extra account would hurt their monthly salaries, much in the same way as the social health insurance idea.

A medical savings account could potentially be an extremely effective solution. However individuals should be able to ‘opt out’ if they so choose. In order to do so they should have to prove that they have coverage through some other means, or in the case of many expatriates living in the city, that they will not remain in Hong Kong for long enough for this scheme to be of any practical use. Outside of this the medical savings account proposal would still create a higher ‘tax’ if you will as individuals must contribute.

• Voluntary Private Health Insurance

Hong Kong has an extremely vibrant insurance industry, and this proposal would involve creating incentives for individuals to obtain private health insurance rather than depend on the government funded public healthcare services. Giving individuals a dollar-for-dollar tax break on all health insurance premiums would help to ensure that Hong Kong residents obtain more protection without actually hurting their own finances to the extent of the other reform ideas.

A voluntary insurance scheme, with incentives (such as tax breaks etc.), would ease the pressure on the government in terms of funding, ensure that a large portion of the Hong Kong population is able to receive coverage under their own health insurance, and create a safety net for an aging population. The other direction that could be taken with this idea is to force employers to provide their employees with some form of medical coverage, so in the event of a catastrophic situation the burden of provision would be taken off an already strained healthcare system

• Mandatory Private Health Insurance

This proposal would force every Hong Kong resident to obtain health insurance, much like the previous ‘voluntary’ idea, but on a ‘must do’ scale. While the suggestion of health insurance is good, it is the mandatory part that potentially creates the issue. If this scheme were enforced then there would most likely be the creation of ‘preferred’ health insurance providers, much in the same way that there are only a certain number of MPF funds. This would stagnate the thriving Hong Kong insurance industry in addition to creating insurance policies that only cover the most basic necessities.

One of the questions asked with the ‘mandatory’ health insurance scheme is with regards to regulation and what will be done to ensure that adequate coverage is provided. Not every individual will be able to afford the better quality plans, and this could potentially lead to a whole host of individuals who are ‘under insured’, a problem that the USA is experiencing at the moment, and this is something that will contribute to even more issues with the Hong Kong healthcare service.

• Personal Healthcare Reserve

The personal healthcare reserve proposal is a mixture of the Medical Savings Account idea and the mandatory health insurance initiative. This proposal would require a specific portion of the Hong Kong population to deposit savings into a personal account which would then cover the costs of private health insurance before and after retirement. These accounts would be linked to investment options with a view to building up capital for a person’s retirement and thereby creating a ‘retirement healthcare fund’. In this sense the Personal healthcare reserve idea is extremely similar to the MPF scheme as the goal is to force individuals to set aside healthcare funds for their retirement.

So there you have it, the 6 ideas currently being floated in regards to reforming the Hong Kong healthcare system. Essentially these changes are only targeting the middle and upper classes of society as the government has promised that it will retain its commitment to low-income and underprivileged elements of Hong Kong society. However the proposals as they stand at the moment will potentially have a massive impact across all of Hong Kong.

It is not only Hong Kong that is experiencing these types of issues, the costs associated with medical treatment around the world have been getting more expensive, and medical inflation is at an all time high. Nations that run a national healthcare system, and nations that operate on open market ideals alike are facing trouble, and although Hong Kong may not have the answer, it is starting to look at the problem before it becomes even more of an issue.

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