Regular HI&P contributor Tony Levene reports from the Association of Medical Insurers & Intermediaries’ annual Health and Wellbeing Summit, held in London last week.
The Chairman’s View
“Who could have forecast ten years ago where we are now?”
That was the opening comment from Association of Medical Insurers & Interediaries (AMII) executive chairman Stuart Scullion introducing the 2019 AMII Health and Wellbeing Summit.
Held in Westminster in London, the Summit was attended by well over 100 members – with a large number of companies demonstrating why they should be the first choice for advisers and others.
“Even with 20-20 vision, who would have predicted where we are now a decade ago?” he said. “Private phone GP services and digital GP apps are now the acceptable norm. Artificial Intelligence was just a glint in a Tomorrow’s World eye. And this time around, I am not going to make the same mistake as I did ten years ago when I said I did not expect the internet to change much.
“We’ll hear more about the cancer challenge later this morning but beyond that we have to think about how to live life better from your mid-sixties onwards – never forgetting that Generation Z has a one in two chance of making it to their personal century. We have to think about how to make private medical insurance both relevant and affordable to older people. Otherwise, I don’t see how individuals will maintain cover into their later years. And without that, the strain will increase on the NHS and that could be overpowering.
“Put bluntly, we all need to eat less and jiggle about more. But beyond the ‘be better’ message, there’s genetic data to consider – it’s having a big effect.”
Scullion outlined the second impact.
“Dementia is an ever-increasing challenge. Currently, we have to work out how to deliver financially sustainable social care. It’s not working – there’s a postcode lottery.
With the Senior Managers & Certification Regime (SM&CR) looming up on December 9, Scullion said firms should be ending their preparation.
But he added: “Some firms have not even started. AMII is offering a cut rate deal for members.”
He concluded: “I’ve been 25 years in health insurance. I have always been struck by the camaraderie between people. It’s a small and sort of incestuous industry but there is a genuine feeling of respect.”
The future: Business, Boris and Brexit
It was B-word time at the AMII Health and Well-Being Summit. And BBC business editor Simon Jack picked up the challenge of trying to forecast Brexit – a job some in the audience saw as walking on eggshells – while trying to work his way between BBC impartiality and an audience that was largely remain.
First, he plugged his employer.
“People still trust the BBC,” he said. “They see something on social media and look at the BBC to see if it’s true. I talk to many across the country – supermarkets say leaving will turn the BLT sandwich into just a B sandwich. It’s difficult to get the balance – I get a load of abusive emails and tweets, although not as many as some colleagues.”
He said: “While some big business owners want Brexit, most don’t. I am not sure about the clash between the Bank of England’s Mark Carney and Jacob Rees-Mogg. And however hard I try, I can’t find a pro-Brexit car manufacturer. Business leaders are not punching the air when Johnson says he will unleash Brexit.
“There is still so much we don’t know. Services – 80% – are not in the political declaration. And you can expect contortions as the UK tries to do new trade deals. Any watering down of regulatory details will ring alarm bells with the EU – so there is a circle to square. Add to that, the government’s own analysis shows that even if we do big trade deals with China, the US, Australia, the Gulf States and other big economies, our GDP will fall. So the prospect for doing free trade with the US and the EU will make the last few years look a walk in the park.”
He then put on his election guessing hat.
He said: “If Boris Johnson gets elected, he has in theory just under 13 months to do a free trade deal with the EU. No one thinks that is possible. So he would have to ask for an extension. But how will that go down with the ERG (the group of Eurosceptic Conservative MPs that form the European Research Group)? It’s a very formidable task so I don’t think this election will provide clarity – the deal on offer is no-deal in disguise.
“Some want a no-deal just to end the agony. But, as Carney said, crystallising a bad deal is not good. It’s like you cut off your own head – there is certainty although it solves nothing and it hurts.”
As for Labour, “it’s the most radical in our lifetimes. McDonnell is talking about corporate greed, the sort of short termism and corporate greed that brought down Thomas Cook, Carillion and the rest. He wants workers to have the biggest stake – it would be a massive overhaul of UK plc.”
He foresees years of problems.
He said: “Whatever happens in the election, it’s not over yet. Brexit is still the biggest risk but we need to lift our eyes. We’ll have to deal with weak UK demand, shares prices at a Brexit discount, low productivity (Italy and France do much better), debt levels and climate change. So when the global map is being redrawn, we do Brexit. It’s no surprise public confidence in business is low.”
Jack said arguments seemingly settled in the 1980s are being revisited.
He said: “The biggest US stock buyer is corporate re-purchase of companies’ own shares. The UK was even more virulent in embracing capitalism than the US – the obsession with quarterly earnings and debt means we are not getting social consent and so business is not seen as a good thing. Our flexible workforce may be a downer. But business has pragmatic resilience despite rates, compliance, auto-enrolment – leaving the EU won’t reduce this. We should concentrate on business working well.”
AI, genetics and virtual GPs – mapping the future
Will Artificial Intelligence (AI) make a big impact over the next decade? Should online GP practices take over? What about genetics? And how can we price for older years when claims increase due to increased pressure on the NHS or with more choosing self-pay, opting to save and buy treatment as and when needed?
These are some of the big questions in planning for the next decade, the AMII 2019 Health and Wellbeing Summit was told.
Trying to answer them was a panel consisting of Fergus Graig (AXA PPP healthcare), James Dalton (Association of British Insurers), Athos Rushovich (Vitality), Iain McMillan (Bupa) and Nick Reynolds (Aviva).
The consensus was that AI use would grow as more data flowed in, there would be better data flowing out. It was seen as complimentary, not a replacement as it was unclear if people would be receptive to procedures and diagnosis by machine.
Consumers had to understand what was going on. They now accept planes flown by computer but with a hands-on person as well. And AI can improve the back office experience.
The panel saw the virtual GP as a good replacement for simple needs especially as it can do a lot of process – imagine how to cope with the current 15 minutes per person including writing up the notes.
They believed people were intelligent enough to know when a machine was adequate but they agreed it was an “age thing” and needed better presentation beyond the “City banker” stereotype.
There were more opportunities but it has to be well-handled, and with regard to other factors which may or may not be irrational.
Genetics was just a sub-set of data but “admittedly sensitive”. The panel thought we might already have had the conversation but for the political uncertainty. Genetic therapies would come for many critical conditions.
As for pricing, this remains a problem for the industry with self-pay increasing 10% per year.
As no insurer wants to hit the headlines for the wrong resons, they need to get better understood by customers with commercial decisions communicated clearly.
Advisers have to go to in-depth explanation of cover, especially with SME policies. The regulator will want to know if the customer really understands what they have bought and what the outcome might be. The level of scrutiny is increasing and expressions of dissatisfaction are growing.
The panel wondered how sustainable cancer treatments costing £1m might be as there is a need to make the product cheaper and more accessible. Maybe, a solution is to tie critical illness to healthcare in corporate products.
Some treatments will fall in cost but other costs could run out of control. It is all very well to control costs but when it is a life/death decision, the thought process is different. And that’s the route to ending up in a tabloid newspaper.
Cancer 2020: Diagnosis, lifestyle, drugs and costs
Six decades ago, fewer than one in six died of cancer. By 2020, one in two will have a cancer diagnosis sometime in their lives – and a substantial number will have a cancer inscribed on their death certificates as the cause of their demise. But the chance of remission is greater. There are over two million “survivors”.
According to Willie Hamilton, the professor of primary care diagnostics at Exeter University, cancer, either personal, close family or friendship group, touches everyone.
He said: “Whether private care or NHS, the bill is enormous with £1bn spent by the state health service on diagnosis alone. There is no special symptom of cancer – almost anything can be a cancer indicator. Or not. Hence it is big business for the media.”
He told the AMII 2019 Health and Wellbeing Summit that the UK performs badly compared to many other countries.
He said: “Around five to ten thousand lives a year are lost through late diagnosis. GPs are under pressure to balance patient expectations – often ‘miracle’ drugs touted in some newspapers. This floods secondary care yet many early warning campaigns are not clear. What about a simple ‘if you have blood in your poo, get checked out.’”
He said there was a clear link between GP willingness to investigate cancer and survival.
“But we investigate less than other countries – perhaps the problem is the GP system where the gatekeeper principal may not be working. In France, for instance, you can go straight to a consultant.”
Where do we go from here? New tests, rapid diagnosis centres and electronic decision making for the GP. But he advised against more screening.
He said: “It does not work too well with breast or ovarian cancer while colon blood testing is too messy for many. There may be other answers ranging from Volatile Organic Compounds to Medical Detection Dogs although I can’t see every GP surgery having canine members of staff. In any case, there will be too many false positives.
“Some drugs work but could just buy a little time before a relapse. They are amazingly expensive and there is enormous pressure to use them before they are fully tested. Surgery has improved, due to specialisation rather than new techniques but I am doubtful about robotic surgery as it makes a small difference to recovery time but tends not to save lives and has big capital costs. Radiotherapy has a place when it is precise, especially for brain tumours. Immunotherapy has some spectacular successes especially on skin cancer but also some failures and the jury is still out on personalised treatment.”
Ultimately, the solution could be a better lifestyle – idleness, smoking and obesity all play significant roles in cancer.
Professor Hamilton ended his talk on a message of hope.
He said: “We shall come to a stage where more will be cured and the incurables will have longer lives. In the meantime, ignore the red meat scare. You would have to eat two bacon sandwiches a day for 40 years to get a one in 100 chance of colon cancer.”
Mental health – a growing challenge
Despite regular discussion, mental health is still the Cinderella in the insurance world. That was the starting point for Helen Undy, the CEO of Money and Mental Health Policy Institute who spoke to the AMII 2019 Health and Wellbeing Summit on “Making the Market work for the one in four”.
“Living with mental health issues should not write you off to debt, but it does. We need a system that works for the 1.5 million with serious mental illness. We have around 100,000 suicides and attempts a year with nearly 25% of those in debt trouble. The insurance market could design something better. And that is easier to solve than the underlying health issues themselves.”
She saw some improvement.
She said: “From the end of 2021, there will be protection from debt interest while in NHS acute mental health care. But this gives no help on discharge.”
Undy reeled out the well-known statistics linking mental health to financial detriment, pointing out that few have insurance cover.
And using material from an August 2018 survey on mental health and travel insurance as a proxy for the rest of the protection world, she mentioned huge increases when proposers mentioned these issues – even when they had been symptom-less for years.
She said: “I accept some loading but it has to be on accurate data – not on management playing safe. There are often exclusions so people pay more for lower cover. Underwriting mental health attracts more in the way of loading than almost any other condition. And add to that, if you have issues, then following the rules, understanding the policy and making a claim are all more difficult.”
The result is fewer disclose – 85% for physical illness but 45% for mental illness. And they risk worthless cover.
She said: “Comparing can be tough as you have to answer the same questions over and over but often the questions are out of date, while those questioning are all too often untrained.”
Undy’s charity wants a review of underwriting and pricing, best practice shared to improve exclusion figures, support and accessible disclosure and product innovation.
“Workplace income protection is a great lifeline for the minority which has it. It can save lives so there is scope for hope.”