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Medical & Health Insurance

Published by: Key Note Publications Ltd

Published: Jul. 1, 2007 - 192 Pages


Table of Contents


Executive Summary

1. Introduction

BACKGROUND

DEFINITION

Long-Term Insurance

General Insurance

2. Strategic Overview

THE UK'S INSURANCE INDUSTRY

Market Leaders

LESS CONFIDENCE IN THE NHS

OVER 7.2 MILLION CLAIMANTS GET ILLNESS AND DISABILITY BENEFITS

Table 1: Trends in Life Expectancy and Healthy Life Expectancy at Birth in the UK by Sex (years and %), 1981 and 2001

SICK BRITAIN, POOR WOMEN

Table 2: Number of Taxpayers and Median Income Before Tax in the UK by Sex and Age (000 and £), 2004/2005

Figure 1: Median Income Before Tax in the UK by Sex and Age (£), 2004/2005

MEDICAL INSURANCE SPENDING VERY LOW

Table 3: Weekly Household Expenditure on Medical Insurance by Income Decile Group in the UK (£), 2005/2006

DISTRIBUTION — TRICKY FOR LONG-TERM PRODUCTS

CONSUMER TRENDS — BRIGHT OUTLOOK FOR PRIVATE HOSPITALS AND SELF-PAY

KEY POINTS

3. Long-Term Insurance

PROTECTION SECTOR IN DECLINE

Table 4: Protection Insurance in the UK — New Regular-Premium Policies — by Type (000, £m and £), 2002-2006

Table 5: Protection Insurance in the UK — New Single-Premium Policies — by Type (000 and £m), 2002-2006

REGULATION RESTRICTING THE MARKET

INCOME PROTECTION INSURANCE: DOWN

Table 6: Individual Income Protection Insurance in the UK — New Individual Regular-Premium Business — by Distribution Channel (000 and £m), 2002-2006

Table 7: Mortgage-Related Term Assurance in the UK — New Individual Regular-Premium Business — by Distribution Channel (000 and £m), 2002-2006

CRITICAL ILLNESS INSURANCE: PACKAGED UP

Table 8: Critical Illness Insurance in the UK — New Business — by Distribution Channel (000 and £m), 2002-2006

Table 9: Income Distribution in the UK (£), 1999/2000 and 2004/2005

Figure 2: Income Distribution in the UK (£), 1999/2000 and 2004/2005

LITTLE COMPETITION IN CARE INSURANCE

Table 10: Trends in Premiums in Long-Term Care Insurance in the UK by Type (£000), 1999-2005

Table 11: Mean Value of New Point-of-Need Long-Term Care Policies in the UK (£), 1995-2005

KEY POINTS

4. General Insurance

PRIVATE MEDICAL INSURANCE

Table 12: Trends in Health Insurance Premiums and Claims in the UK (£m), 1999-2005

Table 13: Private Medical Insurance in the UK by Total Subscribers, Persons Covered and Gross Earned Premiums (000, £m and £), 2000-2006

Table 14: Estimated Market Shares of Companies Offering Personal Private Medical Insurance, Cash and Dental Plans in the UK (%), 1992, 1997, 2001, 2004 and 2007

CASH PLANS AND SELF-PAY

DENTAL OPPORTUNITY

PERSONAL ACCIDENT INSURANCE

Table 15: Trends in Personal Accident Insurance Premiums and Claims in the UK (£m), 1999-2005

MORTGAGE PAYMENT PROTECTION INSURANCE

PECUNIARY LOSS, INCLUDING MORTGAGE INDEMNITY INSURANCE

Table 16: Pecuniary Loss Insurance and All General Insurance in the UK by Net Written Premium Income (£m and %), 2001-2005

KEY POINTS

5. Promotion

MAIN MEDIA ADVERTISING EXPENDITURE

Table 17: Main Media Advertising Expenditure on Health-Related Financial Products by Category (£000 and %), Years Ending March 2003, 2005 and 2007

Figure 3: Main Media Advertising Expenditure on Health-Related Financial Products by Category (£000), Years Ending March 2003, 2005 and 2007

Table 18: Main Media Advertising Expenditure on Health-Related Financial Products by BUPA (£000 and %), Years Ending March 2003, 2005 and 2007

Private Healthcare

Table 19: Main Media Advertising Expenditure on Private Healthcare by Provider (£000 and %), Year Ending March 2007

Table 20: Main Media Advertising Expenditure on Private Healthcare by Provider (£000 and %), Years Ending March 2006 and 2007

Critical Illness

Table 21: Main Media Advertising Expenditure on Critical Illness by Provider (£000 and %), Year Ending March 2007

Income Protection, Mortgage Protection and Accident Insurance

Compensation and Advice

Table 22: Main Media Advertising Expenditure on Accountants and Solicitors — Including Injury Claims — by Selected Provider (£000 and %), Year Ending March 2007

KEY POINTS

6. International Perspective

THE US — HUGE HEALTHCARE SPEND, LIMITED BENEFITS

LOW MEDICAL EXPENDITURE IN DEVELOPING ECONOMIES

Table 23: Public and Private Spending on Healthcare in Selected Countries ($ and %), 2003

Figure 4: Public and Private Spending on Healthcare in Selected Countries (%), 2003

GENDER EQUALITY ACROSS THE EU

KEY POINTS

7. PEST Analysis

POLITICAL FACTORS

ECONOMIC FACTORS

Table 24: Net Expenditure by the NHS (£m), 2002/2003-2005/2006

SOCIAL FACTORS

TECHNOLOGICAL FACTORS

Table 25: Projected Change in the UK Population by Age (000), 2007-2017

KEY POINTS

8. Consumer Dynamics

INTRODUCTION

Table 26: Summary of Results (% of respondents), 2007

ILLNESS AND INJURY, AND INCOME PROTECTION

Illness or Injury Stopped Me Leading My Normal Life for 3 Weeks or More During the Last Year

I Would Have Enough Money to Manage If I Had an Injury or Illness Which Prevented Me From Working or Leading a Normal Life

I Have Income Protection in Case I am Unable to Work Due to Illness or Injury

Table 27: Injury and Illness, and Income Protection (% of respondents), 2007

FUNDING PRIVATE MEDICAL INSURANCE

I Have Private Medical Insurance and I or a Family Member Pays the Premiums

I Have Private Medical Insurance and My Employer, or Someone Else, but Not a Family Member, Pays the Premiums

Table 28: Funding Private Medical Insurance (% of respondents), 2007

Table 29: Take-Up of Private Medical Insurance† Among the Key Working Age Groups (% of respondents), 2007

PAYING FOR TREATMENT AND PRIVATE MEDICAL INSURANCE PREMIUMS

In the Past I Have Paid in Full for Private Medical Insurance Rather Than Wait for Treatment from the NHS

Instead of Taking Out Private Medical Insurance Now, I Would Rather Pay for Private Medical Treatment If I Need it in Future

Premiums for Private Medical Insurance are Good Value

Table 30: Paying for Treatment and Private Medical Insurance Premiums (% of respondents), 2007

NHS OR PRIVATE DENTISTRY

I am Registered With an NHS Dentist

I Have Private Dental Insurance

Table 31: NHS or Private Dentistry (% of respondents), 2007

PERSONAL ACCIDENT INSURANCE

I Have Personal Accident Insurance in Case I Get Killed or Injured in an Accident

I Would Claim for Compensation If I Was Hurt in an Accident and Did Not Have Insurance

Table 32: Personal Accident Insurance (% of respondents), 2007

CONFIDENCE IN THE NHS AND UNPAID CARERS

I Have More Confidence in the NHS Now Than in the Past

I Am an Unpaid Carer of an Ill, Injured, Disabled or Retired Person for At Least 10 Hours a Week

Table 33: Confidence in the NHS and Unpaid Carers (% of respondents), 2007

KEY POINTS

9. Company Profiles

INTRODUCTION

ABBEY

Corporate Strategy

Advertising and Distribution

Profitability

Future Company Developments

AMERICAN INTERNATIONAL GROUP

Corporate Strategy

Advertising and Distribution

Profitability

Future Company Developments

AXA PPP

Corporate Strategy

Advertising and Distribution

Profitability

Table 34: Financial Results for AXA PPP Healthcare Group PLC (£000, number, % and £), Years Ending 31st December 2003-2005

Future Company Developments

BUPA

Corporate Strategy

Advertising and Distribution

Profitability

Table 35: Segmental Revenues and Operating Surplus for BUPA (£m and %), 2006

Future Company Developments

CANADA LIFE

Corporate Strategy

Advertising and Distribution

Profitability

Table 36: Financial Results for Canada Life Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

COMBINED INSURANCE COMPANY OF AMERICA

Corporate Strategy

Advertising and Distribution

Profitability

Table 37: Financial Results for Combined Insurance Company of America ($000), Years Ending 31st December 2003-2005

Future Company Developments

EXETER FRIENDLY SOCIETY

Corporate Strategy

Advertising and Distribution

Profitability

Future Company Developments

FRIENDS PROVIDENT

Corporate Strategy

Advertising and Distribution

Profitability

Table 38: Financial Results for Friends Provident PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

GROUPAMA

Corporate Strategy

Advertising and Distribution

Profitability

Table 39: Financial Results for Groupama Insurance Company Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

HALIFAX

Corporate Strategy

Advertising and Distribution

Profitability

Table 40: Financial Results for HBOS PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

HITACHI CAPITAL

Corporate Strategy

Advertising and Distribution

Profitability

Table 41: Financial Results for Hitachi Capital (UK) PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

LEGAL & GENERAL

Corporate Strategy

Advertising and Distribution

Profitability

Table 42: Financial Results for Legal & General Group PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

LIVERPOOL VICTORIA

Corporate Strategy

Advertising and Distribution

Profitability

Table 43: Financial Results for Liverpool Victoria Insurance Company Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

NORWICH UNION

Corporate Strategy

Advertising and Distribution

Profitability

Table 44: Financial Results for Aviva PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Table 45: Financial Results for Norwich Union Healthcare Ltd (£000, number, % and £), Years Ending 31st December 2003-2005

Future Company Developments

PRUDENTIAL

Corporate Strategy

Advertising and Distribution

Profitability

Table 46: Financial Results for Prudential PLC (£000, number, % and £), Years Ending 31st December 2004-2006

Table 47: Financial Results for Prudential Health Ltd (£000, number, % and £), 13 Weeks Ending 31st December 2004 and Year Ending 31st December 2005

Future Company Developments

SAGA

Corporate Strategy

Advertising and Distribution

Profitability

Table 48: Financial Results for Saga Ltd (£000, number, % and £), Years Ending 31st January 2004-2006

Future Company Developments

SIMPLYHEALTH GROUP

Corporate Strategy

Advertising and Distribution

Profitability

Table 49: Financial Results for Simplyhealth Group Ltd (£000, number, % and £), Year Ending 31st December 2005

Future Company Developments

STANDARD LIFE HEALTHCARE

Corporate Strategy

Advertising and Distribution

Profitability

Table 50: Financial Results for Standard Life Healthcare Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

SWISS REINSURANCE COMPANY

Corporate Strategy

Advertising and Distribution

Profitability

Table 51: Financial Results for Swiss Reinsurance Company UK Ltd (£000, number, % and £), Years Ending 31st December 2003-2005

Future Company Developments

UNUM

Corporate Strategy

Advertising and Distribution

Profitability

Table 52: Financial Results for Unum Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

WESTERN PROVIDENT ASSOCIATION

Corporate Strategy

Advertising and Distribution

Profitability

Table 53: Financial Results for Western Provident Association Ltd (£000, number, % and £), Years Ending 31st December 2004-2006

Future Company Developments

KEY POINTS

10. The Future

ILL PREPARED FOR ILL HEALTH

INSURERS' DILEMMA

THE IMPACT OF SCARCITY

Scenario 1

Scenario 2

SOCIAL STRAINS

THE NHS

LOOKING AHEAD

KEY POINTS

12. Consumer Confidence

METHODOLOGY

KEY FINDINGS THIS QUARTER

THE WILLINGNESS TO BORROW

Confidence Improves

Table A: The Average Amount Consumers Are Willing to Borrow in Order to Purchase Expensive Items at Current and Constant November 2004 Prices (£ and £bn), February 2006-2007

Willingness to Borrow Slips Slightly

Table B: The Number of Adults Willing to Borrow in Order to Purchase Expensive Items (000 and %), February 2006-2007

SPENDING FROM SAVINGS

Slight Increase in Spending from Savings

Table C: The Average Amount Consumers Are Willing to Spend from Savings in Order to Purchase Expensive Items at Current and Constant November 2004 Prices (£ and £bn), February 2006-2007

Saving Grows in Relative Importance

Table D: The Average Amounts Adults Are Confident Spending to Purchase Expensive Items (£ and %), February 2006-2007

13. Further Sources

Associations

Publications

General Sources

Government Sources

Other Sources

Bisnode Sources

Abstract

According to Key Note's exclusive consumer research, in 2007, one person in eight could not lead their normal life because of illness or injury for 3 weeks or more in the preceding year. Illness and disability benefits were paid to 7.2 million claimants in August 2006; healthy life expectancy as a proportion of total life expectancy is falling; women are often carers for the ill and disabled, and their incomes suffer as a result; and consumer confidence in the NHS has fallen, despite billions of pounds of extra investment in the service. Despite all of these factors, private medical insurance (PMI) and income protection remain minority purchases. Household expenditure on PMI is very low, and is above £5 a week only in the highest income decile.

Key Note's research revealed that 39.3% of respondents would pay for treatment if needed, rather than take out insurance. Paying for one's own private treatment is a key trend and is an opportunity for specialist credit issuers to work in partnership with healthcare providers. The escalating costs of medical treatment, and the amount of ill health in the UK, alarm insurers, who are concentrating on health promotion and illness prevention.

Income and payment protection, and long-term care insurance are quiet sectors in which most consumers take little interest, although there was a slight revival in income protection policies in 2006. Average annual new premiums for critical illness cover cost individual policyholders 31.9% more in 2006 than in 2002. Premium cost increases contain growth in this sector. The pre-funded long-term care insurance sector has virtually disappeared, and the market for point-of-need policies is also small.

PMI is a confusing sector for the public, and personal subscribers to PMI policies are in decline, although corporate subscriptions are rising. Premiums have become unaffordable for many personal subscribers. Demand for medical cash plans is rising gently, and dental cash plans are buoyant, as a result of dentists' retreat from the NHS. Loans to patients to pay for private treatment at the point of need form a promising and expanding sector for suppliers. The quiet personal accident sector has suffered from the popularity of post-accident negligence claims. In mortgage payment protection, individuals are less inclined than previously to take out cover.

As in the US, high expenditure on healthcare does not necessarily lead to a healthier population. In the UK, private expenditure on healthcare per capita is relatively low compared with other advanced economies. Public and private expenditure combined is in line with other large advanced economies, but is only two-fifths of the per capita spend in the US. Healthcare for ageing populations in developed economies will exert significant demands on public finances unless whole populations rapidly adopt healthier lifestyles and require less healthcare — an unlikely scenario.

In the UK, households already under financial stress will struggle to provide the additional taxation revenues that the NHS will need, unless the Government radically reduces the scope and reforms the financial basis of the service. The majority of households that cannot afford PMI in 2007 are unlikely to diminish in future.

Despite the finding that 12.2% of respondents to Key Note's survey said that they suffered illness or injury that prevented them from leading a normal life for 3 weeks or more in the preceding year, people are not prepared for this financially: 46.7% of respondents admitted that they would not be able to manage financially if stricken by illness or injury. The majority of respondents in the sample agreed that they do not have income protection, PMI, dental or personal accident insurance, and there is a trend to rely on paying for treatment, should it ever be needed. The survey also revealed a decline in public confidence in the NHS, leading more people to think about the possibility of private treatment, even if they have no insurance. One in six respondents said that they have already paid for private treatment, compared with fewer than one in 12 in a similar survey in 2004.

Men are more likely than women to have income protection, PMI and personal accident insurance, but women do most of the unpaid caring, saving the state billions of pounds a year. A key issue for policymakers should be how to improve women's incomes, for those undertaking unpaid as well as paid work, to enable more of them to afford insurance. For insurers, an equally important issue is how to design policies that more potential customers — including the elderly — understand and accept as providing good value. There appears to be considerable confusion among the public over the precise meaning of insurance terms, a matter for insurance companies to consider. `Fuzzy' perceptions of insurance products are a barrier to growth.

BUPA remains the UK leader in PMI, but it is attaching increasing importance to partnering the NHS. This parallels the trend for consumers to use medical insurance as a top-up for the NHS. Another change of focus in BUPA is a rising emphasis on long-term care for the elderly in the UK and abroad.

Traditional PMI, covering the costs of treatment, is compromised by rising costs resulting from the increasing complexity and wider range of treatments available. Organisations that provide for customers to pay part of the cost of their treatment, such as Western Provident Association (WPA) and Exeter Friendly Society, can exert some control over premium levels. Private medical providers increasingly favour cash plans, which pay out set amounts in specified circumstances. AIG and Simplyhealth Group are among the cash plan specialists. In addition, insurers are trying to persuade their customers to stay healthy so they do not need to claim. Fast-growing PruHealth is especially innovative in this respect.

Elderly people, who need PMI to an even greater extent than young adults, often cannot afford premiums. Policies catering for the elderly include AXA PPP's Retirement Essentials and Saga's Key Treatments, which provide targeted cover at lower cost than conventional PMI. Self-pay is an important trend, as individuals reject medical insurance in favour of paying at the point of need should they ever need treatment. Hitachi Capital, for example, caters for self-payers by providing loans.

In the quiet market for income protection insurance, including critical illness cover, companies are looking more to group sales and less to individuals. Canada Life, Combined Insurance and Unum are among the companies targeting the group market.

As already identified, there is a trend for individuals to pay for treatment should they need to, with a loan if required, rather than taking out PMI, for which the premiums are pushed ever upwards by rising medical costs. These costs threaten the long-term viability of medical insurance, especially for commercial insurers. Confusion is another factor: branding is under-developed in medical and protection insurances, and many policies are complicated, with lists of exclusions and lots of `small print'.

At a time of population increase, the core family type for medical and protection insurance — couples with dependent children — has declined as a proportion of all households, and this trend is unlikely to reverse. Medical insurers will focus increasing efforts on keeping their current customers in good health, and to ensure regular check-ups so there is early warning of conditions before they become so serious that they are expensive to treat.

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