Consistent Results Across Most of The Board

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1 Canadian Health Care Trend Survey Results 2015

2 Consistent Results Across Most of The Board Our 2015 Health Care Trend Survey demonstrates that drug, health and dental cost trend factors have remained consistent with the results from As we do every year, we asked the major Canadian group insurance carriers to provide the annual inflation factors they are using to project health and dental claim costs for the upcoming year in the pricing of their premium rates. We then compared these factors to those provided in our previous surveys in order to get a sense of the long-term health care pricing trends for group insurance plans. The insurers provided us with inflation factors for each type of coverage: prescription drugs, medical, hospital and dental care. The factors account for the insurer s expected increases in claims resulting from the following: Cost inflation Increases in utilization of services New services and products entering the market Legislative changes Changes in the mix of services Shifting costs from the public to the private sector Despite last year s reduction in inflation factors for all of components of health care, this year the overall trend in cost increases showed a slight increase. Looking at all of the health care components on a blended basis, insurers are using an average factor 11.69%, up from 11.56% last year. With prescription drug costs representing the majority of private payer health spend, they have the greatest influence on employer benefit cost trends. Insurer s inflation factors for prescription drugs demonstrate an increase from 10.64% in 2014 to 11.57% for Hospital inflation factors have been consistently on the upswing from 2011 to 2014, however in 2015, there was a drop from 11.24% in 2014 to 9.70%, which is close to the 2013 trend factor. Expected utilization trend of dental services has increased from 5.47% in 2014 to 5.93% this year. Dental cost inflation varies across the country as each province publishes its own fee guide. Our composite fee guide factor over the previous five-year period reveals a slight decrease in the fee guide factor compared to each of the last four years. With the rate of utilization increasing and the slowing of dental cost inflation, there was a small anticipated net increase in total dental trend, from 7.81% in 2014 to 8.02% in

3 Qualification and Commentary The trend factors in this survey reflect insurers projected rates of inflation/claims tend in health and dental care costs: The final premium rate adjustment requested by an insurer may also reflect: Actual plan experience which is higher or lower than originally projected Changes in the insurer s administration expenses Cost of capital and risk charges Funding changes to insurer reserve requirements Changes in any explicit margins for conservatism Recovery of any prior period losses Plan sponsors therefore may see annual premium rate adjustments that differ from the health care trend factors summarized in this report. Our Canadian Health Care Trend Survey is conducted and published annually, although some insurers may update their trends more frequently. 3

4 Summary of Survey Results Health Care Overall Blended Health Care Trend % % % % % *Where insurers did not provide a blended health care factor; this was calculated using a breakdown of 70% for drugs, 25% medical (including vision) and 5% hospital % 11.67% 11.79% 11.56% 11.70% The trend has remained stable and significantly lower than the high reached in Additional commentary follows by component. Results by Benefit Three insurers provided trend factors for each of the health components separately versus using one trend factor for all components of health care. These results show the factors, broken down by component for those insurers who provided the breakdown. Coverage Average Annual Total Trend Factor Prescription Drugs % % % % % Medical Services and Supplies % % % % % Hospital % % % % % 14.20% 12.11% 11.69% 10.64% 11.57% 12.20% 11.14% 13.18% 13.68% % % 8.41% 9.73% 11.24% 9.70%

5 Prescription Drugs The impact of the generic drug price reforms in Alberta, Ontario, Quebec, British Columbia and Nova Scotia that began in 2010 and were phased in over three years can be seen in the historic insurer trend line. The reduced rate of increase was further supported by the expiry of the patents of several widely prescribed drugs through this period. It is interesting to note the trend rate seems to have bottomed-out in 2014 for insurers, while the experience of the Telus book of business suggests the trend has actually been on an upward, although significantly lower than that of the insurers, trajectory since Insurers are anticipating higher increases in the cost of drugs in 2015 than in This reflects both the increase in the utilization of drugs at all ages in the population as well as the release of new expensive drugs, such as the recently introduced drugs for the treatment of Hepatitis C. As insurers drug trends have decreased over the past few years, it was possible to become somewhat complacent in drug plan management, however the new upward direction and the Telus trend line remind us that appropriate plan design and management is key to sustainable affordability of drug plans. Average annual trend factor % % % % % 17.0% 12.0% 7.0% 2.0% -3.0% Insurers Telus Medical Services and Supplies (excluding prescription drugs) -8.0% Note: Telus data is actual, therefore only 2014 is available at the time of publication. The expected inflation has decreased from 2014, after two years of increases, although claims experience indicates increasing utilization under many of the catergories under services and supplies. Many of the covered services and supplies include an annual limit that restrains the inflation. While costs may be rising for a service such as physiotherapy treatment, the annual limit holds. This may result in the plan member receiving less treatment for the same cost to the plan, controlling the plan cost increases but shifting the cost to employees, potentially undermining the value of the benefit. Average annual trend factor % % % % % Hospital 14.0% 13.5% 13.0% 12.5% 12.0% 11.5% 11.0% 10.5% Hospital trend expected by insurers decreased this year, after four years of increases. This is somewhat surprising as hospitals across Canada are seeking increased revenue opportunities. However, with the shift toward outpatient care, shorter hospital stays for routine procedures, the use of drug therapy administered outside the hospital and hospital overcrowding, utilization may be falling slightly % % % % % Average annual trend factor 12.0% 11.0% 10.0% 9.0% 8.0% 5

6 Dental Care Dental trend factors are made up of two components. One is a utilization factor representing the expected increase in utilization of dental services from one year to the next. Each insurer sets this factor according to its own experience and projections. The other component is the increase in fees for dental services from one year to the next, as determined by the provincial dental associations. Dental Care (Utilization Only) The anticipated trend resulting from increased utilization is up slightly from 2014 s 5.47% at 5.93% for Average annual utilization factor % % % % % Dental Care (Fees) 6.0% 5.5% 5.0% 4.5% 4.0% 3.5% 3.0% Dental fee guides are published annually by the Dental Associations in most provinces. In the annual review, the Dental Associations determine the cost adjustment of each procedure code. A blended trend is used by insurers reflecting the typical spread of dental procedures claimed and the distribution of the population of a group throughout the provinces. To determine the five-year trend in overall fees, we developed a composite fee based on the distribution of Canada s labour force according to recent StatsCan labour statistics. The trend continues to decrease in 2015 to 2.09% from 2.34% in Composite fee guide % % % % % Dental Care (Utilization and Fees Combined) 3.0% 2.5% 2.0% 1.5% 1.0% Pricing for employer dental plans incorporates trend factors that combine both the utilization and fee components depending on the location or distribution of the workforce. The trend for the combined utilization and fee components increased from 7.81% in 2014 to 8.02% in Dental combined % % % % % 9.0% 8.5% 8.0% 7.5% 7.0% 6.5% 6.0% 6

7 Provincial General Practitioner Fees The following shows the average increase in general practitioner fees set out in the fee guides published each year across Canada by the provincial Dental Associations. The results show a lower increase than in 2014 for the majority of the provinces. Newfoundland & Labrador posted the largest decrease once again this year from 2.64% to 1.76%. Province Alberta % 4.24% 3.79% 3.77% 3.66% British Columbia 1.88% 2.22% 2.42% 1.86% 1.96% Manitoba 3.49% 3.24% 3.21% 3.16% 3.00% New Brunswick 2.36% 3.30% 2.11% 2.89% 2.04% Newfoundland & Labrador 5.98% 4.29% 4.97% 2.64% 1.76% Nova Scotia 2.39% 2.58% 2.53% 2.09% 2.20% Ontario 2.04% 2.66% 2.20% 1.97% 1.51% Prince Edward Island 2.25% 2.34% 2.80% 2.24% 2.22% Quebec 1.78% 2.29% 3.05% 2.23% 2.09% Saskatchewan 3.07% 3.00% 4.17% 2.49% 1.98% 2 Since the Alberta Dental Association does not publish a Fee Guide, it is common for insurers to use their own experience to determine increases required in conjunction with CLHIA data. Dental (Combined Trend by Province) As noted above, the trend factor that insurers use in their pricing of dental services consists of a combination of the utilization factor and fee guide increase and the province of residence of the employees. The following table shows the combined utilization and fee guide trend by province. As in previous reports, Alberta stands out as having the highest expected cost increases, exceeding 9% again. As it did last year, Manitoba shows the second highest expected cost increase, this year at 8.93%. The remaining provinces fall between 7.4% and 8.2%. The cross-section shows that there is significant variation among the provinces. Most provinces showed an increase in the expected cost increase from 2014: Alberta (9.24%), British Columbia (7.33%), Manitoba (8.63%), Nova Scotia (7.56%) Prince Edward Island (7.71%) and Quebec (7.70%) Dental Utilization and Fee Guide Increases by Province AB BC MB NB NL NS ON PE QC SK Province Increase Alberta % British Columbia 7.89% Manitoba 8.93% New Brunswick 7.97% Newfoundland & Labrador 7.69% Nova Scotia 8.13% Ontario 7.44% Prince Edward Island 8.15% Quebec 8.02% Saskatchewan 7.91% 7

8 Looking Ahead In looking back over the past four years, we can see the projected increases were significant. When piled on top of each other year-over-year, they mean benefit cost increases have well outpaced general inflation. Fortunately, many employer plans have performed below the insurer s anticipated rate of inflation, although still exceeding general inflation. While much of the trend is driven by external forces such as new developments in drugs and technology, the rate of increase may be impacted by plan design. Looking ahead we see no end to the rising cost of benefits. This upward trend is driven by health care inflation and utilization. However, we encourage a holistic approach to employee benefits in order to stem the tide. Some claims patterns can be changed through better consumer behavior. This can be managed with tools like claim costs through co-payments, a plan design that promotes the use of preferred providers and of course targeted communication educating employees around mitigating costs and shopping smart. Behaviour change is difficult to achieve, however, it can be impactful. As detailed in the results of Buck Consultants at Xerox s Working Well A Global Survey of Health Promotion, Workplace Wellness, and Productivity Strategies, workplace wellness initiatives can change the trend of Health Plan costs. While the impact of wellness on benefit cost is not widely measured by Canadian employers, 28% of survey participants from the U.S. indicated their wellness program reduced their Health trend rate. The same survey shows the majority of Canadian participants (88%) do not have specific measures for the outcomes of their wellness programs. The top three wellness outcomes identified by Canadian employers in the survey are: Reducing employee absence due to sickness or disability; Improving worker productivity/reducing presenteeism; Improving workforce morale/engagement; and Reducing health care or insurance premium costs. These outcomes can all be quantified to some degree, although reducing employee absence and health care and insurance costs are definitely measurable. Canadian employers do not typically leverage risk assessments or even their plan claims data to tailor wellness initiatives to their employee population with the intention of addressing modifiable health risk factors or improving treatment compliance for better outcomes. Our framework for future cost management proposes an employer-employee relationship based on the concept that employers can create a workforce of informed, engaged consumers. These consumers will make better decisions to further modify their claims patterns, reflecting positive outcomes through behavior changes in other aspects of their lives, that will reduce the trend line in the future. Conclusion It s a given that medical, prescription drugs and dental plans will account for a major portion of an employer s costs. An aging population and advances in technology suggest that the trend will continue upward. And while many employers currently feel that they reinforce a healthy lifestyle and smart consumerism through the benefit plan they provide to their employees, wellness programs that build a healthier, better educated workforce better may be the best cost containment strategy for the future. If you would like to discuss the details of your plan and possible enhancements or modifications to better align with corporate objectives or to reduce the trend rate of your plan, please contact us. 8

9 Participating Organizations Desjardins Financial Securities Great-West Life Green Shield Industrial Alliance Manulife Financial Medavie Blue Cross SSQ Financial Standard Life Sun Life Financial Contact Us Promoting a culture of health in your organization has never been more important. We can help you develop, update, or enhance your health care programs to keep your offerings competitive, your costs under control, and your employees healthy and productive. Buck Consultants, A Xerox Company 155 Wellington Street West, Suite 3000 Toronto, ON M5V 3H1 Phone: Fax: Toronto: Montreal: Ottawa: This survey is also available electronically at Xerox Corporation and Buck Consultants, LLC. All rights reserved. Xerox and Xerox and Design are registered trademarks of Xerox Corporation in the United States and/or other countries. Buck Consultants is a registered trademark of Buck Consultants, LLC. in the United States and/or other countries. BR15653

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