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1、2022年医疗支出趋势报告普华永道的健康研究所(HRI)与在美国健康计划工作的 精算师和该行业其他部门的医疗保健高管进行了交谈, 以估计来年的医疗成本趋势。考虑到大流行导致的成本膨胀和缩减,HRI预计2022年 的医疗成本趋势为6.5%。这趋势略低于2021年预计的 7%,略高于2016年至2020年期间的所有预测值。与2021 年相比,2022年的医疗成本的下降趋势反映了疫情对医 疗支出的持续影响逐步缓和。接受HRI采访的美国健康计划高管一致认为,2022年的 2022年的医疗支出将恢复至疫情前的基线水平。2022年值得关注的医疗支出趋势 药品支出专业药品支出是医疗成本趋势的持续驱动因素。对
2、昂贵 的细胞和基因疗法的管道的资金投入只会增加,因为 FDA今年已经批准了两种新的细胞疗法治疗癌症,预计 在未来五年内将有15到30种此类疗法上市。据IQVIA称,生物仿制药在美国的使用已经开始增加, 预计从2020年到2024年将节省1040亿美元,其中大部 分将在2023年和2024年实现。雇主正在承担更多的成本增长。平均而言,与十年前相 比,保险在处方药零售支出中所占的份额有所增加,而 消费者在这方面所占份额近年来已趋于平稳。 网络安全与数据泄露和勒索软件攻击相关的间接成本可能创下新 高,这阻碍了企业的运作能力。毫无疑问,网络攻击仍然是一个巨大的威胁,但要制定 防御网络威胁的投资决策却并
3、不那么简单。普华永道调 查的健康行业高管中,48%的人表示,他们将在2021年 增加网络预算。 意外账单 将于2022年1月1日生效的无意外法案(No surprise Act)在很大程度上缓和了支付方和提供商之间的行业内 部争端。但这对雇主医疗支出的影响尚不明确。国会预算办公室表示,该法案将把保费降低0.5%至1%,因为“部 分医疗服务提供商获得的保费将减少”。医疗保健成本研究所总裁兼首席执行官Niall Brennan在 接受HRI采访时表示,“用来结束意外账单的机制似乎可 能会增加管理成本,最终将通过更高的保费转嫁到消费 者身上“。PwC Health Research Institut
4、epwcMedical cost trend: Behind the numbers 2022pwc8mAis/medicalcosttrends二 (Ctf 821 -，才M umbw;O助” E 邓R- ia tffjtfcal rcoi;Heart of the matter Figure 1: HRI projects medicThe COVID-19 pandemic reshaped Americans lives as they grappled with illness, hospitalizations, death and an economic calamity. At
5、 the center of this turmoil was the US health system, which rapdly responded with herculean effcxls to care for its patients and the development, manufacture and drstribution of safe, effective diagnostics, therapes and vaccines.The pandrrc made a pronounced impact on how and where Americans gain ac
6、cess to care, a shift large enough to influence multiple aspects of price and 5小zabon and. thus, medical cost trend. Some of these shifts represent deflatorsof trend; others, infiators. These changes may persist for years in a system that has long resisted profound shifts. In 2022, the haattn system
7、 will take a txeath and survey the fallout from these extraordinary few years.As it has done for the past 15 years. PwCs Health Research Institute (HRI) spoke with actuaries working at US health plans and healthcare executives in other parts of the industry to generate an estimate of medical cost tr
8、end for the coming year. Faking into account the pandemic-rooted inflators and deflators of cost, HRI m pfo and infrastructure changes. Digital investments to enhance the patient relationship increase utilization. HRI expects providers to accelerate investments in digital toote and analytics capabil
9、ities to strengthen the patient relationship, boosting utilization in 2022.At the same ome. some positive changes in constmer behavior and provujer operabng models that occurred d5,09 the pandemic are expected to drive down spending in 2022: Consumers lean into lowermost sites of car。. Fhe pandemic
10、prompted many consumers to embrace virtual care, retail chntcs and other alternative sites of care, in some cases in place of a visit to the emergency department. HRI expects this adoption of lower-cost sites will dnve lower spending in 2022. Health systems find ways to provide more healthcare for l
11、ess. The new ways of working forced by the pandemic, including remote workforces, process automation and cloud technology, can help providers lower thetr cost structure n response to pressure on prices, including the new pnce transparency regulations and growing interest in narrow networks? HRI expe
12、cts this will dampen price increases and spending in 2022.While the pandemic remains the primary driver behind these factors increasing and decreasing the medical cost trend m 2022, other non-pandemic-refated dnvers or dampeners of spending should not be ignored, including drug spending, cybersecunt
13、y and the surprise-billing legislation passed m December 2020 that takes effect Jan. 1. 20227公公!公公IINFLATORSForgone, not conrwng bock Annual preventive care visit Diagnostic lab or imaging that is needed Surgery that has been replaced intensive interventionDeferred, coming back in the same form Knee
14、 surgery Sinus surgery Other non-urgent but necessaryDeferred, now requires more intervention Delayed cancer screening that c stage 3 cancer that could have t caught at stage 1 Prediabetes that worsens into diType of careExamplesINFLATOR:The COVID-19 hangover leads to increased utilizationThe pandem
15、ics long tail may increase utilization and healthcare spending in 2022 thanks to the return of some care deferred dun ng the pandemic, the ongoing costs of COVID-19, increased mental health and substance use issues, and worsening population health.Some care deferred during the pandemic returnsOveral
16、l, healthcare spending by employers in 2020 was lower than expected, m large part because of the deferral of cane as a result of the pandemic. Some of this care is expected to rebound in 2022. and some of it likely will increase healthcare spending (see Figure 2).Figure 2: Care deferred during the p
17、andemic tha higher cost than it would have been in 2020Scurco Hvelth Reerc*i nM0Lo erat/)临 & krervietws with emfioy*N04 The RendinQ mpscta reltoct m|73cl on nperxfirig in a year compared wit * nr dvnponod iXJbatlon and tficrding nxpocwd ttunng the 5: M at 20 I wth an t tor 九 jrmt.Fifteen percent of
18、American consumers with employer-sponsored insurance surveyed by HRI in September 2020 said they had deferred some care between March and September/ These consumers reported delaying an average of 62% of their care since March 1. Consumers were most likely to delay annual preventrve visits. They als
19、o were likely to report delaying routine visits for chronic illnesses, laboratory tests and screenings (see Figure 3). Sxty-eght percent of office-based providers and office-based nurses surveyed by HRI said their volumes for these types of care remained below prepandemic levels m the spring of 2021
20、.*COVID-19 costs are likety to persistThe costs of testing for COVID-19t treating patients and administering vaccinations for the disease likely will continue into 2022. Pandemic-related diagnostic testng may be knitted into return-to-work strategies for employers. Eighty-six percent of employees su
21、rveyed by PwC in January 2021 said they would agree to employer-required, employer-funded testing for SARS-CoV-2, the virus that causes COVID-19.6 Testing for SARS-CoV-2 may also become a seasonal cost during the winter months. Eighty-nine percent of immunologists, infectious-diseaseFigure 3: During
22、 the first six months of the pw insurance most commonly deferred their anrTypes of care deferred by individuals with em clinician-ne ported levelsOffcbAMd providers and off ce-baMd nurws rx that thi* serVCe was below pre-pandemc levelsSource. P*C sm Research 43cWkm survey. Acnl 2gl. and PwC Note： Ba
23、sed on ceaporacs168 EMduahtemptayer-fcased imiMarco wNwo/AKi H20, and tcm ? omce-b*Md皿 0ttk.t0 Mtorch-Aprt ?02l#betcm Marth BOOttiee七wcrtirq ouside hospital and h e cnharhotp:cu!ade a hmphai frtg and n a 00Mv cdier ihan acute ewe nuraing.Appendix Medicalcost trerdAdolescGnt behavioral N growth in sp
24、ending in 20 functional adoi escent mshortness of breath, headaches and difficulty concentrating lasting eight weeks or longer?3IMPUCATIONS Payers and employers: Go beyond analyzing the impact of worsening population health on spending. Model how the pandemc may worsen health and, in tum, increase h
25、ealthcare spending for drfferent individuals based on the health status. Use machine learning to proactively target interventions that could help prevent and mibgate worsening health. Consider investing savings from lower-than-expected healthcare spending in 2020 in disease management programs, expa
26、nded mental health benefits, or nutrition and exercise discounts/programs that coukj help mitigate or reverse some of the fallout of poor haaith behaviors and isolation of the pandemic.Providers: Be proactive and personalized to get patients back in for care. Forty percent of consumers surveyed by H
27、RI with employer-based insurance who had deferred care since March 1, 2020, and still not received it or rescheduled it as of September 2020 said they would be encouraged to reschedule their doctor said it was safe/1 Fifty percent of officebased providers and office-based nurses surveyed by HRI who indicated that some patents had deferred care said they had encouraged