Stroke, cancer and cardiac events – has COVID-19 caused a rise in critical conditions?
An in-depth look at MAXIS GBN claims data
COVID-19 has changed the world, potentially forever. Transformations to how people access healthcare have been talked about at some length, but has the pandemic also had an impact on the types of conditions people are seeking treatment for?
This is important for employers all over the world as they look to put the sort of proactive wellness plans in place that can help keep their employees healthy and productive, while also mitigating their healthcare costs.
And, as so often is the case, data is the key. Multinationals can analyse their own healthcare claims to understand the biggest challenges facing their people and the wellness programmes that could make the biggest difference for them. However, not everyone has access to the in-depth data they need to be able to do this.
"Data is the key."
At MAXIS we have access to an incredible amount of data in the global healthcare space, via our network of local insurers. We collect anonymised medical claims data from over 43 local insurers in 27 markets across Asia, the Middle East, Africa, Europe and the Americas. We then standardise and analyse the data to get a snapshot of the changing trends in the private healthcare landscape.
Analysing MAXIS claims data
To give us an understanding of how healthcare has changed since COVID-19 took hold of the world in 2020, we have analysed our claims data for 2020 and 2021 and compared this to a benchmark of 2017-19. This comparison allows us to see where we are witnessing an increase in paid claim amounts for certain conditions. Such an increase normally highlights a rise in the number of claimants, the severity of conditions, or both.
In this Viewpoint, we will look at some of the biggest changes our data has highlighted, explore some potential reasons why and look at what this could mean for you as a multinational employer.
If you’d like to find out more on this fascinating subject, register for our webinar, where our Chief Health & Wellness Officer, Dr Leena Johns, will talk about the data in more detail. More details coming soon... You won't want to miss it!
Global healthcare trends - a rise in critical conditions
In our global data analysis we performed a proportional analysis of claims in 2020 and 2021 with that of 2017-2019.
Before we look at the results in more detail, here are some key takeaways.
There has been a significant rise in claims for critical conditions – strokes, neoplasms (or cancers) and cardiac conditions which have all risen by more than 65%, with stroke costs rising by 150%.
Mental health costs more than doubled, with a rise of 128%. And an increase in other conditions that could be linked to mental health (palpitations, migraines etc) also rose significantly.
Maternity related conditions (miscarriages and congenital malformations) all show large increases.
Let's look at the data in full...
The largest increases, all of which were by more than 100%, are stroke, migraine, cancers and mental health claims.
A drastic increase in critical conditions...
Let’s first look in more detail at claims related to stroke, as with an over 150% increase, it’s a good place to start our analysis. Of course, we wonder if this is an anomaly or a wider trend, and yet, it seems that there is a link between COVID-19 and a heightened risk of stroke. A study in April 2021 found that the risk of stroke was more than twice as high for COVID-19 patients compared to people of the same age, sex, and ethnicity in the general population – 82.6 cases per 100,000 people compared to 38.2 cases for those without a COVID-19 diagnosis.1
"...it seems that there is a link between COVID-19 and a heightened risk of stroke."
According to Jonathan Kizinger, DPT, from the University of Utah Health: “We are definitely seeing a huge increase in younger stroke survivors who are post-COVID diagnosis. We know that vascular complications go along with COVID infections, which can lead to strokes and other cardiovascular issues.”
Kizinger’s observation about cardiovascular issues is backed up by our data – we saw a 66% increase in claims for cardiac signs and symptoms in 2020/21 when compared to before the pandemic. And it’s not just the private medical sector that has seen this increase. The Financial Times analysed data from the UK’s National Health Service (NHS) and found that there were significant rises in deaths from heart disease since the start of the pandemic in all but the very oldest age groups. In the 40-64 age group, heart attack deaths increased 15% in 2021 compared with 2019.2
"We saw a 66% increase in claims for cardiac signs and symptoms in 2020/21 when compared to before the pandemic."
Meanwhile in the US, a study found that conditions like heart failure and stroke were substantially higher in people who had recovered from COVID than in similar people who were not infected.2
The link between COVID-19 and a higher rate of these critical conditions is a worry for employers. Not only could there be an increase in the number of their people who become seriously ill, the additional costs of insurance plans could be significant.
"The link between COVID-19 and a higher rate of these critical conditions is a worry for employers."
Mental health – are increasing cases a sign of a lifting of stigma?
So much has been written about the pandemic, lockdowns and links to mental health, it is hardly surprising to see that mental health costs have more than doubled in our data. According to the World Health Organization (WHO) the pandemic has triggered a 25% increase in anxiety and depression worldwide.3
As well as an increase in the prevalence of mental health problems, the increase in our data could also be due to a shift in the stigma associated with mental health claims, as people become more comfortable talking about and seeking help for their mental health conditions. And the increase in medical professionals using the ICD codes for mental health conditions, rather than batching them into “other” categories, could play a role in the increase.
There are also other conditions to consider too. While it’s hard to say definitively, mental health conditions could be manifesting as physical conditions like migraines and palpitations, both of which increased significantly in our data.
What does this mean for employers?
Mental health has been a hot topic for years but the pandemic has helped people further understand it, and accept that poor mental health isn’t just “a sign of weakness”. The rising costs associated with mental health conditions are not unexpected and employers should be considering providing access to mental health support for all their people.
Offering proactive mental health services like employee assistance programmes (EAP), tele-mental health services and counselling can go a long way to providing employees with the support they need while building a supportive and inclusive culture.
"The rising costs associated with mental health conditions are not unexpected and employers should be considering providing access to mental health support for all their people."
Major differences between 2020 and 2021
The proportional analysis of 2020 and 2021 costs give us a good idea of the conditions that have become more prevalent or increased in severity, but it is also worth looking at the differences between 2020 and 2021.
The line graph shows the volatility in claims in 2021, with the yellow line representing 2021 ahead of the orange 2020 line in almost every area. Huge increases in stroke, migraines, mental health and neoplasms are particularly noticeable.
These differences raise some interesting questions.
- Are these increases a transient trend or is the trend set to continue and possibly become even worse in 2022?
- Have the delays in accessing healthcare in 2020 increased the severity of conditions?
- Was 2021 so much higher than 2020 because healthcare services were clearing a backlog after 2020 lockdowns?
- How can employers help to mitigate the potential cost increases?
While nobody knows what the future holds, multinationals should certainly be thinking about what this data could mean for them.
Regional focus
Now we have looked at the differences between the two “pandemic years” data, it’s worth looking at how medical claims costs vary by region...
As you can see, we have split the data for six major health categories by region. This way we can understand the differences between Latin America (LATAM), Middle East and North Africa (MENA), Asia Pacific (APAC) and Europe.
There are some very interesting trends here, so we’ll look at some of these conditions in more detail.
Mental health
Let’s start with mental health claims as we’ve talked about this already in the overall global statistics. Interestingly, here we see the largest increase in the MENA region, with a rise of over 340%. Significant increases in Europe and APAC look incidental when compared to the MENA data but are still 163% and 131% (respectively).
Latin America saw a, comparatively, small increase of 17%, which could suggest that the stigma towards mental health is still prevalent in the region, or access to treatment is very limited.
Congenital malformations
Congenital malformations, or birth defects, are conditions that develop prenatally and may be identified before or at birth, and sometimes later in life. According to the WHO, an estimated 6% of babies worldwide are born with a congenital anomaly.4
Here we saw our largest regional growth, with a 388% increase in the APAC region. There were also large increases in MENA and LATAM.
Neoplasms
In our July Viewpoint we wrote about the need to focus on cancer in the aftermath of COVID-19, and our data here backs this up. Across all regions we saw an increase in cancer claims costs, both in incidence and severity.
Cardiac symptoms
Just like neoplasms, there was a large increase in cardiac conditions across all regions. For cardiac claims, Europe saw the largest increase within the cardiac symptoms category, with costs more than doubling.
Palpitations
Palpitations is one symptom category that, as we mentioned earlier, could indicate a cardiac condition or could be a result of stress and anxiety. In our data we can’t identify the underlying cause for palpitations as the information is captured in a single diagnostic code. We see the incidence of people presenting with palpitations increasing in almost all of our regions, with MENA showing an increase of more than 50% and APAC and Europe more than doubling in number.
Nervous system disease
In our final category, nervous system diseases also saw a large increase everywhere. The amount paid in claims for these conditions more than doubled in all regions, except for LATAM which saw a 61% increase.
What’s next in the post-pandemic world?
“The level of damage that’s been done to population health [during COVID], it would be as if everybody suddenly decided to take up smoking in one go,” said Dr David Strain from the University of Exeter in the UK.2
When analysing our claims data from 2020 and 2021 and comparing it to the years before the pandemic, Dr Strain’s analogy seems quite fitting. The huge increase in claims for critical conditions and mental health cases show a bleak picture for the overall health of people around the world. And looking at the regional breakdowns, this isn’t an isolated issue – it’s truly global.
There could be a multitude of causes for the increase in the severity and frequency of these conditions – whether caused by delays to treatment, the long-term side effects of suffering from COVID, or something else entirely. Even though we don’t know the cause for certain, it’s clear that the “COVID years” of 2020 and 2021 have had a drastic impact on the healthcare landscape.
Looking at the regional breakdowns, this isn’t an isolated issue – it’s truly global.
What we do know is that multinationals need to act quickly to help keep their people as healthy as possible while controlling their medical costs.
As a multinational employer - what can you do?
- Analyse your own medical claims data to understand the medical conditions that are having the biggest impact on your people.
- Encourage healthy behaviours to minimise the risk factors of lifestyle-related chronic diseases.
- Think about offering proactive screening programmes.
- Ensure you’re offering the right critical disease treatment programmes.
- Offer mental health support via EAPs, counselling services and more.
- Join our webinar with Dr Leena Johns to hear even more insights into this claims data and what this means for employers and employee benefits professionals - more details coming soon!
What happens next, we don’t know, but it will be interesting to look at 2022 data and see if there is any sign of a return to the “old normal” or if the impacts of the 'COVID years' are here to stay.
Like this piece? Read our other related stories...
Returning to work - supporting your employees who have had cancer
Helping your people with a comfortable transition
This document has been prepared by MAXIS GBN and is for informational purposes only – it does not constitute advice. MAXIS GBN has made every effort to ensure that the information contained in this document has been obtained from reliable sources but cannot guarantee accuracy or completeness. The information contained in this document may be subject to change at any time without notice. Any reliance you place on this information is therefore strictly at your own risk.
The MAXIS Global Benefits Network (“Network”) is a network of locally licensed MAXIS member insurance companies (“Members”) founded by AXA France Vie, Paris, France (“AXA”) and Metropolitan Life Insurance Company, New York, NY (“MLIC”). MAXIS GBN, a Private Limited Company with a share capital of €4,650,000, registered with ORIAS under number 16000513, and with its registered office at 313, Terrasses de l’Arche – 92727 Nanterre Cedex, France, is an insurance and reinsurance intermediary that promotes the Network. MAXIS GBN is jointly owned by affiliates of AXA and MLIC and does not issue policies or provide insurance; such activities are carried out by the Members. MAXIS GBN operates in the UK through its UK establishment with its registered address at 1st Floor, The Monument Building, 11 Monument Street, London EC3R 8AF, Establishment Number BR018216 and in other European countries on a services basis. MAXIS GBN operates in the U.S. through MAXIS Insurance Brokerage Services, Inc., with its registered office located at c/o Katten Muchin Rosenman LLP, 50 Rockefeller Plaza, New York, NY, 10020-1605, a NY licensed insurance broker. MLIC is the only Member licensed to transact insurance business in NY. The other Members are not licensed or authorised to do business in NY and the policies and contracts they issue have not been approved by the NY Superintendent of Financial Services, are not protected by the NY state guaranty fund, and are not subject to all of the laws of NY. MAR01133
Built with Shorthand