Covid-19 is dominating the corporate healthcare space, with organisations looking at ways to keep employees safe in the workplace. But, with this focus meaning that other serious diseases have gone undiagnosed, a surge in cancer claims could put the cost of medical insurance cover back on the agenda.
Long before the pandemic, advances in cancer treatment were already putting claims costs under considerable pressure. “Cancer treatment and care has been the main source of cost increases for the last few years, and will be for at least the next few too,” says Axa PPP Healthcare commercial director Fergus Craig. “It’s good news for patients, as it signals improved survival rates, but it does come at a cost.”
Costs are significant. While the £20,000 plus price tags on biological therapies such as Herceptin and Avastin may have caused palpitations among medical insurance underwriters when they were introduced 20 years ago, they’re small beer when compared to the latest advances. For instance, CAR T-cell therapy is a form of immunotherapy where small changes are made to a patient’s T cells to help them target the cancer. Its highly specialist nature means it can cost £500,000 plus.
Absorbing an expensive cancer claim on a medical insurance scheme is already challenging but
Aon Employee Benefits principal Rachel Western believes that, because of Covid-19, it’s going to get tougher. “People have been so worried about contracting the virus, they’ve delayed seeking medical advice about other health worries,” she says. “With cancer, any delay in diagnosis can make it harder to treat.”
Figures released by the NHS highlight the scale of the problem. In April, with the country in lockdown, the number of people seeing a cancer specialist following a referral by their GP fell by 60 per cent to 79,500 according to NHS England. There were also 20 per cent fewer patients starting treatment. Mercer partner Chris Bailey is also concerned. “There will be a huge bubble in cancer cases after we’ve dealt with Covid-19,” he says. “Sadly, the delay in seeking medical advice can mean more evasive treatment is required, at exactly the time the NHS is catching up on all the other treatment that had to be postponed.”
Projections by the NHS Confederation give an indication of the size of this challenge. Before lockdown, NHS waiting lists were around 4.2 million but, it now expects them to reach 10 million by the end of the year.
As large claims potentially get even larger, corporate medical insurance schemes could see some significant premium increases. “The market will change,” says Western. “Employers will start asking
themselves whether medical insurance is the right place for cancer treatment. We’re not seeing it being removed yet but, as soon as the full cost of lockdown starts to come through, employers will be looking at ways to reduce expenses.”
As well as the removal of cancer cover, she expects to see employers cutting costs by taking dependants off medical schemes. “After salary and pension, medical insurance is the third biggest expense for employers,” she adds. “They need it to benefit the business as well as employees.”
A large claim could make cover prohibitively expensive but others argue that, post Covid-19, employers will want cancer cover more than ever. “Lockdown has heightened awareness of health but also created a real focus on talent,” says Bailey. “Employers will want to step in and help employees diagnosed with cancer wherever they can.”
Willis Towers Watson director Usman Sheikh agrees. “Cancer affects the individual, their family and the business,” he says. “Providing cover is a good way to enhance the support an employer provides.”
No one yet knows exactly how organisations will respond post- Covid-19, but with many employers facing financial pressures, there is certainly room for a rethink in the way they support employees with cancer.
Critical illness insurance is a potential substitute for cancer cover according to Western. “Providing an employee with a small lump sum can give them options and choices when they’re having treatment,” she says. “This could be supplemented with helplines giving clinical input and advice to provide reassurance.”
This type of support is offered by companies such as RedArc. Managing director Christine Husbands says cancer patients can need a very broad range of support, from medical right through to financial and practical advice. “The emotional toll can be just as great as the physical effect of cancer,” she explains. “It can also be a very long process, lasting way beyond when someone gets the all-clear, and affecting family and friends as well as the person undergoing the treatment. Having an expert friend to turn to at this time can be invaluable.”
There’s also a larger role for prevention according to Sheikh. “Lifestyle factors such as obesity and smoking play a part in a significant number of cancers,” he says. “A wellbeing programme can help employees adopt healthier lifestyles and reduce these risks.”
Although the pandemic will potentially lead to a spike in cancer cases as people postponed seeking medical advice, the experience could also bring a number of benefits.
For starters, even though homecare is already available on medical insurance policies, its increased use during the pandemic could see it becoming more commonplace. This could drive cost savings, as Healthcare at Home general manager – private services Peter Snuggs explains: “Drugs administered at home are VAT exempt so, at worst, it’s cost neutral to deliver chemotherapy this way. It’s not right for every patient, with some preferring to go to hospital, but many like the convenience it offers.”
The other key benefit comes from the pharmaceutical companies working together to deliver a vaccine for Covid-19. Bailey believes this collaboration will lead to many advances across the medical field. “It’s so positive that they’re working together rather than competing against each other,” he says. “Their research includes looking at how the virus affects the genes, which could potentially lead to new drugs for diseases such as cancer as well as a cure for Covid-19.”
Delivering cancer care during a pandemic
With the independent health sector providing capacity and resources to the NHS to help it fight Covid-19, medical insurance had to rethink cover. But, while this meant many operations were rescheduled, most cancer treatment has been able to continue.
“All urgent cases have been managed through a joint system with the NHS to ensure that patients received the care they needed,” says Axa PPP Healthcare commercial director Fergus Craig. “The only cancer patients likely to have been affected are cases where chemotherapy, for example, was delayed in view of the risks from the virus.”
Faced with less capacity, healthcare providers also found more innovative ways to deliver treatment.
For example, in the NHS, four chemotherapy buses were deployed around the country, enabling around 60 sessions to be delivered a day. Insurers also adapted their services with Craig saying that, at Axa PPP Healthcare, delivery of cancer services to patients was often reconfigured to minimise unnecessary face-to-face contact.
The amount of chemotherapy delivered at home also increased, across both the NHS and the private sector. One provider, Healthcare at Home, saw a threefold increase in its patient numbers during the pandemic. “Cancer patients can have pretty much any out-patient chemotherapy in their home,” explains Healthcare at Home general manager – private services Peter Snuggs. “Some consultants switched all their patients to homecare and we also received referrals from consultant we’d never worked with before.”