1. PRIVATE MEDICAL COVER
1.1 Scope of Private Medical Insurance
1.2 Headline statistics
1.2.1 Volume of demand
1.2.2 Type of cover
1.2.3 Payor split
1.2.4 Spending
1.2.5 Margins (Loss ratios)
1.2.6 Revisions
1.3 Volume of demand for private medical cover
1.3.1 Long term trends and current market prospects
1.3.2 History
1.3.2.1 The 1980s ‘golden’ period for private medical cover demand
1.3.2.2 Private medical cover demand growth decelerates with the 1991 recession
1.3.2.3 Mid-1990s to the 2007/08 credit crisis ? modest growth in demand driven by company paid schemes
1.3.2.4 Private health cover demand slumps with the global financial crisis of 2007/08
1.3.2.5 Limited impact of the 2020 Covid-induced recession on private medical cover demand
1.3.2.6 Current prospects, 2023-
1.3.3 Employer-paid schemes now the main focus of demand
1.3.4 SME vs. larger corporate share of company paid schemes
1.3.5 Insured vs. self-insured share of company paid schemes
1.3.6 Individual paid subscribers
1.3.7 New business and lapses for private medical cover
1.3.8 Penetration of private medical cover - people covered
1.3.9 Regional penetration of private medical cover
1.3.10 Penetration of private medical cover by age
1.4 Market value trends
1.4.1 Counterfactual calculation of market value no longer used
1.4.2 Segmentation by type of cover and source of funding
1.4.3 Market value trends - individual/employee paid
1.4.4 Private health cover spending by region and age
1.5 Price trends
1.6 Claims trends and gross margins
1.6.1 Claims
1.6.2 Gross margins
1.6.3 Historic trends in claims paid, cost inflation and gross margins
1.6.4 Impact of Covid and adoption of virtual GP services as a core element of PMI
1.6.5 Management of claims costs
1.6.5.1 Claims and contract administration
1.6.6 Networks
1.6.7 Directionality
1.6.8 Clinical pre-authorisation and outcomes measurement
1.6.9 Case management
1.6.10 Wellbeing and fitness
2. HEALTH CASH PLANS
2.1 Volume of demand
2.1.1 Drivers of company paid health cash plan growth
2.1.2 Drivers of individual paid health cash plan contraction
2.1.3 New business and lapse rates
2.2 Market value and average prices
2.2.1 Market value trends - company paid health cash plans
2.2.2 Market value trends - individual/employee paid health cash plans
2.2.3 Average prices of health cash plans by funding source
2.3 Claims and gross margins (loss ratios)
2.4 Breakdown of Health cash plan benefits
3. DENTAL COVER
3.1 Dental capitation/maintenance plans
3.1.1 Volume of demand
3.1.2 New business and lapse rates
3.1.3 Market value and average price
3.1.3.1 Market value
3.1.3.1 Average prices
3.1.4 Future prospects for dental capitation/maintenance plans
3.2 Dental insurance
3.2.1 Volume of demand
3.2.1.1 Individual/employee paid dental insurance demand trend
3.2.1.2 Company paid dental insurance demand trend
3.2.2 New business and lapse rates
3.2.3 Market value and average prices
3.2.3.1 Market value
3.2.3.2 Average prices
3.2.4 Claims and gross margins (loss ratios)
3.2.4.1 Claims incurred
3.2.4.2 Gross margins (loss ratios)
3.2.5 Future prospects for dental insurance
4. DISTRIBUTION
4.1 Private medical cover
4.1.1 Intermediation
4.2 Health cash plans
4.3 Dental insurance
4.4 Digital distribution
5. MAJOR HEALTH COVER PROVIDERS AND INDUSTRY STRUCTURE
5.1 Private medical cover - insurers and third party administrators
5.1.1 Market participants
5.1.2 Market shares
5.1.2.1 Private health cover market (insured + self-insured business combined)
5.1.3 Market structure
5.1.3.1 Barriers to entry
5.1.3.2 Consolidation
5.1.3.3 Entries and exits
5.2 Health cash plans
5.2.1 Market participants and share
5.2.2 Barriers to entry
5.2.3 Consolidation
5.2.4 Entries and exits
5.3 Dental capitation and insurance plan providers
5.3.1 Market participants
5.3.1.1 Dental capitation
5.3.1.2 Market players
5.3.2 Market shares
5.3.3 Barriers to entry
5.3.4 Consolidation
6. MARKET POTENTIAL
APPENDIX 1. GLOSSARY
APPENDIX 2. DEFINITIONS
APPENDIX 3. TRADE BODIES AND ASSOCIATIONS
APPENDIX 4. MAJOR PROVIDERS OF HEALTH COVER PRODUCTS
APPENDIX 5. INDUSTRY LEADERS REFLECTIONS ON 2021
APPENDIX 6. FINANCIAL APPENDIX
LIST OF TABLES
Table ES1 Market potential for private health cover products
Table 1.1 Private medical cover subscribers and enrolees, UK, 1995-2021
Table 1.2 Company paid and individual paid health cover subscribers/enrolees, UK, at year end 1995?2021
Table 1.3 SME company paid and large corporate company paid medical cover subscribers (insured and self- insured (Healthcare Trusts)), 2012-2021
Table 1.4 New business and lapses rates for private medical insurance by funding source, 2000-2021
Table 1.5 New business and lapses rates for corporate private medical cover, SME insurance, large corporate insurance and (large corporate) self-insured business, 2018-2021
Table 1.6 People covered by private medical cover by funding source, and penetration of UK population, UK, 1995?2021
Table 1.7 Revenue of private medical cover providers by type of cover (insured vs. self-insured), and real spending index, UK, 1995?2021
Table 1.8 Revenue of private medical cover providers by funding source (company-paid vs. individual/employee paid), and real spending index, UK 1995-2021
Table 1.9 Company paid revenue of private medical cover providers by company scale (SME and larger corporate), and real spending index, UK, 1995?2021
Table 1.10 Average household spending on ‘medical insurance premiums’ by region, 2015/16?2020/21
Table 1.11 UK household annual average spending on private medical insurance premiums by age group, 2010/11?2020/21
Table 1.12 Average price paid for private medical cover (insured + self-insured) and real price index by source of funding, UK, 1996?2021
Table 1.13 Private medical cover claims incurred (insured and self-insured medical expenses schemes), UK, 1995?2021
Table 1.14 Cost inflation for insured and self-insured medical expenses schemes ? claims incurred per subscriber/enrolee, UK, 1996?2021
Table 1.15 Loss ratios for private medical cover (insured + self-insured business), UK, 1996?2021
Table 2.1 Health cash plan contributors, by funding source and people covered, 1995-2021
Table 2.2 Market value ? health cash plan spending by source of funding and real terms index (1999=100), UK, 1995-2021
Table 2.3 Average prices paid for health cash plans and real terms average price index (2000 = 100) after deflation by CPI, by source of funding, UK, 1995?2021
Table 2.4 Claims paid by health cash plan funding source, UK, 1995?2021
Table 2.5 Breakdown of health cash plan benefits paid by value and number of claims in 2018, 2020 and 2021
Table 3.1 Dental capitation plan subscriber numbers, persons covered and population penetration, UK, 2007?2021
Table 3.2 Dental capitation plan market value, average price and real terms index (2000=1.00), UK, 2007?2021
Table 3.3 Dental insurance subscriber numbers, persons covered and population penetration, UK, 2007?2021
Table 3.4 Dental insurance premium income, UK, 2007?2021
Table 3.5 Dental insurance average annual premium paid per subscriber, UK, 2013?2021
Table 3.6 Dental insurance claims incurred, UK, 2013?2021
Table 4.1 Breakdown of ‘new business’ private medical insurance sales (number of new subscribers) by distribution channel, UK, 2018, 2020 and 2021
Table 4.2 Breakdown of ‘new business’ health cash plan sales (number of new subscribers) by distribution channel, UK, 2020 and 2021
Table 4.3 Breakdown of ‘new business’ dental insurance sales (number of new subscribers) by distribution channel, UK, 2020 and 2021
Table 5.1 Private medical cover insurers and third party administrators, UK, 2023
Table 5.2 Private health cover (insured + self-insured business) market share by value, UK, 2017, 2020 and 2021
Table 5.3 Private medical insurance (PMI) market share by premium income, UK, 1997?2021
Table 5.4 Entries and exits in the private health cover sector
Table 5.5 Health cash plan providers, UK, 2022
Table 5.6 Health cash plan market share by contribution income earned, UK, 2005-2021
Table 5.7 Entries and exits in the health cash plan sector
Table 5.8 Dental benefit plan providers, UK, 2022
Table 5.9 Entries and exits in the dental capitation and dental insurance sectors
LIST OF FIGURES
Figure ES1 Private health cover market value, £m, UK, 2021
Figure ES2 Private medical cover market value by funding source, £m, UK, 2021
Figure ES3 Number of people on NHS waiting lists for specialist treatment and median RTT waiting times, England, 2007?2023
Figure ES4 First cancer treatments under the NHS and the percentage meeting the 62-day standard, England, 2009/10?2022/23
Figure ES5 Value of private medical cover (PMI and self-insured medical expenses schemes) spending envelope, £m, UK
Figure ES6 PHIN’s private hospital admissions comparison, Q1 2019?Q4 2022
Figure ES7 Gross margins for UK private medical cover (insured + self-insured business), 1995?2021
Figure ES8 Private medical cover subscribers/enrolees, UK, 1975?2021
Figure ES9 Number of health cash plan contributors by funding source, UK, 1975?2021
Figure ES10 Dental capitation plan subscriber numbers, persons covered and population penetration, UK, 2007?2021
Figure ES11 Dental insurance subscribers and persons covered by funding source and population penetration by persons covered, UK, 2007?2021
Figure ES12 Breakdown of ‘new business’ private medical insurance sales (number of new subscribers) by distribution channel, UK, 2020
Figure ES13 Private medical cover market shares of leading providers by value (PMI + self-insured business combined), UK, 2021
Figure ES14 Health cash plans market share of leading providers by value, UK, 2021
Figure 1.1 Private medical cover subscribers/enrolees and persons covered, UK, 1975?2021
Figure 1.2 Private medical cover subscribers/enrolees and people in full-time employment, UK, 1995?2021
Figure 1.3 Year on year growth and contraction in private medical cover subscribers by sector, UK, 1996-2021
Figure 1.4 New business and lapse rates for private medical insurance, UK, 2000-2021
Figure 1.5 Real terms price inflation for company paid and individual/employee paid private medical cover, UK, 1997?2021
Figure 1.6 Year on year correlation between real growth/contraction in company paid private medical cover spending and GDP, UK, 1996?2021
Figure 1.7 Year-on-year correlation between real growth and contraction in individual paid private medical cover spending and household spending, UK, 1996?2021
Figure 1.8 Average private medical cover real terms price index by funding source (employer paid and individual/employee paid), UK, 1995?2021, (Index 1995 = 1.00)
Figure 1.9 Gross margins for private medical cover (insured + self-insured business), UK, 1996?2021
Figure 2.1 Number of health cash plan contributors by funding source, UK, 1975-2021
Figure 2.2 New business and lapse rates for company paid health cash plans, UK, 2018?2021
Figure 2.3 New business and lapse rates for individual/employee paid health cash plans, 2018-2021
Figure 2.4 Real terms market value and price indices (2000 = 1.00) for company paid health cash plans, UK 2000?2021
Figure 2.5 Real terms market value and price indices (2000 = 1.00) for individual/employee paid health cash plans, UK, 2000?2021
Figure 2.6 Gross margins of health cash plan providers, 1995?2021
Figure 3.1 Dental capitation plan subscriber numbers, persons covered and population penetration, UK, 2007?2021
Figure 3.2 New business and lapse rates for dental capitation/maintenance plans, UK, 2018?2021
Figure 3.3 Dental insurance subscribers and persons covered by funding source and population penetration by persons covered, UK, 2007?2021
Figure 3.4 New business and lapse rates for company paid dental insurance, UK, 2018?2021
Figure 3.5 New business and lapse rates for individual/employee paid dental insurance, UK, 2018?2021
Figure 3.6 Gross margins of dental insurance providers, 2013?2021
