There is no getting around the fact that cancer treatment is costly.
Mindful of these costs, the focus for insurers is firmly on prevention and early diagnosis and a more individualised approach to cover.
And while the private healthcare sector also offers access to treatment not available on the NHS, one insurer is exploring ways of working with the service to offer more cost effective cancer treatment.
But with the conversation focused on providing value and positive outcomes, insurers are also looking into what good value looks like as newer treatment costs grow “exponentially”.
Most common claims
Scottish Widows’ data for the year 2022 found cancer was the most common critical illness claim – accounting for 63% of all CI claims.
The insurer’s data is typical of the sector as Alan Lakey, director at CIExpert, points out.
“Cancer is the main reason for a claim – around 64% of all claims are due to cancer and this is the main buying trigger, the fear of diagnosis.”
Balancing cost and care
But insurers are exploring ways of balancing cost and care, says Russell Young, UK sales and account management director at Further Group.
“Rising global oncology spending is a significant factor, with spending on cancer medicines expected to reach $375bn globally by 2027,” Young says.
“To address this, insurers are investing in innovative solutions, offering comprehensive and specialised coverage that goes beyond traditional medical aspects.”
A significant tool at insurers’ disposal are severity payments, according to Jennifer Gilchrist, protection expert at Royal London.
“So you have a smaller pay out for earlier stages of cancer, so in a way that has managed down some of the cost where you get an earlier pay out,” Gilchrist says.
“I think with an earlier pay out you’re being diagnosed earlier, which means you’re treated earlier. And hopefully that means it won’t escalate into a big full pay out and potentially a death at the end of it.
“With the products constructed that way, we’re trying to get people diagnosed earlier and with financial support.”
Focus on prevention
The extent of these pay outs rests, however, on how early cancer is diagnosed.
Dr Tim Woodman, medical director for cancer services at Bupa UK Insurance, explains the pandemic accelerated a “crucial shift” in cancer care propositions, leading Bupa to adopt a more joined-up approach to prevention, screening, treatment and aftercare.
“One way we’re doing this at Bupa is through our specialist centres for cancer which have expanded rapidly in the last few years to meet increased demand,” Dr Woodman explains.
“Early data analysis shows customers are getting diagnosed much faster, and at earlier stages when it’s easier to treat.
“This joined-up approach with our hospital partners and our additional support services is crucial in achieving better outcomes for customers.
“Digital health and at-home care remains popular with our customers.
“Since launching our remote skin cancer triage service in June 2020, nearly 10,000 customers have benefitted from fast access to specialist assessment from the comfort of their own homes.
“On average, customers receive their test results in just three working days, which is nearly a month faster than a face-to-face consultation.
“We’ve now fully embedded this service and are exploring new digital tools that provide high quality, and good value care.”
This emphasis on early detection has also been an area of focus for Vitality, with Dr Keith Klintworth, MD at VitalityHealth, revealing its approach has been around providing access to a range of cancer screening and detection services to diagnose and start treatment for cancer earlier.
“Importantly, this improves patient outcomes, and at the same time often means treatment is done for less time and at a lower cost,” Dr Klintworth said.
More screenings is an approach backed by Joanna Streames, owner of Velvet Mortgage and Insure Services.
“Prevention is of course, always better than cure.
“In the public sector screenings are common because it is understood that these need to be ‘caught’ as soon as possible.
“I think it would be a good idea to offer this on plans for private sector. It could be an upgrade to include this or be built into the price.”
But Dale North, managing director at Pure Protect, maintains some providers have gone down the route of offering critical illness plans of “varying quality” in order to capture the cost and comprehensive areas of the market.
“Although this has made critical illness cover more complicated, it has increased the need for advice rather than buying off the shelf,” North adds.
Determining value
Determining value is impossible however, without knowing what good likes like. This is an area Axa Health has been exploring, as Elizabeth Pocock, cancer category lead, reveals.
“We’re one of the founding fathers for the Health Value Alliance Cancer Performance Indicator – a coalition of organisations.
“The cancer performance indicator creates a set of internationally recognised metrics to understand what good quality and value care looks like for cancer treatment in the private sector.
“It’s not something that should be done by one party or two parties alone, and so it is a coalition with key stakeholders across the cancer industry.
“As a group we have come together to understand what metrics should be used to really understand good quality and value care, and then factoring that data to be able to model what that looks like and understand performance across the industry.”
Dr Suba M, medical director at Aviva, explains the insurer’s approach is centred around value-based healthcare.
“This is understanding the outcomes – both the patient experience and health outcomes and then looking at the direct and indirect costs of delivering that. And that gives you that value equation.
“If you really drill down into each aspect of it, and gain as much transparency as you can, and being super intentional about how we measure outcomes and make sure what we are paying for gives you the best value for our customers – that is the key approach we are using in order to make sure healthcare is sustainable for everybody.
“That cost is breaking down from the moment somebody is diagnosed, or even before that, all the way through the customer pathway.
“For example, different types of cancer are approached and consumed differently. So, we think about screening, early detection, prevention – all of that will mean the downstream cost of it is reduced.
“This approach is about making sure it’s not an ‘everybody gets everything’ approach, but very much a personalised way of looking at an individual’s risk assessment, making it much more tailored for that particular segment. Creating awareness, for example, will all ladder up to reducing cost.”
But Dr Suba M adds a further consideration when it comes to the final component – outcomes is costs connected to newer treatments and therapies seem to be increasing “exponentially.”
Working with the NHS
Graham Singleton, CEO of National Friendly, told Health & Protection the mutual is looking at a novel way of managing costs for customers incorporating the NHS.
“The new area that we’ve looked at but haven’t deployed at the moment requires a bit of shift in mindset in terms of private insurance versus NHS.
“Some people see private medical insurance as a threat to the NHS. You’re privatising the NHS.
“One way of managing costs for members is to give them an option so they’ve been diagnosed with cancer and by far the biggest ask for members is just getting a diagnosis – there’s something wrong with me, what is it?
“One option is we provide an option for people so they have had their diagnostics using private medical insurance, but then they can default back to the NHS for the actual delivery of the treatment.
“Then they could get some form of support, daily allowance, for the time that they’re in the NHS hospital care.”
Singleton said the mutual is planning to conduct market research between February and March to see if members of public might be interested in it.
“It’s something that we might offer on a discretionary basis at the moment. But if you can get the blend right, that helps to manage the cost,” he added.
Though the NHS does not offer all the answers.
Daniel Lloyd-John, CEO at Broadway Insurance, points out PMI provides cover for costly drugs and treatments not available on the NHS.
“Insurers are therefore needing to proactively manage an oncology claim from start to finish,” he says.
“Insurer pathways are focused on delivering the fastest possible solution to policyholders, this means early diagnosis and a smooth treatment journey.
“With the delays in the NHS, policyholders are worried about relying on the NHS. Policyholders are turning to insurer pathways as the fastest and most direct route to specialist care and treatment.”
Dr Julie Denning, managing director, chartered health psychologist at Working To Wellbeing, explains the NHS does not routinely provide rehabilitation or vocational rehabilitation to those surviving cancer.
“We are also seeing that due to the pressures on the NHS since the pandemic there has been a trend for delayed diagnosis which has an impact on the stage of cancer and recovery, with long waiting lists,” Dr Denning adds.
“We are also seeing that due to the pressures on the NHS since the pandemic there has been a trend for delayed diagnosis which has an impact on the stage of cancer and recovery, with long waiting lists.
“Emotional and physical support has increasingly been offered by private providers and the insurance sector has really stepped in with regards to recovery and return to work support.
“We have even noticed trends in supporting people with a palliative diagnosis who want to remain in work for as long as their health enables them to.”
Ultimately, the end outcome for the customer is the most important factor.
And Christine Husbands, commercial director at RedArc, maintains support for cancer offered by insurers needs to cater specifically for the needs of cancer patients.
“They need long-term tailored support, and while services such as online GPs are valuable, more needs to be available for those with long-term conditions such as cancer,” Husbands says.
“Support for cancer needs to be available from diagnosis, through treatment and into recovery catering for the changing needs throughout that time, providing relevant therapies, information and advice.”