globemed qatar overview of key statistics · incorporated under the qatar financial centre in 2007,...

GlobeMed Qatar

Overview of Key Statistics

Prepared bySarkis M. El Zein, PhD

LEGAL DISCLAIMERGlobeMed Qatar is providing this bulletin as an information tool only, without any other purpose whatsoever. Although GlobeMed Qatar has made every effort to ensure that the content of the bulletin is correct and accurate, it cannot be held liable of any of the information contained herein.This bulletin is not addressed to the general public. It is designed to be distributed to the collaborators and clients of GlobeMed Qatar (insurance companies, health services providers, etc…). It constitutes a forum of communication that allows a better dialogue and a better understanding of health issues that are of interest to all parties.

Copyright GlobeMed Qatar, 2014. All rights reserved.

Statistics & Technical Work byHiba Kiwan, Senior Actuarial Analyst

Prepared bySarkis M. El Zein, PhDVice President, Actuarial and Reinsurance Services Division

Work Experience Employer Position

2/1995 - Present GlobeMed Limited, Lebanon. Senior Vice President, Actuarial and Reinsurance Services Division.

3/2006 - 2011 Université Saint-Esprit de Kaslik, Lebanon. Part Time Lecturer,Actuarial Courses.

1997 - 2001 Muhanna Foundation, Lebanon Lecturer-Actuarial Courses.

2/1995 - 7/1995 Notre Dame University, Lebanon. P/T Math Instructor.

1987-1994 Auto Club of Southern California, Los Angeles, CA, USA.

Senior Actuary.

1985-1987 Farmers Insurance Group, Los Angeles, CA, USA.

Assistant Actuary.

1982-1984 University of Southern California, Los Angeles, CA, USA.

Teaching Assistant, Math Department.

1977-1979 Lebanese Republic. Secondary Schools Math Teacher.

Education Institution Degree

1985 University of Southern California, Los Angeles, CA, USA.

PhD in Math Education.

1978 Lebanese University, Lebanon. CAPES, Math.

1977 Lebanese University, Lebanon. B.S.C., Math.

Professional Actuarial Education

Member of the Society of Insurance Research, U.S.A.

Associate of the Lebanese Association of Actuaries, Lebanon.

Copyright GlobeMed Qatar, 2014. All rights reserved.

Table of ContentsA word from the General Manager of GlobeMed QatarIntroductionPortfolio CharacteristicsClaims ExperienceIn Hospital ClaimsAmbulatory ClaimsPrescription Medicines ClaimsDoctor Visit ClaimsDental ClaimsOptical Claims

List of TablesTable 1 Breakdown of the Health Insurance BillTable 2 Total Claims Distribution by Age Brackets Table 3 Most 10 Frequent Causes of Admission for Overnight Stay ClaimsTable 4 Top 5 Costliest Admitting Diseases for Overnight Stay Table 5 Top 10 Conditions with The Longest Hospital StayTable 6 Top 5 Costliest SurgeriesTable 7 Top 10 Common SurgeriesTable 8 Top 10 Surgical Procedures with the Longest Hospital StayTable 9 Most Frequent Prescribed Medicines by GenderTable 10 Top Five Costliest Medications

List of GraphsGraph 1 Adherents Distribution by Underwriting YearGraph 2 Adherents Distribution by Business TypeGraph 3 Adherents Distribution by Gender and Age BracketsGraph 4 Claims Distribution by Gender Graph 5 In Hospital Claims Distribution by Gender and Age BracketsGraph 6 In Hospital Claims Cost Distribution by Gender and Age BracketsGraph 7 In-Hospital Claims - Average Claims Size by Gender and Age BracketsGraph 8 In Hospital Claims Distribution by Confinement TypeGraph 9 Top 10 Frequent Admitting Chapter Diseases for Overnight Stay ClaimsGraph 10 In-Hospital Claims Distribution by Service Type - Top 10 ServicesGraph 11 Ambulatory Claims Distribution by Age BracketsGraph 12 Ambulatory Claims Distribution by Service Type - Top 10 Services Excluding ProceduresGraph 13 Prescription Medicines Claims Distribution by GenderGraph 14 Prescription Medicines Claims Distribution by Age BracketsGraph 15 Prescription Medicines Claims - Average Claims Severity by Age BracketsGraph 16 Doctor Visit Claims Distribution by Age BracketGraph 17 Doctor Visit Claims Distribution by GenderGraph 18 Dental Claims Distribution by Age BracketGraph 19 Dental Claims Distribution by GenderGraph 20 Dental Claims Distribution by Service TypeGraph 21 Optical Claims Distribution by Age BracketsGraph 22 Optical Claims Distribution by Gender

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GLOBEMED QATAR BULLETIN / 2013

Being the leading Third Party Administrator (TPA) in Qatar, we have successfully defined the industry throughout the years. GlobeMed Qatar success story is but the result of over 2 decades of GlobeMed group’s multifaceted knowhow, technical expertise and information technology aimed at providing the finest in the management of healthcare benefits. Incorporated under the Qatar Financial Centre in 2007, GlobeMed Qatar is one of the 11 franchisees of GlobeMed Limited.GlobeMed Qatar has succeeded to hold a significant market share in Qatar. We currently serve 8 renowned insurance companies and have contracts with a comprehensive network of healthcare providers covering the whole country.

GlobeMed Qatar has been nominated as one of the joint exclusive subcontractors, to serve the National Health Insurance Scheme that has been launched by the Supreme Council of Health in July 2013. Our role will be to support the Supreme Council of Health in enhancing the wellness of the people of Qatar through the provision of full health insurance coverage within 5 years.

I would like to thank you in advance for allotting some of your valuable time to read this first bulletin and I promise you more bulletins in the coming years.

Best Regards,

Salem HaidarGeneral Manager

A WORD FROM THEGENERAL MANAGER OF GLOBEMED QATAR

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GlobeMed Qatar grew in a short period of time to become a leading TPA in the Qatari market; serving more than 50,000 insured members by year end 2012. Over the same period of time, around 460,000 claims were processed; amounting to over 123 million Qatari Riyal (Q.R).The following sections address the key characteristics of the insured population, and shed the light on the claims profile including the main causes for hospitalizations in addition to the volume and nature of OUT services.The results cover the time period extending from early 2006 to December 2012. The data was extracted on June 30, 2013.

INTRODUCTION


PORTFOLIOCHARACTERISTICS

GlobeMed Qatar’s portfolio has witnessed a huge growth from 999 adherents in underwriting year 2006 to more than 55,230 adherents in underwriting year 2012.

Ninety Six Percents are group members while only 3.7% are Individuals and Families.

Graph 1: Adherents Distribution by Underwriting Year

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Graph 2: Adherents Distribution by Underwriting Year & Business Type

Sixty Five Percents of the adherents are males; 35% of males are aged between 25 and 35. Around 78% of females are below the age of 35.

This composition is due to the fact that 96% of the population is insured under Group business and therefore most insured members are young.


Ninety Eight Percents of the members are insured under Private class.

Looking at Group business distribution by nationality, it is worth mentioning that 26% of insured members are Qatari adherents followed by Indians (17%), Lebanese (10%) and Filipinos (10%).

As for the Individual and Family portfolio, 75% of adherents are Lebanese.

Almost all adherents purchase In-Hospital, Ambulatory, Prescription Medicines and Doctor Visit.

In 2012, 53.5% of adherents purchased Dental coverage and 39.2% purchased Optical coverage.

Graph 3: Adherents Distribution by Gender & Age Bracket

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Throughout the years, GlobeMed Qatar processed around 460,000 claims. These claims are related to In-Hospital, Ambulatory, Prescription Medicines, Doctors’ Visits, Dental and Optical coverage.

In-Hospital claims constituted 0.8% of the number of claims and 23.6% of total claim cost.

For out-patient coverage, Doctor Visit claims constituted 37.1% of claim count, followed by Prescription Medicines (34.2%) and Ambulatory (24.0%). The last 4% are related to Dental (3.1%) and Optical (0.8%).

In terms of count and cost, the breakdown of the health insurance bill was as follows:

CLAIMS EXPERIENCE

Benefit Count Percent Cost percent

In-Patient 0.8% 23.6%

Ambulatory 24.0% 27.5%

Prescription Medicines 34.2% 21.7%

Doctor Visit 37.1% 16.4%

Dental 3.1% 8.4%

Optical 0.8% 2.4%

Table 1: Breakdown of the Health Insurance Bill

Males accounted for 62% of claims count and for 56% of claims cost.

More than 50% of total claims were incurred by adherents aged between 25 and 45.

Graph 4: Total Claims Distribution by Gender


Females Males

Benefit Nb of claims Amount of claims Nb of claims Amount of claims

<= 17 yrs 22.5% 16.0% 16.3% 14.0%

18y-24y 9.3% 8.9% 6.3% 5.6%

25y-35y 39.8% 41.3% 32.1% 29.4%

36y-45y 18.2% 20.6% 23.9% 24.9%

46y-64y 10.1% 13.1% 21.1% 25.7%

>= 65 yrs 0.1% 0.1% 0.3% 0.4%

Table 2: Total Claims Distribution by Age Brackets

IN HOSPITAL CLAIMSAs mentioned earlier, In-Patient claims constitute 1% of the total number of claims and 24% of total claims cost.

Even though females constituted 35% of the total portfolio, their claims represented 51% of total In-Hospital claims count and 30% of claims cost.

Females aged between 18 and 35 are more likely to be admitted to the Hospital than their male counterparts. That’s probably due to maternity related cases. Males tend to get hospitalized at a much higher level above the age of 35.

Graph 5: In-Hospital Claims' Distribution by Gender and Age Bracket

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Looking at the severity of claims, we noticed that children have same claims severity for both genders; as the age increases, females claims severity becomes higher than their male counterparts.

Graph 6: In Hospital Claims's Cost Distribution by Gender and Age Brackets

Graph 7: In-Hospital Claims - Average Claims Size by Gender and Age Brackets


Looking at the claims distribution by cause of admission for overnight stay, we realized that 25% of In-Hospital claims are related to “Pregnancy, childbirth and puerperium” costing 24% of total In-hospital claims cost.

Diseases of the digestive system is the second most frequent admitting chapter disease (15% of In-Hospital cost)...

Graph 8: In Hospital Claims' Distribution by Confinement Type

72% of In-hospital claims are admitted to the hospital for at least one night, while 23% are admitted for one day treatment and the last 5% are admitted to the emergency department.

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...followed by diseases of the respiratory system (13.6% of In-Hospital cost).

Below is the list of the top 10 frequent admitting chapter diseases for overnight stay claims:

Graph 9: Top 10 Frequent Admitting Chapter Disease


Rank Cause of admission % of Cost % of Losses

1 Single spontaneous delivery %10.68 9.92%

2 Single delivery by cesarean section %6.49 8.06%

3 Diarrhea and gastroenteritis of presumed infectious origin %4.12 1.30%

4 Acute appendicitis, unspecified %2.37 %3.15

5 Deviated nasal septum %2.14 %4.32

6 Fever, unspecified %1.68 %0.80

7 Calculus of ureter %1.45 %1.45

8 Acute bronchitis, unspecified %1.11 %0.59

9 Hypertrophy of adenoids %1.07 %0.96

10 Acute tonsillitis, unspecified %0.95 %0.51

Table 3: Most 10 frequent causes of admission for overnight stay claims

Excluding Normal and Cesarean deliveries for females, “Diarrhea and gastroenteritis of presumed infectious origin” is the most frequent disease for males and females; it constitutes 3.6% of total male’s claims and 2.9% of total female’s claims.

The most common frequent diseases between males and females are:

• Chalazion• Acute appendicitis, unspecified• Other and unspecified abdominal pain• Fever, unspecified

“Diarrhea and gastroenteritis of presumed infectious origin” is the most frequent cause of In-Hospital admission for children and is included in the list of top frequent diseases for adherents aged between 18 and 45.

Looking at the causes of hospital admissions, we identified that 10.7% of In-Hospital claims are related to single spontaneous delivery, 6.5% are related to Cesarean delivery and 4.1% are related to “Diarrhea and gastroenteritis of presumed infectious origin”.

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“Diabetic retinopathy” and “Senile cataract, unspecified” are the most frequent diseases for the age categories “46 to 64 years” and “above 65 years” respectively.

“Single Spontaneous delivery” is the leading cause for hospital admission for females aged between 18 and 35 while “Single delivery by Cesarean section” is the leading cause for hospitalization for the age category “36 to 45 years”.

Excluding Normal and Cesarean deliveries, 5 of the top 10 frequent diseases by age brackets are common for adherents aged between 18 and 45:

• Acute appendicitis, unspecified• Calculus of ureter• Chalazion• Deviated nasal septum• Diarrhea and gastroenteritis of presumed infectious origin

The costliest 5 hospitalizations are shown in table 4. The costliest one is related to malignant neoplasm of lymphoid, hematopoietic and related tissue.


The longest hospital stay ever recorded under GlobeMed Qatar’s’ experience is 43 days; it is related to “Subacute osteomyelitis, other site”.

Rank Admitting Disease Incurred Losses (in QAR)

1 Other specified malignant neoplasms of lymphoid, haematopoietic and related tissue 307,088

2 Malignant neoplasm of breast, unspecified part 109,324

3 End-stage renal disease 94,640

4 Salpingitis and oophoritis, unspecified 90,000

5 Hallux valgus (acquired) 80,812

Table 4: Top 5 costliest admitting diseases for overnight stay

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Rank Admitting Disease Length of Stay

1 Subacute osteomyelitis, other site 43

2 Radiotherapy session 40

3 Meningitis in bacterial diseases classified elsewhere 36

4 Other specified surgical follow-up care 31

5 Dislocation of hip, unspecified 31

6 Carcinoma in situ of oesophagus 31

7 Malignant neoplasm of breast, unspecified part 30

8 Haemorrhage in early pregnancy, unspecified 30

9 Meningitis in bacterial diseases classified elsewhere 29

10 Dislocation of hip, unspecified 29

Table 5: Top 10 Conditions with the Longest Hospital Stay

Looking at the health bill divided by service type, 50% of approved items are related to pharmacy and medical supplies. However, these only contributed to 10% of the total In-Hospital bill.


Surgeries constituted 6% of total approved items and 42% of total In-hospital cost. This is due to the high fee of the surgeons.

Looking at the top 5 costliest surgeries, “Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)” was the top surgery with a cost of 64,694 Qatari Riyal.

% of Cost % of Count

Graph 10: IN-Hospital Claims Distribution by Service Type - Top Ten Services

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Rank Item Description Incurred Losses

1 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

64,694 QAR

2 Mastectomy, simple, complete 59,040 QAR

3 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

55,947 QAR

4 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (e.g., Mitchell, Chevron, or concentric type procedures)

53,381 QAR

5 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar

47,714 QAR

Table 6: Top 5 Costliest Surgeries

3. 4.1.


Rank Item Description % of Count

1 Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care

7%

2 Cesarean delivery only; including postpartum care 6%

3 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

3%

4 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

2%

5 Submucous resection inferior turbinate, partial or complete, any method 2%

6 Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less)

2%

7 Tonsillectomy and adenoidectomy; younger than age 12 2%

8 Excision of chalazion; single 2%

9 Incision and drainage of abscess ( e.g. carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single

1%

10 lapsurgery: Cholecystectomy 1%

Table 7: Top 10 Common Surgeries

1. 2. 8.

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Rank Item Description Length of stay

1 Meninges of the brain 36

2 Renal Allotransplantation, implantation of graft; with recipient nephrectomy 25

3 Salpingo-Oophorectomy, complete or partial, unilateral or bilateral (separate procedure) 16

4 Thoracotomy, major; for postoperative complications 16

5 Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) 16

Table 8: Top five surgical Procedures with the Longest Hospital Stay

1. 2.

The most common surgery for males and females, excluding Normal and Cesarean deliveries is: “Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)”. This surgery constitutes 4% of male’s surgeries and 3% of female’s surgeries.

3 other surgeries are common between males and females:

• Submucous resection inferior turbinate, partial or complete, any method (3% for males and 1% for females)• Tonsillectomy and adenoidectomy; younger than the age of 12 (2% for males and 1% for females)• lap surgery: Appendectomy (2% for males and females)

The top five surgical procedures with the longest hospital stay are shown in the following table:


Ambulatory claims constitute 24% of the total number of claims and 27% of total claims cost.60% of Ambulatory claims were incurred by males; their cost represented 57% of total Ambulatory cost.Looking at the claims distribution by age brackets, adherents aged between 25 and 35 years old are most likely to incur Ambulatory claims (39% of claims count), followed by “36- 45years” age bracket (24% of claim count).

Procedures are coded under Ambulatory services and they represented 17% of total Ambulatory tests and 15% of total Ambulatory cost.

Excluding procedures, Laboratory tests constituted 55.5% of total approved quantities of items and 72.1% of Ambulatorycosts. Radiology represented 10% of Ambulatory tests count followed by ultrasonography (6%).

AMBULATORY CLAIMS

% of Claims Cost % of Claims Count

Graph 11: Ambulatory claims distribution by Age Brackets

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Although MRI constituted only 1.2% of total Ambulatory tests, their cost were around 8.3% of total Ambulatory costs due to its high severity.

Graph 12: Ambulatory Claims' Distribution by Service Type

% of Total Approved Quantity % of Total Cost


34% of total claims are related to Prescription Medicines coverage incurring around 22% of total cost.65% of Prescription Medicines claims are related to males; which is normal since 65% of adherents are males.

Sixty Percents of Prescription Medicines claims are incurred by young members (aged less than 35 years old) and their respective cost constituted 46% of total cost.

PRESCRIPTION MEDICINES CLAIMS

Graph 13: Prescription Medicines claims distribution by gender

Graph 14: Prescription Medicines' claims distribution by Age Bracket

% of Count % of Cost

Female

Male

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This implies that as adherents get older, their pharmacy claims become costlier.

Graph 15: Prescription Medicines claims - Average Claims Severity by Age Brackets


The top 5 prescribed medications were:

XYZALXyzal is used to treat symptoms of year-round (perennial) allergies, symptoms of seasonal allergies and to treat itching and swelling caused by chronic urticaria (hives).

CATAFLAMCataflam is used to treat pain or inflammation caused by arthritis or ankylosing spondylitis.

CEFUTILCefutilis an antibacterial agent with broad-spectrum activity against a wide variety of pathogens.

ZINNATZinnatis used to treat infections caused by bacteria.

SINECODSinecod is the most widely used as a cough suppressant. It can be used to treat dry cough of any cause as well as cough caused by bronchoscopy.

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In fact, XYZAL is the leading prescribed drug for both males and females. CEFUTIL is the second most prescribed drug for males but is not shown in the list of most prescribed drugs for females.

Females Males

Rank Drug % Drug %

1 XYZAL 4.13% XYZAL 4.04%

2 ZINNAT 3.14% CEFUTIL 3.79%

3 ADOL 2.55% CATAFLAM 3.71%

4 AUGMENTIN 2.55% SINECOD 2.36%

5 CATAFLAM 2.36% ZINNAT 2.19%

6 CEFIX 2.36% ADVIL COLD & SINUS 2.11%

7 SINECOD 2.16% AERIUS TABLET 2.11%

8 ADVIL LIQUIGEL 1.96% PANADOL ADVANCE 2.11%

9 AERIUS TABLET 1.96% LORINE TAB 1.94%

10 PANADOL ADVANCE 1.77% CLARINASE 1.85%

Table 9: Most Frequent Prescribed Medicines by Gender


The Top 5 prescribed medicines by age bracket are as follow (with the respective percent of total number of medicines):

1. Age Category < = 17 years: CEFIX (5.52%) ADOL (4.29%) ADVIL SYRUP (4.29%) LORINASE SYRUP (3.99%) AERIUS (3.37%)

2. Age Category 18-24 years: SINECOD (5.71%) CIPROHEXAL (4.76%) TAVANIC (4.76%) XYZAL (3.81%) ZINNAT (3.81%)

3. Age Category 25-35 years: XYZAL (4.11%) CEFUTIL (3.93%) CATAFLAM (3.36%) SINECOD (3.18%) ADVIL COLD & SINUS (2.43%)

4. Age Category 36-46 years: XYZAL (5.57%) CATAFLAM (5.35%) AERIUS TABLET (3.43%) ZINNAT (3.43%) TAVANIC (2.57%)

5. Age Category 46-64 years: CEFUTIL (6.56%) XYZAL (5.02%) CATAFLAM (3.47%) AERIUS TABLET (2.32%) LORINE TAB (2.32%)

AERIUS is the common prescribed drug between all ages (from 0 to 64 years old).

Rank Drug Drug Dose Average Price (in Q.R)

1 SERETIDE EVOHALER 25/250 MCG 510.00

2 SINGULAR PAEDIATRIC CHEWABLE 4 MG 440.16

3 EXFORGE 5 / 160 MG 438.48

4 SINGULAIR 5 MG 436.24

5 NEXIUM 20 MG 428.96

Table 10: Top Five Costliest Medications

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Doctor Visit claims constitute 37% of total count and 16% of total cost. The average cost per visit was 125 Qatari Riyal in 2012.Adherents aged between 25 and 35 are most likely to use this benefit (35% of total Doctor Visit claims), followed by children (21% of Doctor Visit claims).

Sixty Percents of Doctor Visit claims are incurred by males.

DOCTOR VISIT CLAIMS


Graph 16: Doctors' Visits Claims Distribution by Age Bracket

Graph 17: Doctors' Visits Claims' Distribution by Gender

Female

Male


DENTAL CLAIMS

In 2012, around 54% of adherents purchased Dental coverage.The total number of dental claims processed throughout the years is 14,365; 11,165 in 2012. 30% of dental claims are incurred by children.

Fifty one percents of claims are incurred by males.

Graph 18: Dental Claims' Distribution by Age Bracket

Graph 19: Dental Claims' Distribution by Gender

Female

Male


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Twenty eight percents of approved items were related to initial exams, 21% were related to restorative dentistry, while 13% where related to each of radiology and Periodontics.

Graph 20: Dental Claims' Distribution by service type


OPTICAL CLAIMSOptical coverage started effectively in 2011. During 2012, 39.2% of adherents purchased Optical coverage; 3,656 claims were processed during 2012.27% of claims were incurred by children accounting for 25% of total optical expenditures. Adherents aged between 46 and 64 spent 27% of total optical expenditures.

Graph 21: Optical Claims' Distribution by Age Brackets


Fifty Four percents of claims were incurred by males.

Graph 22: Optical Claims' Distribution by Gender

Female

Male

GlobeMed Qatar LLCDoha, West BayQFC Tower 1, 3rd flr.Office No. 302T 44056900F +974 4405 6990

www.globemedqatar.com

globemed qatar overview of key statistics · incorporated under the qatar financial centre in 2007,...

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