here - Mapfre

Travel
Insurance
Observatory
2014
Research which contributes to excellence in the
tourism experience
TRAVEL INSURANCE
OBSERVATORY 2014
Acknowledgements
The data on which this study is based comes from the health claims and
outcomes database of MAPFRE ASISTENCIA and its subsidiary InsureandGo
UK. The claims data is compared with statistics from two sources: Forward
Data S.L. and its ForwardKeys.com database; and the Office for National
Statistics (ONS), based on the ONS International Passenger Survey (IPS),
which is the official source of statistics on UK inbound and outbound travel,
and the UK Travel Trends reports for 2012-2013.
Disclaimer
The analysis, interpretation and conclusions expressed in this report are based
on data contained in the databases of MAPFRE ASISTENCIA and the UK
ONS and do not reflect the views of any individual, organisation or institution.
MAPFRE ASISTENCIA does not guarantee, and accepts no legal liability
whatsoever arising from or connected to, the accuracy, reliability, currency or
completeness of any material contained in this document. Readers should
seek appropriate independent professional advice prior to relying on, or
entering into any commitment based on, material published here, which is
published solely for reference purposes.
Published and printed by:
MAPFRE ASISTENCIA
Carretera de Pozuelo, 52 – Edif. 1 – Anexo
28222 Majadahonda
Madrid
Spain
Website: www.mapfre-asistencia.com
Email: [email protected]
Copyright © 2014 MAPFRE S.A.
All rights reserved. The contents of this report may be quoted, provided the
source is given accurately and clearly. Distribution or reproduction in full or in
part is permitted for own or internal use only.
2
TRAVEL
INSURANCE
OBSERVATORY
2014
Contents
Foreword
4
Glossary
6
Key Highlights
7
Part 1 Trends Around the World
15
1.1
1.2
1.3
1.3.1
1.3.2
1.3.3
1.4
1.5
15
16
19
19
22
25
27
31
Introduction
Overview of World Trends
Analysis by Source Region
Europe
Latin America
Asia Pacific
Leading Source Markets: UK, Spain and Brazil
Analysis of Seasonality
Part 2 The UK Market
36
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
36
37
38
39
41
43
50
51
Background and Methodology
Types of Travel Insurance Cover
Non-medical Claims
Medical Claims
Medical Claims by Destination Region
Individual Country Analysis
The Link between Age and Medical Problems
Seasonality of Medical Claims
Appendices
3
55
Foreword
Contributing to safe travel
With increasing political and social unrest in different parts of the world, not to
mention the outbreak of new and sometimes untreatable diseases such as the
Ebola virus or even Avian flu, travellers are understandably more and more
concerned about the risks they might incur for their safety and security when
travelling. But while travel advisories from governments and intergovernmental
bodies such as the World Health Organization play an important role in raising
awareness among the public of many of the risks involved, there is not yet any
regular health monitoring system in place that can be consulted by travellers
and the tourism industry.
Clearly, there is still a long way to go before a universally approved, reliable
system can be put in place. But in the meantime, in an effort to provide a service
of benefit to the public and industry stakeholders, MAPFRE ASISTENCIA has
developed its Travel Insurance Observatory (TIO), based on its own in-house
travel insurance research – a comprehensive database of the claims filed by
travel insurance customers of MAPFRE ASISTENCIA and its partners.
This 2014 Travel Insurance Observatory, the second edition of what is
intended to become an annual report, contains an overview of some of the key
findings taken from MAPFRE ASISTENCIA's growing database of health
claims and outcomes. Not only does it highlight the main medical problems
suffered by travellers in different parts of the world, but it also clearly identifies
the different reasons for the medical problems and complaints – in other
words, those that could have affected the tourists anywhere in the world and
those that are related to specific destinations or travel experiences.
The 2014 Travel Insurance
Observatory
The first MAPFRE ASISTENCIA Travel Insurance Observatory report,
published in 2013, focused only on the UK market – MAPFRE ASISTENCIA's
largest travel insurance customer base – and covered the period July 2012 to
April 2013. This edition was presented at the 20th General Assembly of the
United Nations World Tourism Organization (UNWTO) held in Zambia,
Zimbabwe.
This year's analysis monitors a full 12-month period, May 2013 to April 2014
(hereafter referred to as 2013/14).
In this 2014 edition, we provide more in-depth coverage of the UK market,
highlighting, as we did last year, the destinations in which most medical claims
originated, as well as the type of medical complaint affecting UK travellers in
the different destinations visited. In addition, we provide some comparisons
with data for the same 12-month period of 2012/13, and we take a closer look
at medical claims by age group and disease type, and also at seasonal trends
– which months of the year account for the most claims and where.
4
Part 1 contains new information on a number of other markets – in Europe, the
Americas and Asia Pacific – in which MAPFRE ASISTENCIA travel insurance
policies are sold.
We hope you will find the information useful as well as interesting and that it
will help lead to a better and broader understanding of the risks posed by
particular types of travel experiences and destinations. Happy reading!
5
Glossary
Medical Assistance Claims
Claims that involve immediate assistance from MAPFRE ASISTENCIA's call
centres and/or hospitalisation of the insured (inpatients).
Medical Reimbursements
Claims from MAPFRE ASISTENCIA's insured who need to pay for medical
attention in the outpatients' department of a hospital or clinic, or at a doctor's,
and who are reimbursed for these expenses after their trip.
Other Personal Benefits
(OPB)
Non-medical claims related to travel cancellations and to the personal
possessions of the insured (e.g. the loss of personal belongings, including
computers, mobile phones, spectacles, cameras, etc., and the loss of travel
and bank documents such as passports and credit cards.
EHIC
European Health Insurance Card, valid in all European Economic Area (EEA)
member countries (including Switzerland).
GEA
Gastro-intestinal infections.
UTI
DRD
Destination Related Diagnoses, such as allergies, animal and insect bites,
infectious diseases (of both bacterial and viral origin), gastro-enteritis,
diarrhoea (GEA) and abdominal pain, respiratory infections, urinary tract
infections, dermatitis, conjunctivitis, altitude and decompression sickness,
sunburn and other burns, etc.
ONDRD
Other Non-Destination Related Diagnoses, including chronic illnesses, cardiovascular diseases, anaemia, tumours, epilepsy, etc.
TRAUMA
6
Urinary tract infections.
Trauma-related disorders, such as bone fractures, strains, etc.
Key Highlights
First global
Travel Insurance
Observatory report
The 2014 Travel Insurance Observatory (TIO) report, which is based on
MAPFRE ASISTENCIA's database of travel insurance claims from around the
world, is the first global report to be published by the company. It looks at
medical claims submitted by tourists from several source countries in Europe,
Latin America and Asia Pacific travelling around the world, with a particular
focus on the destinations in which their claims originate.
European tourists still favour
travel insurance …
In mature markets such as Europe, where public health care is widely
available, it is still very common for travellers to take out travel insurance, even
though the European Health Insurance Card (EHIC) entitles tourists from EU
and EEA-member countries to the same health care throughout the EU and
EEA free of charge or at a subsidised cost. This is attributed to the fact that
many Europeans prefer to have a back-up, just in case they encounter
problems, such as for trips involving winter sports and other sports activities.
The number of associated claims received by MAPFRE ASISTENCIA is also
quite high – higher than would normally be expected – notably during the
winter sports' season and with regard to claims originating in countries with
mountain resorts such as France, Spain and Andorra.
… even for domestic
travel
Travel insurance is clearly less common for domestic trips, since most travellers
are covered by either national or private health schemes in their own countries.
But many travellers do have annual policies, or policies included with their
package tours, and some still take out insurance for independent domestic trips
– as evidenced by the high share of domestic claims in some source markets.
In the case of claims handled by MAPFRE ASISTENCIA, the domestic share
ranges from as low as 1% in Germany, or virtually 0% in the UK, to 30% in
China, 31% in Spain, 33% in France, 58% in Turkey and 61% in Australia.
The pattern of claims is
very much in line with
travel flows
The results of the 2014 TIO analysis show that the incidence and share of
medical claims in different destinations and in different months of the year
closely follow holiday destination and seasonal travel trends, since 75% of all
travel insurance policies sold are for leisure trips.
The seasonality of medical claims is, not surprisingly, influenced by peak
holiday periods such as the ski season, and is affected by annual shifts in
popular travel periods like Easter, as well as by special events. In Brazil, for
example, the main domestic peak for claims falls in February, during Carnival.
One example from the UK, which highlights the impact of different events, was
the sharp decline in the share of claims originating in Egypt in July 2013, the
month in which a coup d'état in the country caused a sharp drop in travel
demand for the destination.
7
Trends in medical claims
by age – the case of
the UK
The destination shares of claims by age group, for which MAPFRE
ASISTENCIA has detailed information in its database on the UK market,
provide some interesting insights into the type of medical problems incurred in
individual parts of the world, and by whom.
In the majority of regions, the highest share of medical claims comes from
those aged 25-64 (find out more about age ranges in the body of this
document) and, contrary to common perceptions, the 65-plus age group
submits the lowest share. Nevertheless, as can be seen from the following
chart, the medical reasons for these claims vary considerably across the three
broad age group categories indicated.
Among young travellers under the age of 25, the most frequent claims by a
wide margin are those involving Destination Related Diagnoses (DRD) while,
among seniors aged 65 years or older, there is a higher preponderance for
claims relating to Non-Destination Related Diagnoses (ONDRD).
MAPFRE ASISTENCIA claims from the UK, by age group and medical diagnosis (%), 2013/14
TRAUMA cases are most prevalent among 25-64 year-olds – and, indeed,
specifically among those aged 50-65, as will be seen in the main report.
The second chart looks at claims by different types of Destination Related
Diagnoses (DRD) across the different age groups. Claims for gastro-enteritis
8
and intestinal problems (GEA) – the most common cause of DRD worldwide –
are most prevalent among 25-64 year-olds; young people (aged 0-24 years)
and seniors aged 65 and over are more likely to suffer from other types of
infections, according to the respective shares of claims.
Skin problems, although much less widespread, are not so prevalent among
the oldest age groups; as is the case with allergies, but animal and insect bites
appear to account for similar shares of claims across the different age
segments.
MAPFRE ASISTENCIA claims from the UK, by age group and DRD type (%), 2013/14
Regions where most
(health incidents giving
rise to) medical claims
originate
9
The chart overleaf shows that almost half of all MAPFRE ASISTENCIA
medical claims worldwide originate in Europe, followed by North America and
Latin America. The shares of claims originating in other regions are relatively
modest. If domestic claims are excluded from the calculations, Europe's share
falls by eight percentage points, with most other regions showing slightly
higher shares as a result, but the share of claims from Oceania and Africa
remains small – in line with the respective regions' shares of world travel flows.
MAPFRE ASISTENCIA medical claims by destination region – total and excluding domestic
claims, 2013/14
Domestic claims affect
top destination country
ranking
The destinations in which the majority of MAPFRE ASISTENCIA claims take
place, are Spain, the USA and Turkey. But if domestic claims are excluded, the
top two rankings reverse, putting the USA in first place, ahead of Spain, and
followed by Egypt in third place.
The prominence of the USA and Spain is hardly surprising given their
importance as international tourism destinations – ranking second and third in
UNWTO's world ranking in arrivals (after France). But the reason for Egypt's
third position – as discussed in some detail in Part 2 of this report – is its
relative importance in the UK market and the overall weighting of the UK
market in total MAPFRE ASISTENCIA claims.
Total MAPFRE ASISTENCIA medical claims by destination country, 2013/14
17%
16%
13%
9%
7%
7%
5%
Spain USA Turkey Egypt France
Total (Including domestic)
10
8%
6%
4%
USA Spain Egypt Turkey France
Total (excluding domestic)
Claims from the main
source regions by
travel destination
In order to understand better the kind of medical problems that different source
markets experience in different parts of the world, we carried out a
comparative analysis of the three main source regions from which MAPFRE
ASISTENCIA receives medical claims – i.e. Europe, Latin America and Asia
Pacific. As suspected, the findings reveal some interesting similarities as well
as differences in terms of where the medical claims originate.
As can be seen on the chart on the following page, the vast majority of
European medical claims originate in Europe, followed by Latin America and
North America, with the Middle East and Asia accounting for just a modest
share. If domestic shares are excluded, the difference in shares of the top three
destination regions is slightly less marked, but Europe still dominates. The top
three regions combined account for some 78% of MAPFRE ASISTENCIA
medical claims from Europeans, or 74% excluding domestic claims.
For Latin Americans, the top three destination regions in which medical claims
originate are North America, Europe and Latin America – generating more than
90% of total claims between them, whether or not domestic claims are taken
into account.
In the case of markets from Asia Pacific, however, the overall picture changes
somewhat when domestic claims are excluded from the count, due to the high
share of domestic claims from Australians. The top three regions in which
claims originate are Oceania, Asia and Europe – or an 85% share of total
claims from Asia Pacific between them – and, in order of importance, Asia,
Europe and North America, excluding domestic claims (87% combined).
Top 3 destination regions where claims of European, Latin Americans and Asia Pacific
travellers took place, 2013/14
11
Countries accounting for
the highest shares of
medical problems
Looking at destination countries rather than regions, the highest shares of
European claims originate in Spain, Turkey and the USA or, excluding
domestic cases, in the USA, Egypt and Spain.
A breakdown of Latin American medical claims shows that North America
dominates the overall picture because it is such an important destination for
Brazilians. Indeed, Brazil is the leading outbound market from the region,
generating more than one third of all trips abroad in 2013/14, according to
various national and international sources (see Appendix for details) – about
the same as its share for medical claims.
Top 3 destination countries where Claims of European travellers took place, 2013/14
19%
11%
Spain
9%
9%
Turkey
USA
Total (including domestic)
11%
9%
USA
Egypt
Spain
Total (excluding domestic)
Top 3 destination countries where Claims of Latin American travellers took place, 2013/14
35%
34%
9%
USA
Spain
10%
6%
Brazil
Total (including domestic)
12
5%
USA
Spain
Argentina
Total (excluding domestic)
Top 3 destination countries where Claims of Asia Pacific travellers took place, 2013/14
33%
16%
12%
11%
8%
Australia
USA
Thailand
USA
Total (including domestic)
Destinations:
Thailand
10%
India
Total (excluding domestic)
Spain
Brazil
Egy pt
Turkey
Australia
Argentina
USA
Thailand
India
In Asia Pacific, MAPFRE ASISTENCIA is established in four countries in the
travel insurance business – Australia, China, India and the Philippines.
Australia, the USA and Thailand are the destinations in which the largest
shares of claims originate – again due to Australia's high share of domestic
claims in the overall count. Excluding domestic claims, the USA, Thailand and
India feature in the top three rankings.
13
Looking Forward
As MAPFRE ASISTENCIA's travel insurance business expands and moves
into even more markets, both organically and by acquisition, the Travel
Industry Observatory report is expected to develop into an increasingly reliable
and valuable source of information on trends in this key segment affecting
international travel and tourism.
The travel insurance market is a particularly interesting one to study as it
provides a mine of information relating to customer preferences and behaviour
– all extremely useful for the travel industry. By way of example – and to whet
your appetite for next year – it is interesting to note that:
In the UK, 1 in 4 travel insurance policies sold by MAPFRE ASISTENCIA
is bought by a young person aged 19-30 years old; the respective share in
Australia is 33%.
4 in 10 of the medical claims received by MAPFRE ASISTENCIA from the
UK market relate to trips of longer than 1 month abroad.
According to market research:
In the USA, 1 in 5 policies sold is to the 71-plus age group.
In the UK, under-40s are increasingly purchasing their travel insurance
online; but the majority of travellers still prefer call centres because of the
personal contact, and 4 in 10 call centre sales are to the 60-plus age
group.
Mondays and Thursdays are the most popular days for buying travel
insurance in the UK; but in Ireland, the preferred day is Tuesday (17.4%).
Most online transactions take place after 21:00, while call centre bookings
tend to be made from 10:00-12:00, except in Ireland when the most
popular time is after 16:00.
14
Part 1
Trends Around the World
1.1 Introduction
First insights from
MAPFRE ASISTENCIA's
medical claims database
This is the first time that MAPFRE ASISTENCIA has opened up its worldwide
database of travel insurance claims following the decision to share information
of interest and, hopefully, of benefit to governments, the travel and tourism
industry and the travelling public.
Last year's Travel Insurance Observatory covered just the UK market, which is
again a major topic of this 2014 report, in Part 2. Part 1 provides a first insight
into trends around the world generally, in markets in which MAPFRE
ASISTENCIA and its partners are established in the travel insurance sector.
The report covers primarily the 12 months of May 2013 to April 2014 (hereafter
referred to as 2013/14), although there is also some comparison with the same
period of 2012/13 for those markets for which MAPFRE ASISTENCIA has
adequate claims data for analysis. It should also be noted that the analysis
covers only medical claims – both for Medical Assistance (which involve
assistance from MAPFRE ASISTENCIA and/or its partners / agencies, and
may require hospitalisation or repatriation) and Reimbursements (of the costs
incurred, for example, from a visit to a doctor or the outpatients department of
a hospital or clinic).
We have followed the definitions laid down by the World Tourism Organization
(UNWTO) in terms of geographical regions, with one exception. This is the
case of Mexico which, as a source market, displays travel patterns and
behaviour much more in line with other Central and South American (Latin
American) nations, rather than with its North American Free Trade Association
(NAFTA) partners, the United States and Canada. Interestingly, this definition
was also adopted by UNWTO for the purposes of its 2014 report on Key Latin
American Outbound Travel Markets.
Data sources
The data contained in Part 1 of the 2014 Travel Insurance Observatory and
which forms the basis of the report comes from MAPFRE ASISTENCIA's
database of medical claims originating in different countries around the world.
The report looks at the main source markets in terms of the share of total
claims handled by MAPFRE ASISTENCIA, and the main destination regions
and countries where the claims originated in 2013/14. The more detailed
analysis of the Spanish and Brazilian markets, which is also interesting to
compare with the UK (where the different variables permit this), also includes a
comparison of seasonal flows.
The different source markets relating to MAPFRE ASISTENCIA claims are:
Europe: Belgium, France, Germany, Italy, Malta Portugal, Spain, Turkey
and UK;
Latin America: Argentina, Brazil, Colombia, Mexico and Uruguay;
15
Asia Pacific: Australia, China, India and the Philippines.
Belgium, Italy, Malta, Mexico, India, the Philippines and China are included in
the overall analysis, but are not identified individually in the report as source
markets, due to their relatively small sample of cases, but they are of course
included in the overall analysis of destinations where claims originate.
The claims data is set against data from the ForwardKeys database of Forward
Data S.L, as well as statistics from national tourism surveys with regard to
outbound trips from Brazil, Spain and the UK, and the World Tourism
Organization (UNWTO) for arrivals in different countries from those markets.
1.2 Overview of World Trends
The following chart demonstrates clearly the dominance of the UK and Spain,
in terms of share of the medical claims handled by MAPFRE ASISTENCIA in
the 12 months May 2013 to April 2014 (2013/14). The top five source markets
accounted for more than 80% of total claims.
Breakdown of MAPFRE ASISTENCIA medical claims by source market, 2013/14
Relative importance of
claims originating in
domestic markets
16
Travel insurance is clearly much less common for domestic trips, since most
travellers are covered either by national or private heath schemes in their own
countries. And this is also true for travellers from European Union (EU) or
European Economic Area (EEA) countries (including Switzerland) travelling
within the EU and EEA, as long as they carry the European Health Insurance
Card (EHIC). If they do, they are entitled – in theory, at least – to free or
subsidised health care. However, many travellers do take out domestic travel
insurance for specific travel activities, such as winter sports – or just to be on
the safe side as the EHIC does not cover private health care.
It is important to look at domestic claims as they account for very different
shares of MAPFRE ASISTENCIA medical claims from one market to another
and can, therefore, distort the overall picture. Markets in which domestic claims
strongly influence the overall shares include Turkey, Australia, Portugal,
France and Spain. The relative share is particularly important in the case of
Spain, which accounts for such a high share of claims overall, as seen in the
previous chart.
More importantly, the inclusion or exclusion of domestic claims has a marked
impact on trends. With all claims included, the total number of MAPFRE
ASISTENCIA claims increased by 9.3% in 2013/14 – but only by 0.7% if
domestic claims are excluded from the count.
Share of domestic claims in total MAPFRE ASISTENCIA claims, for selected source markets,
2013/14
Europe dominates the
destination shares, even
without domestic claims
The respective shares of the destination regions in which MAPFRE
ASISTENCIA claims originate – both with regard to total claims and excluding
domestic claims – are compared in the following table. As already discussed,
Europe dominates in terms of share, followed by North and Latin America.
MAPFRE ASISTENCIA medical claims, by destination region, 2013/14 (%)
Destination
Africa
Asia
Europe
Latin America
Middle East
North America
Oceania
Worldwide
17
including domestic
2.6
7.1
48.8
14.4
7.2
14.5
5.4
100.0
excluding domestic
3.2
8.5
41.2
16.7
8.7
17.6
4.1
100.0
The overall picture for claims involving foreign travel can be seen more clearly
in the following chart:
Total MAPFRE ASISTENCIA medical claims by destination region (excluding domestic claims),
2013/14
Middle East
9%
Africa
3%
Oceania
4%
Asia
9%
Europe
41%
Latin America
17%
North
America
17%
Similarly, an analysis by individual destination country – of claims from all
source markets in which MAPFRE ASISTENCIA sells travel insurance – shows
that the largest shares of claims originate in Spain (26%), the USA (20%) and
Turkey (11%). But if domestic claims are excluded, the top spots are held by
the USA, Spain and Egypt, albeit with smaller shares overall – as shown in the
following chart.
The prominence of the USA and Spain is hardly surprising given their
importance as international tourism destinations – ranking second and third in
UNWTO's world ranking in arrivals (after France).
18
MAPFRE ASISTENCIA medical claims by destination (in which claims originate),
excluding claims originating in domestic markets, 2013/14
USA
16%
Spain
9%
Egypt
8%
Turkey
France
Mexico
6%
5%
4%
Thailand
3%
Australia
3%
Andorra
2%
Dominican Rep.
2%
Others
43%
The reason for Egypt's third position in the claims ranking – as discussed in
some detail in Part 2 of this report – is its relative importance in the UK market
and the overall weighting of the UK market in total MAPFRE ASISTENCIA
claims. The presence of Andorra and the Dominican Republic can be attributed
in large part to the popularity of these destinations from Spain and, in the case
of the latter, also the UK.
1.3 Analysis by Source Region
This section compares trends across the three main source regions – Europe,
Latin America and Asia Pacific.
1.3.1 Europe
European source markets
generate the most claims
As already indicated, European source markets account for the largest share
of medical claims handled by MAPFRE ASISTENCIA – 49% in 2013/14, or
41% of all international claims (i.e. those originating in foreign countries for the
respective source markets). More than half the claims from the region also
stem from medical problems that occur in Europe.
The UK, in first position in the source market ranking, generates the majority of
all non-domestic claims, ahead of Spain – with the two together accounting for
a high 86% share between them. France, Germany and Portugal, each
representing only very modest share, make up the top five.
19
Total MAPFRE ASISTENCIA medical claims (excluding domestic) from Europe, by source
country, 2013/14
52%
UK
34%
Spain
France
4%
Germany
4%
Portugal
4%
Turkey
1%
Other
1%
The following chart highlights the destination regions in which most European
medical claims originate: Europe again predominating, ahead of Latin America,
North America, the Middle East and Asia. Although this study only covers
claims from MAPFRE ASISTENCIA, the volume of claims amply justifies the
analysis. However, this breakdown is quite surprising on at least two counts.
Latin America comes well down the list of most visited destinations from
Europe, according to UNWTO and national statistics – certainly some way
behind North America and Asia, if not also the Middle East and Africa – yet it
accounts for 16% of medical claims, second only to Europe in share. Africa's
4% share, meanwhile, which one might expect to be higher, is in fact very
much in line with the destination's share of overnight volume out of, say, the
UK (5%), or share of trips from Spain (5%) – 2013 results for MAPFRE
ASISTENCIA's two most important European source markets.
Total MAPFRE ASISTENCIA medical claims (excluding domestic) from Europe, by destination
region, 2013/14
Oceania
4%
Asia Africa
8% 4%
Middle East
11%
North
America
12%
20
Europe
45%
Latin
America
16%
By way of comparison, the next table shows the respective shares of
destination regions in which European claims originate – with and without
domestic claims.
Total MAPFRE ASISTENCIA claims from Europe by destination region, 2013/14 (%)
Destination
including domestic
Africa
Asia
Europe
Latin America
Middle East
North America
Oceania
Worldwide
European claims relate
to a broad spread of
destinations
3.1
6.2
55.3
13.2
9.1
10.1
3.0
100.0
excluding domestic
3.8
7.6
44.5
16.4
11.3
12.5
3.9
100.0
On a country-by-country basis, the highest shares of European claims
originate in Spain (19%), followed by Turkey and the USA (both accounting for
9%). Spain's top place, however, is due to the high share of claims from
Spaniards travelling within their own country, and the same trend also affects
Turkey's position in the overall ranking.
If domestic claims are excluded from the count, the top three ranking changes
to the USA, Egypt and Spain, with the full top ten (see below) highlighting the
variety of destinations visited by Europeans, as reflected in UNWTO and
national statistics. In these top ten destinations, three are in the Americas
(USA, Mexico and the Dominican Republic), one is in Asia Pacific (Australia),
one in the Middle East (Egypt), and just five in Europe (Spain, France, Turkey,
Greece and Andorra).
MAPFRE ASISTENCIA medical claims (excluding domestic) from Europe, by destination
country, 2013/14
USA
11%
Egypt
11%
9%
Spain
8%
Turkey
France
Mexico
4%
Andorra
3%
Dominican Rep.
3%
Australia
3%
Greece
3%
Others
21
5%
41%
1.3.2 Latin America
The majority of claims
from Latin American
markets are from Brazil
MAPFRE ASISTENCIA's well-established travel insurance business in Brazil,
coupled with the strong growth in both domestic and outbound travel demand
from Brazilians, means that a majority of claims are generated from this
country – for domestic as well as international trips. Nevertheless, the growth
over the past 12 months in claims from Latin American travellers has not come
from Brazilians, but rather from Argentinians – from a much lower base, of
course – and, to a lesser extent (in percentage terms), Uruguayans.
MAPFRE ASISTENCIA medical claims (excluding domestic) from Latin America, by source
country, 2013/14
55%
Brazil
22%
Uruguay
19%
Colombia
Argentina
Mexico
3%
1%
Given Brazil's dominant share of claims, however, it is hardly surprising that
the market heavily influences the shares of destinations in which claims
originate. Indeed, as can be seen clearly in the following two charts (both of
which exclude domestic cases), North America dominates the overall picture
because it is such an important destination for Brazilians, attracting more than
one third of all trips abroad in 2013/14, according to various national and
international sources – about the same as its share for medical claims. Europe
ranked second and neighbouring Latin American countries third.
MAPFRE ASISTENCIA medical claims (excluding domestic) from Latin America, by destination
region, 2013/14
Asia
Oceania 3%
4%
Africa
Middle East
1%
0%
North
America
37%
Latin
America
25%
Europe
30%
22
With claims from Brazil taken out of the equation completely, the picture
changes dramatically. Not surprisingly, since most of the less mature Latin
American markets like Colombia and Uruguay travelled primarily within their
own region in 2013/14 – as they traditionally tend to do – the share of claims
originating in Latin America increased sharply, to 33%, ahead of that for
Europe (with 28%) and North America (with 26%). Claims originating outside
those three regions were relatively few and far between.
MAPFRE ASISTENCIA medical claims (excluding domestic and Brazil) from Latin America, by
destination region, 2013/14
Asia
4%
Middle East
0%
Oceania
8%
Latin
America
33%
North
America
26%
Europe
28%
23
Africa
0%
The following chart, which helps to substantiate the findings noted above,
compares the share of Latin American claims by destination region – the
region where the claims originated (excluding domestic cases and all cases
related to the Brazilian market) – to that of inbound overnight volume from
those countries. The chart shows just how important intraregional travel is for
Latin Americans, since the region generates two thirds of all nights spent
abroad (2013/14 data). Yet the share of medical claims originating in Latin
America is only half that – according to industry experts, most likely attributable
to the fact that many Latin Americans do not bother to take out travel insurance
on short trips to neighbouring countries.
MAPFRE ASISTENCIA claims from Latin Americas vs. nights spent abroad in different
destination regions, 2013/14 (%)
65,2
Claims
Nights
28,5
32,7
25,8
21,1
12,4
0,3 0,2
Africa
4,4
7,8
0,7
Asia
0,4 0,2
Europe
Latin America Middle East North America
0,3
Oceania
Source region: Argentina,Colombia, Mexico and Uruguay (excludes Brazil).
Finally, it is interesting to look more closely at the individual destination
countries in which claims from Americas markets originate. Since domestic
claims are relatively unimportant – in terms of their share of total claims from
Latin American markets – their inclusion or exclusion makes little different to
the overall breakdown. But, once again, we compare the shares with and
without Brazil as a source market. In the case of the former, the USA stands
out as the number one destination by a wide margin, accounting for more than
one third of claims, followed by Spain and Argentina – a 50% share for the
three combined.
When we exclude Brazil as a source market, the top three destinations – the
USA, Spain and Brazil – are closer together in share and together account for
a lower 44%.
24
% shares of destinations in which MAPFRE ASISTENCIA claims from Latin America
originated, 2013/14
Destination
including Brazil
as a source market
excluding Brazil
as a source market
USA
Spain
Argentina
France
Mexico
Brazil
UK
Portugal
Italy
Canada
New Zealand
Peru
Others
Total
35
10
5
4
4
4
3
3
3
3
27
100
23
13
6
3
8
5
2
4
6
2
28
100
Without the influence of Brazil, which we focus on as a source market later in
this report, other perhaps surprising destinations emerge in the top ten – New
Zealand, accounting for a 6% share of claims, and Peru, with 2%.
1.3.3 Asia Pacific
A fast-growing source
region, with a high share
of domestic claims
MAPFRE ASISTENCIA is established in the Asia Pacific travel insurance
market, selling policies in four countries – Australia, China, India and the
Philippines – and its operations are already showing signs of rapid growth.
Australia as a source market for medical claims has increased by more than
200% over the past 12 months – in line with the market's overall growth – and
there has been a similar trend in Asia.
A breakdown of medical claims by source country shows the strong dominance
of Australia and China, but this is partly due to the fact that both markets have
a very high share of domestic claims. The respective share of domestic claims
in total claims is extremely modest in the case of India and the Philippines.
MAPFRE ASISTENCIA claims from Asia Pacific, by source country, 2013/14
The high share of domestic claims from Australians also distorts the overall
picture in terms of the breakdown of destinations in which MAPFRE
25
ASISTENCIA medical claims originate. In 2013/14, one third of all claims from
the region originated in Australia, 11% in the USA and 8% in Thailand.
However, if domestic cases are excluded from the destination analysis, in
order to remove the bias in favour of Australia and, to a lesser extent, China, it
can be seen that Asia still features very strongly as a source of claims for
Asian policy-holders. But Europe follows closely behind, some way ahead of
North America and Oceania – Australia, New Zealand and the Pacific Islands.
Only a modest share of claims originates in other regions of the world.
MAPFRE ASISTENCIA claims (excluding domestic) from Asia Pacific, by destination region,
2013/14
Africa
Oceania
2%
7%
Latin
America
2%
Middle East
1%
Asia
40%
North
America
18%
Europe
30%
The destination country breakdown of claims is quite diverse, reflecting the
wide range of destinations visited. The USA and Thailand head the list,
followed by Indonesia and Spain.
MAPFRE ASISTENCIA medical claims from Asia Pacific by destination country, 2013/14
USA
16%
Thailand
12%
Indonesia
10%
Spain
8%
Germany
New Zealand
4%
France
3%
Japan
3%
Canada
2%
UK
2%
Others
26
5%
35%
1.4 Leading Source Markets: UK, Spain and Brazil
Europe generates
a high share of claims
in all three markets
As already discussed, the three most important source markets in 2013/14, in
terms of the share of total medical claims handled by MAPFRE ASISTENCIA
(excluding domestic cases), were the UK (31%), Spain (30%) and Brazil (9%).
Domestic cases have been excluded from the comparison because they are
far more important as a share of total claims for Spain than for the other two
markets, which would distort the findings.
The following graph compares the shares of claims originating in different
destination regions for the three source markets. In the case of the UK and
Spain, Europe accounts for the highest shares of claims, ahead of Latin
America in the case of Spain, and the Middle East in the case of the UK.
Travel destination preferences are naturally different for Brazil, because of its
geographical location – on a different continent and in the Southern
Hemisphere – but Europe is still important as a claims-originating region for the
Brazilian market, albeit some way behind the USA in top spot.
Given the pattern of travel flows from these three markets to destinations
around the world, the share of claims would seem to be more or less in line
with the importance of each destination region to the specific market. But
among the anomalies, or surprise findings, of our comparative analysis is the
low share of Asia in the case of the UK and the lower than expected share of
Latin America in the case of Brazil.
% shares of MAPFRE ASISTENCIA medical claims by destination region for the three leading
markets Spain, UK and Brazil, excluding domestic claims, 2013/14
Brazil
50
Spain
UK
48
38
33
33
21
9
1
4 2
Africa
More differences than
similarities between the
three markets
27
3
Asia
13 14
13
6
5
Europe
0 1
Latin Middle East North
America
America
2 1 2
Oceania
The UK is the subject of more detailed analysis in Part 2 of this report. But it is
nevertheless interesting to highlight here some of the key findings of the UK
analysis, so as to make direct comparisons with the other two markets,
particularly with Spain, a sister European market.
% share of MAPFRE ASSISTENCIA claims from Spain, UK and Brazil
in top 3 and top 10 destinations, 2013/14
Let us consider the top destination countries in which UK claims originated in
2013/14. The top three – Egypt, Spain and Turkey – accounted for 50% of total
claims made by UK travel insurance policy-holders, while for Spain the
respective share (of the top three foreign destinations: USA, Mexico and
Andorra) was a mere 17%. Brazil's top three destinations (USA, Spain,
Portugal) generated a 54% share, closer to that of the UK. In terms of the top
ten shares, the differences were equally striking – 80% in the case of the UK
and 77% for Brazil, but just 36% for Spain.
Where MAPFRE ASISTENCIA claims from the UK originated (excluding domestic), 2013/14
UK is Europe's second
largest outbound
travel market
28
As Europe's second most important outbound travel market after Germany, the
UK generates some 58.5 million trips abroad annually (2013), with 22% of total
trips to, and 40% of overnights in, destinations outside Europe. This is a much
higher share than the average for European markets.
Spain is the UK market's leading destination, ahead of France and the USA –
two other destinations also featuring high up the list in terms of claims. In 2013,
Spain attracted 11.8 million British tourists who stayed an average of 9.2 nights
per person, or a total of 108 million nights in the country. Turkey is also an
increasingly popular choice for British holidaymakers, recording 1.4 million
arrivals from the UK and 16.5 million overnights in 2013.
Egypt, while not featuring among the UK's leading tourism destinations, is a
favourite for year-round holiday travel, especially among those looking for
some winter sunshine. Despite the continuing unrest and intermittent violence
in Egypt since the start of the Arab Spring, UK demand for the destination has
held up reasonably well, showing growth of more than 5% in overnight volume
in 2013 to around 5 million overnights from more than 400,000 British tourists.
But, as will be discussed later, the coup d'état in July 2013 did cause a sharp,
if short-lived, decline.
Spanish domestic travel
booms but outbound
still lags behind
According to the 'Familitur' survey conducted by Spain's Instituto de Estudios
Turísticos (IET), Spaniards took 156 million trips in 2013. Of these, 145 million,
or 93%, were domestic. The high level of domestic travel demand is not
surprising given the vast array of tourism attractions offered by Spain, not least
for summer sun & beach vacations. And the importance of domestic travel is
understandably reflected in the volume and share of Spanish medical claims
originating in Spain.
Where MAPFRE ASISTENCIA claims from Spain (excluding domestic) originated, 2013/14
USA
8%
Mexico
5%
Andorra
5%
France
4%
Dominican Rep.
3%
UK
3%
Italy
2%
Germany
2%
Peru
2%
China
2%
Others
64%
The Spanish outbound travel market still lags somewhat behind that of its
northern European neighbours, as well as France and Italy. But it is more
adventurous than many other European markets, with 22% of its 11.2 million
outbound travellers in 2013 heading to non-European destinations. The
Americas attracted 1.2 million, Africa 1.0 million and Asia – still the least
developed non-European region in terms of demand in the Spanish market –
around 300,000.
29
This helps to explain why so many non-European countries feature among the
top ten foreign destinations in which Spanish claims originate – the USA,
Mexico, the Dominican Republic, Peru and China. However, the absence of
African destinations in the claims' breakdown is somewhat surprising.
Andorra, in third place in terms of share of medical claims from Spain, is
especially popular as a winter destination, as can be seen in the time series
charts in the following sub-section. And France, in fourth place, is a popular
city break destination for Spaniards, usually visited in the shoulder months in
spring and autumn.
Brazilians' strong bias
towards the USA
With 62% of all Brazilian outbound trips generated by the Americas – and first
and foremost by the USA – it comes as no surprise to see that the USA
accounts for such a high share of Brazilian medical claims abroad. It is also a
year-round destination, although the highest shares of claims originate in the
peak summer and winter travel months of January (14%) and July (11%).
As already indicated, Europe generates 31% of all claims, spread across a
number of countries, with Spain, Portugal and France being the most
important. The trend also appears to be in line with outbound travel patterns
from Brazil to Europe.
Where MAPFRE ASISTENCIA claims from Brazil (excluding domestic) originated, 2013/14
USA
43%
Spain
6%
Portugal
5%
France
5%
Argentina
3%
Italy
3%
UK
3%
Canada
3%
Germany
3%
Mexico
Others
2%
23%
By way of interest, Brazilians took 53 million trips in 2013 involving overnights
in commercial accommodation – i.e. excluding most VFR travel. Outbound
travel intensity, or the share of the population who travel abroad, is still only
4%, but these 7.9 million Brazilians took 8.7 million outbound trips.
30
1.5 Analysis of Seasonality
Valuable insights to be
gained from seasonal
flows
The case of the UK is presented in more detail in Part 2 of this report but, at
the risk of repetition, we would like to highlight some of the differences across
the three markets for comparative purposes – at least in terms of their
respective monthly and seasonal shares of total medical claims.
The case of Egypt has already been noted – the dip in claims and travel during
the month of July 2013 following the coup d'état – but the graph also highlights
the predominance of claims during the summer months, which account for at
least two thirds of all British trips abroad. The stagnation in share of claims in
March and April 2014 can in part be attributed to the timing of Easter, which fell
in April in 2014, boosting travel demand during that month.
Records from the UK Office of National Statistics show that, in spring 2013,
domestic travel demand was strong, possibly at the expense of travel abroad,
which might explain the apparent stagnation in share of claims.
Monthly shares of MAPFRE ASISTENCIA medical claims from the UK, 2012/13 – 2013/14
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May Jun
Jul
Aug Sep Oct Nov Dec Jan Feb Mar
Apr
The following chart highlights the monthly breakdown of claims among the top
five destinations, in terms of share. As an example, Egypt accounted for its
highest monthly share of UK claims in November, a favourite month for UK
tourists, but one with a lower overall share as the chart above shows. Claims
originating in Spain and the USA are fairly balanced in terms of share through
the 12 months, highlighting the fact that they are year-round destinations.
Turkey, on the other hand, accounts for a much higher share of UK claims in
summer, in line with its high share of overnights from the UK.
31
Monthly % shares of MAPFRE ASISTENCIA claims from UK in top five destinations, 2013/14
Egypt
Spain
Turkey
USA
France
Others
Total
Seasonal claims
patterns in line with
travel flows
May
20
19
20
10
2
29
100
Jun
23
14
25
7
2
28
100
Jul
13
15
22
11
3
37
100
Aug
18
14
20
13
4
32
100
Sep
23
16
19
11
2
29
100
Oct
24
17
15
14
1
29
100
Nov
38
14
2
14
1
31
100
Dec
20
13
1
18
9
38
100
Jan
20
10
1
13
14
42
100
Feb
14
13
0
13
11
49
100
Mar
18
12
1
16
12
41
100
Apr
14
13
6
24
7
35
100
While domestic claims in the UK are insignificant in number, and so do not
really warrant detailed analysis, Spain presents a totally different picture. In the
first graph, which looks at total travel for 2012/13 and 2013/14, the summer
and spring months all show a higher than average share of claims. However,
the shares for the months of January through March were quite a bit higher in
2013/14 – likely due in part to the later Easter, but also because of increased
winter sports travel to Andorra and domestic ski resorts.
MAPFRE ASISTENCIA medical claims from Spain (total), 2012/13 – 2013/14 (%)
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Domestic vs.
international trends
32
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
There is little difference in the overall trends regarding international claims, i.e.
claims originating in foreign destinations, as can be seen from the following
chart.
MAPFRE ASISTENCIA medical claims from Spain, excluding domestic, 2012/13 – 2013/14
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
In sharp contrast to the situation in the UK, and also Brazil (see below), the top
five destinations in which claims originate from the Spanish market (2013/14
data) never account for more than 50% of all claims in any one month. And the
average share for the year is around one third, or 33%. The 50% is only
reached in the peak winter sports months of January and February when
Andorra's share rises to 20% and 26%, respectively.
The USA's monthly share of claims remains steady through the winter months
at around 10%, but picks up to 13-14% in the peak Spanish summer travel
season, at the expense of neighbouring destinations like Andorra and France.
France is the favourite summer hot spot for several European nations. But not
in the case of Spain, since the majority of Spaniards still take their main
summer vacations in their own country. In the case of the Spanish market, as
reflected by the respective shares of medical claims originating in France on a
monthly basis, the destination is less popular in the peak travel season. But, as
France's tourism industry has recognised for many years, demand from Spain
– which is pretty heavily concentrated on city trips and short breaks – is much
higher, relatively speaking, in the winter and shoulder months of the year. It
therefore comes as no surprise to see France's monthly share of medical
claims peak at 10% in the month of December and 9% in April.
Monthly % shares of MAPFRE ASISTENCIA claims from Spain in top five destinations, 2013/14
33
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
USA
10
12
14
13
11
12
10
11
10
10
9
13
Mexico
10
9
9
10
6
8
8
6
6
6
7
7
Andorra
1
0
1
1
0
1
1
9
20
26
11
5
France
4
5
6
4
5
5
4
10
7
6
5
9
Dom. Rep.
3
5
4
6
5
5
4
4
4
2
4
3
Others
71
68
66
66
72
70
73
61
54
50
64
64
Total
100
100
100
100
100
100
100
100
100
100
100
100
The monthly shares of domestic claims present a much more dramatic picture.
The two seasonal peaks can be explained by Spaniards' enthusiasm for winter
sports holidays, or at least mountain holidays, which tend to peak between
February and Easter – no doubt resulting in a rise in cases of TRAUMA, such
as skiing fractures.
Monthly shares of MAPFRE ASISTENCIA domestic claims in Spain, 2012/13 – 2013/14 (%)
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
The August 2013 peak may be attributed to the upturn in Spain's economic
situation at about that time, motivating Spaniards to go on holiday. Statistical
trends from IET's Familitur database also point to a strong increase in
domestic travel in 2013, which has continued into 2014.
Brazil outbound travel
and medical claims
show the same annual
peaks
Seasonal patterns from Brazil, in terms of medical claims, show a peak during
the main summer holidays, in January, but also during the winter. In 2013/14,
the two peaks were equally important.
MAPFRE ASISTENCIA medical claims from Brazil, excluding domestic, 2012/13 – 2013/14 (%)
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
34
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
This coincided with the sharp peak in medical claims in January 2014. At the
start of 2013, according to the ForwardKeys database, outbound travel
demand in Brazil suffered a drop of nearly 6%, resulting in a fairly flat year in
terms of seasonal flows. The trend is also reflected in the spread of medical
claims over 2012/13 when seasonality was somehow more flat. Interestingly, in
the following year 2013/14, the share of medical claims started to fall slightly
from February, with the decline accelerating in April. This was possibly due to
the approach of the FIFA World Football Cup, which also saw a marked
slowdown in demand for travel, especially to long-haul destinations.
The following chart confirms in no uncertain terms the importance of the USA
as a destination from Brazil, accounting for between 38% and 52% of total
claims each month in 2013/14. Other significant destinations on a monthly
basis are Spain – where the share of claims peaks in February (12%) and May
(10%), and France in June (10%).
Monthly % shares of MAPFRE ASISTENCIA claims from Brazil in top five destinations, 2013/14
USA
Spain
Portugal
France
Argentina
Others
Total
35
May
42
10
10
6
1
30
100
Jun
42
9
7
10
1
29
100
Jul
38
5
6
7
9
36
100
Aug
39
3
5
5
5
43
100
Sep
46
7
4
3
3
38
100
Oct
48
8
4
3
2
34
100
Nov
46
4
6
6
3
34
100
Dec
50
7
1
6
2
34
100
Jan
49
7
4
3
3
35
100
Feb
49
12
7
5
2
26
100
Mar
54
4
4
5
4
30
100
Apr
52
2
3
3
6
33
100
Part 2
The UK Market
2.1 Background and Methodology
MAPFRE ASISTENCIA
in the UK
Since MAPFRE ASISTENCIA acquired 'InsureandGo' in October 2010, it has
not only expanded the UK brand considerably, but has also exported it to a
number of other countries, including the United States, Ireland and Australia.
InsureandGo is now the leading UK travel insurance specialist, selling an
increasing share of its policies in the UK online, as well as being the overall
world leader in online travel insurance distribution, with more than 2.8 million
sales in 2013.
Following the parameterisation of the InsureandGo medical assistance claims
data subsequent to the brand's acquisition, MAPFRE ASISTENCIA set up a
Travel Insurance Observatory in 2012. The findings of the first statistical
analysis, published in September 2013, covered the part-year July 2012-April
2013 (see Appendix for more details). This was the first significant period for
which data was deemed sufficiently accurate for meaningful analysis, including
diagnosis per claim – in line with the World Health Organization's International
Classification of Diseases (ICD-10).
Scope of analysis
Part 2 of this 2014 Travel Insurance Observatory report, which provides a
comprehensive review of the UK market, including an analysis of trends over
the past 12 months, covers the travel insurance claims handled by MAPFRE
ASISTENCIA through its subsidiary InsureandGo in May 2013 to April 2014
(hereafter referred to as 2013/14) – claims corresponding to InsureandGo
international travel policies issued in the UK.
Medical claims – whether for Medical Assistance or Reimbursements – are
handled separately from non-medical claims (Other Personal Benefits), which
allows for a more accurate assessment and understanding of the diagnoses
related to the medical claims that are directly linked to the destinations visited
by the UK travel insurance policy-holders. Claims for Other Personal Benefits
are discussed briefly, but the main focus of this report is on medical claims.
In addition to a detailed breakdown by destination – the region and country in
which the medical problems originated – the analysis looks at the types of
medical problems most faced by UK travellers abroad – the so-called
diagnostic groups. Cases are also analysed by age and how they relate to the
flow of travellers from the UK to the same regions and countries. This analysis
is made possible thanks to the findings of the UK Travel Trends reports for
2012-2013, together with other data from the UK Office for National Statistics
(ONS) International Passenger Survey and air bookings data from Forward
Data S.L. and its ForwardKeys.com database.
Some comparisons are also made with MAPFRE ASISTENCIA's findings
related to 2012/13 – the period has been updated and aligned with that of May
2013 to April 2014 to provide a full 12 months of data.
36
2.2 Types of Travel Insurance Cover
Medical incidents
account for most UK
claims
A breakdown of the total claims handled by MAPFRE ASISTENCIA in the UK
shows that medical, or health-related, claims – comprising those involving
comprehensive Medical Assistance as well as those simply for Medical
Reimbursements – accounted for 56% of the total cases handled in the
12-month period 2013/14, while Other Personal Benefits (non-medical claims)
represented 44%.
The breakdown was virtually identical in 2012/13 although, due to a typing error,
the respective shares for Medical Assistance and Medical Reimbursements were
mistakenly reversed in MAPFRE ASISTENCIA's 2013 Travel Insurance
Observatory report.
Breakdown of total MAPFRE ASISTENCIA claims, 2013/14
Other Personal
Benefits
44%
Medical
Assistance
Claims
22%
Medical
Reimbursemen
ts
34%
Medical Assistance Claims are those that need immediate assistance and/or
hospitalisation of the insured at the destination, or even repatriation, and for
which the direct intervention of MAPFRE ASISTENCIA operators is required.
Medical Reimbursements, on the other hand, relate to less serious cases,
possibly requiring a visit to the outpatients department of a clinic or hospital for
a medical diagnosis and prescription for medication, the costs of which will be
later reimbursed.
Other Personal Benefits (OPB), the non-medical cases, primarily concern trip
cancellations for health issues affecting the beneficiaries prior to the start of
their trip (i.e. in the country of origin), but they can also involve incidents during
their trip such as lost baggage, travel delays, missed flights and other
problems (see below).
Medical versus nonmedical problems
37
It is interesting to compare the respective shares of UK travellers' claims
related to medical and non-medical incidents (OPB). As highlighted in the
following chart, which compares the shares in the top ten destination countries
in which medical claims originate, the share of OPB (which excludes
cancellation cover since this is largely restricted to the country of origin)
generally exceeds that of medical claims.
However, this is not at all the case in Egypt, where the share of medical claims
outnumbers that of OPB by 9:1, or in Turkey where the ratio of medical to nonmedical claims is 3:1, and in the USA, where it is just under 2:1.
Selected destinations' shares (%) of MAPFRE ASISTENCIA medical and non-medical (OPB)
claims, 2013/14
Destination
Egypt
Spain
Turkey
USA
France
Greece
Cyprus
Thailand
Canada
Mexico
Others
Total
Medical claims
20.2
14.7
14.6
12.4
4.4
4.0
0.4
0.4
0.4
0.4
19.7
100.0
OPB
2.3
24.4
4.7
7.3
6.9
4.8
1.7
2.2
1.2
1.3
43.4
100.0
In Spain, where the ratio of medical to non-medical (OPB) claims is reversed –
nearly 2:1 in favour of OPB – one seemingly obvious explanation is that
travellers to the European Union (EU) or other European Economic Area
(EEA) member countries are entitled to free or heavily subsidised stateprovided healthcare if they carry the European Health Insurance Card (EHIC).
The EHIC does not cover private medical healthcare or costs, such as
mountain rescue in ski resorts, repatriation to the UK, or lost or stolen property,
but it should certainly cover the majority of non-serious medical complaints
from which travellers are prone to suffer while abroad. The fact that such a
high share of claims in the EU and EEA still relate to medical complaints would
tend to suggest that the EHIC might not be as reliable as travellers might
expect in all countries. Forewarned is forearmed, the well-known idiom goes…
2.3 Non-medical Claims
Ten broad categories –
of which three account
for 90% of claims
Non-medical claims, or Other Personal Benefits (OPB), can be divided into ten
broad categories, as shown in the following chart. As already indicated,
cancellation of a trip – due to health or other concerns prior to the traveller's,
or the travel group's, scheduled departure – is the most common reason for
claiming OPB: it accounts for 48% of all OPB claims The share has risen from
42% in 2012/13.
The second most frequent reason for OPB claims is lost or stolen baggage
(21%), followed by lost documents or money (11%) and travel delays for
different reasons (10%). These three categories represent a high 90% of all
OPB claims. More significantly, the respective shares, in terms of the number
38
of claims for OPB overall, have shown virtually no change over the past 12
months.
Breakdown of Other Personal Benefits relating to MAPFRE ASISTENCIA claims, 2013/14
8%
0,2%
0,5%
1,7%
10%
Cancellation
0,0%
Baggage
0,0%
Documents/money
Travel delays
Travel changes
48%
11%
Sports-related
Special cover
Additional expenses
21%
Muggings & crime
Transport
2.4 Medical Claims
What kind of medical
problems are the
most common?
Medical claims can be classified into three different categories, broadly
dependent on the health risk associated with the destination or type of
destination and/or travel experience.
A significant share of claims can be attributed to causes more or less related to
the travel destination: allergies, animal and insect bites, infectious diseases
(both bacterial and viral), gastro-enteritis, diarrhoea and abdominal pain
(GEA), respiratory infections, urinary tract infections, dermatitis, conjunctivitis,
altitude and other decompression sicknesses, sunburn and other burns. These
have been catalogued for the purposes of this monitor as 'Destination Related
Diagnoses', hereafter referred to as 'DRD'.
A second series of complaints can be grouped under the heading of TRAUMA.
These are mainly attributable to accidents, which may or may not be related to
the travel experience and/or destination. A fall or a traffic accident, for
instance, may have occurred independently of the trip. A skiing accident,
bungee jump or rafting accident, on the other hand, will be very much linked to
the type of travel. Nevertheless, such claims may have a much weaker causal
link to the destination itself than the previous group, and so are referred to in
this report's analysis as simply 'TRAUMA'.
Finally, the third category is linked to causes independent of the destination, or
which could have occurred even if the trip had not taken place: chronic
illnesses, cardio-vascular diseases, anaemia, tumours, epilepsy, etc. These
are referred to here as Other Non-Destination Related Diagnoses, or 'ONDRD'.
39
Of the total medical claims handled in the UK by MAPFRE ASISTENCIA in
2013/14, 49% were diagnosed as DRD, 26% were TRAUMA related and 25%
ONDRD. This breakdown shows little change over that of 2012/13, when the
shares were 48%, 27% and 25% respectively.
MAPFRE ASISTENCIA medical claims worldwide from the UK, by type of diagnosis, 2013/14
ONDRD
25%
DRD
49%
TRAUMA
26%
UK travellers are more
likely to suffer a DRDrelated medical problem
outside Europe
The following chart highlights the different types of health risk for UK travellers
in Europe and in destinations further afield. Not surprisingly, given that many
popular destinations outside Europe are in the tropics, where climate- and
food-related ailments are inevitably more common, the share of DRD medical
claims is much higher in these regions than in Europe (59% as against 39%).
In Europe, on the other hand, TRAUMA accounts for a significantly higher
share of claims (33% compared with 19% in the rest of the world), no doubt in
large part because of skiing and other sports-related accidents. Although other
regions, such as North and South America, Northeast Asia and Australia and
New Zealand, offer fantastic conditions and facilities for winter sports, British
enthusiasts are more likely to take their winter sports holidays in Europe.
MAPFRE ASISTENCIA claims from the UK by type of diagnosis, 2013/14
in Europe
ONDRD
28%
TRAUMA
33%
40
in the rest of the world
DRD
39%
ONDRD
22%
TRAUMA
19%
DRD
59%
2.5 Medical Claims by Destination Region
Type and level of health
risk vary by region
As already indicated, the type of medical problems experienced by UK
travellers abroad varies considerably from region to region. A more detailed
analysis by region and country is provided below but, as a general rule, claims
originating in the Middle East are much more likely to be destination-related
(DRDs) than those originating in other regions. DRDs account for 80% of all
claims originating in the Middle East. They also account for high proportions of
claims in Asia (51%) and Latin America (50%), but a low proportion in Oceania
(27%).
The share of DRDs in Europe is also relatively low. This can of course be
explained by the fact that the majority of UK residents travelling in continental
Europe – at least in the EU and EEA member countries – carry the European
Health Insurance Card (EHIC) and are able to receive medical care either free
of charge or at reduced cost.
% shares of MAPFRE ASISTENCIA UK claims by type of diagnosis in each region, 2013/14
DRD
TRAUMA
ONDRD
80
51
39
28
50
38
33
23
26
34
41
40
28
22
28
28
32
27
32
9 11
Africa
Asia
Europe
Latin Middle East North
America
America
Oceania
The proportion of TRAUMA cases is highest in Europe and Oceania, with
Oceania also having the highest proportion of Other Non-Destination Related
Diagnoses (ONDRD).
Half of all claims
originate in Europe
41
Not surprisingly, given the dominant position of Europe in the UK ranking of
foreign destination regions visited, a significant share of the UK claims (50%)
handled by MAPFRE ASISTENCIA in 2013/14 originated in Europe. However,
the share was still well below the 78% share of actual trips taken to, or
overnights (60%) spent in, other parts of the European region. Again, this can
be explained by the fact that most UK residents travelling in continental Europe
carry the EHIC, as described just above.
MAPFRE ASISTENCIA UK medical claims by destination region, 2013/14
Africa
2%
Latin America
5%
Oceania
2%
Asia
6%
North America
14%
Europe
50%
Middle East
21%
A comparison with the 2012/13 results shows that the breakdown has
remained stable. Europe's share is down very slightly, as are Asia's and
Oceania's, with North America showing the most appreciable increase, albeit a
modest one, of two percentage points.
High share of Middle
East-originating claims
attributed to Egypt
In order to avoid any distortion of the regional breakdown due to the impact of
the European Health Insurance Card (EHIC) on claims originating in EU and
EEA countries, the following chart excludes Europe from the world breakdown.
This draws attention to the relative significance of the Middle East in the overall
picture, especially when the share of claims is compared with that of
overnights spent in the region in 2013/14 by UK travellers.
Share of nights spent abroad by UK residents vs. medical claims by region,
excluding Europe, 2013/14
Claims
41%
Nights
28% 28%
26%
15%
12%
14%
10%
10%
7%
5%
Africa
42
3%
Asia
Latin America Middle East North America
Oceania
t is therefore important to note that more than 50% of medical claims in the
Middle East region originate in Egypt. Although the civil unrest and violence in
Egypt over the past few years have undoubtedly taken a toll on demand for the
destination, it remains a popular destination for UK outbound holidaymakers,
accounting for some 4.8 million overnights from the UK in 2013/14. And, as
other evidence will confirm later in this report, the incidence of DRDs is
relatively high in Egypt's main tourism resorts.
North America shows a
close correlation
between medical claims
and overnights
The only region in which the shares of claims and overnights appear to be well
correlated is North America, although Latin America comes close behind. For
the purposes of this report, Mexico has been included in Latin America rather
than in North America.
North America, which therefore comprises the USA and Canada for the
purposes of this study, is not a region that is perceived as posing serious
health risks for travellers. But because it is seen as a very expensive
destination for medical treatment of all kinds, the British, like most other
travellers, do pay particular attention to taking out travel insurance when
visiting North America. And it would seem that the region's share of claims is in
proportion to the overnight volume from the UK.
For Latin America, on the other hand, the fact that the share of medical cases
per overnight volume is quite modest comes as a surprise, since local tour
operators and suppliers usually recommend taking out good insurance
coverage for any trip to the American sub-continent. The same is also true of
Africa (another region representing a small sample) and the trend also begs
the question "Why?" The most likely answer is that the destinations most
visited by the British in Africa pose less of a health risk than general
perceptions of the continent would lead some to believe.
In Oceania, i.e. Australia, New Zealand and the Pacific Islands, where the
situation is similar, there is a good explanation. Under reciprocal healthcare
arrangements between the UK, Australia and New Zealand, British citizens
resident in the UK and travelling on a British passport are entitled to limited
subsidised health services when visiting the two countries. So it makes sense
to see a reduced incidence of medical claims in these destinations.
2.6 Individual Country Analysis
Top ten countries
account for 77% of all
medical claims
43
Of the total UK claims handled by MAPFRE ASISTENCIA in 2013/14, 77%
originated in just ten countries, and a mere four countries accounted for as
many as 62% – Egypt, Spain, Turkey and the USA, in order of importance. The
ranking remains unchanged from that of 2012/13, as do the countries in the top
20, in which more than 90% of all claims arose.
Top ten destinations in terms of MAPFRE ASISTENCIA medical claims from the UK market,
2013/14
Destination
2012/13
Egypt
Spain
Turkey
USA
France
Greece
Cyprus
Thailand
Bulgaria
Canada
Others
% share
2013/14
2013/14
3,080
2,211
2,090
1,519
779
697
524
523
258
195
2,925
3,202
2,339
2,310
1,961
692
635
627
474
215
266
3,138
20.2
14.7
14.6
12.4
4.4
4.0
4.0
3.0
1.4
1.7
19.8
14,801
15,859
100.0
Total
Breakdown of total MAPFRE ASISTENCIA UK claims by destination country, 2013/14
Others
23%
Egypt
20%
Thailand
Cyprus 3%
4%
Greece
Spain
15%
4%
France
4%
USA
12%
Turkey
15%
In order to provide a better understanding of the relative sample size in relation
to the importance of the destination, the following tables compare the shares of
total claims with the respective shares of nights from the UK in 2013/14. The
results should be interpreted with caution since reliable conclusions cannot be
drawn without more details of total medical claims as a share of policies sold.
But the exercise does provide a useful indication of the relative weight of
medical claims in different destinations.
The analysis has been separated into two groups – the first covering European
countries and the second, the rest of the world without Europe – so as to take
into account the differences in claims that could be attributed to the effects of
the European Health Insurance Card (EHIC).
Spain and Turkey
account for the highest
shares of medical claims
44
Just under 50% of all medical claims handled by MAPFRE ASISTENCIA in
2013/14 originated in Europe, which generated about 60% of all nights spent
abroad by UK travellers over the same period. With the notable exception of
Turkey, the destinations in which most medical claims originate among UK
travellers are all members of the EU and/or the EEA, led by Spain and France
– the top European destinations for the British in terms of both trips and nights
spent abroad.
Turkey accounts for the second highest share of medical claims but is only the
sixth most popular European destination out of the UK in terms of nights. This
suggests that it is a destination that poses a higher health risk than average.
The share of claims in France, Italy and Portugal are below what their market
share would suggest, whereas in Bulgaria, Cyprus and, to a lesser extent,
Greece, Austria and Malta, they are well above. Spain and Switzerland show a
more moderate relationship although, in the case of Spain, the volume is
significant, while Switzerland represents a very modest number of claims.
Breakdown and shares of claims and nights in European destinations, 2013/14
Destination
No. of
claims
No. of
nights
% share of
claims
% share of
nights
% share of claims/
% share of nights
Spain
Turkey
France
Greece
Cyprus
Bulgaria
Italy
Austria
Portugal
Malta
Switzerland
Other Europe
2,339
2,310
692
635
627
215
194
155
141
107
78
8,038
107,886
16,474
63,266
19,722
7,923
3,516
21,820
4,649
19,486
5,504
5,720
92,226
15.1
14.9
4.5
4.1
4.0
1.4
1.2
1.0
0.9
0.7
0.5
51.8
29.3
4.5
17.2
5.4
2.2
1.0
5.9
1.3
5.3
1.5
1.6
25.0
0.5
3.3
0.3
0.8
1.9
1.4
0.2
0.8
0.2
0.5
0.3
2.1
Total Europe
15,531
368,193
100.0
100.0
1.0
Note: The shares of claims and nights have been rounded which causes some distortion in the
calculations of % share of claims over % share of nights.
Sources: MAPFRE ASISTENCIA for no. of medical claims; UK Travel Trends, UK Office of National
Statistics (ONS) for overnight data.
Egypt stands out as the
destination posing the
greatest health risks
Non-European countries accounted for 50% of all the medical claims made by
British travellers and handled by MAPFRE ASISTENCIA in 2013/14 – the
same as for Europe overall. As might be expected, however, Europe attracted
a much higher share of trips (78%) and nights (60%) but the British are
nevertheless adventurous travellers, with over 12.6 million of them in 2013
choosing destinations outside Europe where they spent 243 million nights.
As far as medical claims were concerned, the majority of countries in the top
ten (for claims) accounted for fewer claims than might have been expected,
with India (0.2), Australia (0.3), South Africa (0.5) and Tunisia (0.7) heading the
list. Thailand (1.6), the USA (1.4), Canada (1.3) and Mexico (1.1) registered
more claims than they should have done, but in a ratio of not much more than
45
1.1. In sharp contrast, Egypt accounted for substantially more claims than it
should have done (20.2), implying that it is a high-risk destination.
Breakdown and shares of MAPFRE ASISTENCIA UK claims and nights in non-European
destinations, 2013/14
Destination
No. of
claims
No. of
nights
% share of
claims
% share of
nights
% share of claims/
% share of nights
Egypt
USA
Thailand
Canada
Mexico
Australia
India
Tunisia
South Africa
Other non-Europe
3,202
1,961
474
266
227
176
136
102
101
1,316
4,966
43,507
9,000
6,274
6,203
16,472
22,232
4,450
6,119
124,073
40.2
24.6
6.0
3.3
2.9
2.2
1.7
1.3
1.3
16.5
2.0
17.9
3.7
2.6
2.5
6.8
9.1
1.8
2.5
51.0
20.1
1.4
1.6
1.3
1.1
0.3
0.2
0.7
0.5
0.3
Total non-Europe
7,961
243,296
100.0
100.0
1.0
Notes: The shares of claims and nights have been rounded which causes some distortion in the
calculations of % share of claims over % share of nights. The Dominican Republic is not included as
comparative data on UK overnights is not available. But these are estimated at around 1.2 mn.
Sources: MAPFRE ASISTENCIA for no. of medical claims; UK Travel Trends, UK Office of National
Statistics (ONS) for overnight data.
Five countries account
for nearly 80% of all
medical claims outside
Europe
The following chart highlights the relative weight of the most important
destinations in terms of share of medical claims. With Europe excluded from
the count, Egypt's share increases to 40%, followed by the USA with 25% and,
some way behind, Thailand with 6% and Canada and Mexico with 3% each.
Breakdown of total MAPFRE ASISTENCIA UK claims by destination country, excluding
Europe, 2013/14
Others
23%
Egypt
40%
Mexico
3%
Canada
3%
Thailand
6%
USA
25%
46
GEA cases strongly
predominate in terms of
type of medical claim
An analysis of medical claims from around the world shows that gastrointestinal and other abdominal problems (GEA) are the most widespread. In
2013/14, they accounted for more than half (51%) of all the medical claims
handled by MAPFRE ASISTENCIA from sales of InsureandGo travel insurance
policies. The second most common category was infections (34%) – all types,
whether bacterial or viral – followed, a long way behind, by animal and insect
bites (7%), allergies (4%), skin problems (3%) and altitude sickness (1%),
including decompression problems.
Interestingly, there has been almost no change in the breakdown of medical
complaints in the 12 months since 2012/13. The shares of GEA and animal /
insect bits have fallen, while skin problems and infections have risen slightly.
However, the overall picture does mask a number of regional variations. While
gastro-intestinal problems represent the majority of all DRDs in Mediterraneanbordering countries (notably Turkey and Cyprus), including the Middle East
(64%) and Africa (67%), as well as close to 50% in Asia and Latin America,
they are much less prevalent in EU / EEA Europe, North America and
Oceania.
Infections, on the other hand, represent some 59% of all claims in North
America and 74% of those originating in Oceania, but only a small share of
those in the Middle East (17%). Tropical countries show the highest incidence
of insect and other animal bites, although their share in total claims is still
modest. Dermatitis and other skin problems are more significant in the Middle
East or Latin America.
Total MAPFRE ASISTENCIA UK claims by DRD type, 2013/14
Allergies
4%
Animal bites
7%
Skin
problems
3%
Altitude
sickness
1%
GEA
51%
Infections
34%
Differences in diagnoses
by destination
Clearly, there are also differences in the types of infections, skin problems etc.
that are prevalent in different countries. DRDs in the Mediterranean region are
primarily caused by dermatitis and other skin infections. GEA is much more
common among UK travellers in Africa and the Middle East, however, with the
vast majority of cases in the latter region originating in Egypt – in part because
of the larger number of British travelling to this destination.
In Asia, DRDs are primarily linked to cases of GEA, notably in the sub-regions
of Southeast and South Asia. The incidence of viral infections is also much
47
higher in Southeast Asia compared with the other sub-regions, representing
the majority of all claims with regard to infections in Asia.
TRAUMA claims are most common in Europe, and especially in countries
within the Alpine region, which is a popular destination for British winter sports
enthusiasts.
In Latin America, while DRD claims have generally increased their share since
2012/13, the share of TRAUMA has declined and there has been no change in
the share of ONDRD. The trend has also been the same in North America,
where DRD nevertheless accounts for 10% fewer medical claims overall than
they did a year ago.
In the following series of charts, we highlight a few of the more interesting
individual country examples of the diagnoses linked to medical claims. The
selection focuses on countries in which most of the medical claims of UK
travellers originate.
Egypt
Spain
United States
In Egypt, where more than 20% of all
UK medical claims originate, DRDs
account for as more than 80% of
cases. The highest proportion of DRDs
in Egypt during the period under
review were due to GEA, followed by
sickness resulting from animal / insect
bites, skin problems and respiratory
infections.
Claims in Egypt by diagnosis, 2013/14
The picture is much more balanced in
Spain, which shows a fairly even split
between cases of DRD, TRAUMA
and ONDRD. About three quarters of
the DRD cases are caused by GEA or
respiratory infections. Viral, urinary
infections and dermatitis cases are
also quite significant.
Claims in Spain by diagnosis, 2013/14
As in Spain, medical claims originating
in the USA are fairly well balanced
between DRD, TRAUMA and ONDRD.
However, in contrast to the situation in
other regions, respiratory and viral
infections account for the most claims,
ahead of GEA and skin-related
complaints.
Claims in the USA by diagnosis, 2013/14
ONDRD
TRAUMA
DRD
ONDRD
DRD
36%
TRAUMA
29%
ONDRD
32%
DRD
41%
TRAUMA
27%
France and Austria
These two charts show the very high share of TRAUMA cases in UK medical
claims originating in France (68%) and Austria (82%). As already discussed,
these are two of the most popular winter sports destinations for UK travellers,
48
and skiing or other sports-related accidents are bound to be a lot more
prevalent than in countries without winter sports facilities.
Claims in France by diagnosis, 2013/14
ONDRD
22%
Claims in Austria by diagnosis, 2013/14
DRD
10%
ONDRD
12%
TRAUMA
82%
TRAUMA
68%
Turkey
India
49
DRD
6%
In Turkey, 55% of medical claims
through InsureandGo by British
travellers relate to DRD, while
TRAUMA and ONDRD account for
24% and 21% of claims respectively.
The three more common DRDs, as in
Greece and Cyprus, are GEA,
respiratory infections and dermatitis.
Claims in Turkey by diagnosis, 2013/14
DRDs in India represent 49% of the
total cases. And the most common
diagnosis
for
these
diseases
concerns GEA (63% of DRDs),
followed by respiratory infections and
infections caused by viruses. Less
common are cases of dermatitis,
animal bites, urinary infections and
bacterial diseases.
Claims in India by diagnosis, 2013/14
ONDRD
21%
TRAUMA
24%
DRD
55%
ONDRD
30%
TRAUMA
21%
DRD
49%
2.7 The Link between Age and Medical Problems
Medical claims
by age group
The following chart shows the share of UK claims registered worldwide by
MAPFRE ASISTENCIA by age group in the 2013/14 12-month period under
review.
MAPFRE ASISTENCIA UK medical claims by age, 2013/14
80+ years
4%
0-19 years
18%
60-79 years
23%
40-59 years
24%
20-39 years
31%
Not surprisingly, the worldwide shares mask some interesting variations from
one region to another. In the majority of regions, with the exception of Europe
and Oceania, the age group accounting for the highest share of medical claims
is the 20-39 year-olds. The respective shares for this age group range from
28% in the case of Africa to 51% in Asia – a region where young people are
travelling more and more due to the growth of low-cost airline services.
In Europe and Oceania, the 60-69 year age group generates the highest
shares of medical claims – of 28% and 41% respectively.
Claims by type of
medical problem
50
A breakdown of claims by type of disease or medical problem highlights the
wide variations across the different age groups. DRD cases are most common
among infants and children aged 0-4 years, with children generally and young
travellers up to the age of 24 also showing a higher incidence of destination
related diseases (DRD) than average. TRAUMA cases are most prevalent
among 50-64 year-olds, while the incidence of ONDRD is highest among
travellers above the age of 70 – as one might expect.
MAPFRE ASISTENCIA UK claims in each age group by diagnosis type (%), 2013/14
DRD claims by problem
Age group
DRD
TRAUMA
ONDRD
0-4 years
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
66
57
55
56
59
55
50
50
55
50
45
39
36
37
32
32
32
15
27
28
26
24
25
26
29
23
27
30
32
31
30
24
29
26
19
16
16
18
17
21
24
21
22
24
25
29
34
33
43
39
42
An analysis of DRD claims by the broad categories of medical complaints
highlights the wide variations across the different age groups. GEA, which is
the most common cause of DRD worldwide, is most prevalent among the 1549 year-olds, while infections are most common among the very young – 0-19
year-olds – and the 70+ age group.
Skin problems, although less widespread, tend to affect the 30-54 year-olds
most, and altitude sickness (also much less frequent) is most likely to affect the
30-34 year-olds, while allergies are most prevalent in the 15-24 year age group.
Breakdown of MAPFRE ASISTENCIA UK claims in each age group by DRD type (%), 2013/14
Age group
0-4 years
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
51
Allergies
4.4
3.4
5.0
6.1
5.9
5.1
3.1
5.3
4.2
4.1
5.8
3.5
5.6
2.9
0.9
0.6
2.4
Altitude
sickness
0.0
0.0
0.3
0.2
0.3
0.4
1.1
0.5
0.4
0.2
0.6
1.2
1.1
0.7
0.4
0.0
0.6
Animal &
insect bites
GEA
Infections
Skin
problems
2.2
2.5
4.4
6.3
8.3
6.7
8.8
6.0
7.3
8.2
10.3
8.7
10.6
5.5
1.8
5.8
4.3
30.4
38.3
37.7
56.4
60.9
60.1
57.4
56.8
56.2
57.1
53.0
53.8
44.1
47.0
46.3
44.2
33.5
60.9
53.0
49.1
28.0
21.2
24.9
25.0
27.3
27.0
26.3
26.6
31.2
36.7
42.2
47.6
48.8
57.9
2.0
2.8
3.5
3.1
3.5
2.7
4.6
4.3
5.0
4.1
3.6
1.7
1.9
1.7
3.1
0.6
1.2
2.8 Seasonality of Medical Claims
Share of claims follows
similar trends as for
overnights
As would be expected, travellers are likely to make a higher share of claims in
months in which they travel the most. This is not always the case, of course,
but the peak in share of claims through the Northern Hemisphere months of
June through September coincides with the peak summer travel period. Note
that the black dotted line refers to the monthly average over the 12-month
periods May-April in 2012/13 and 2013/14 (100% ÷ 12 = 8.33%).
In 2012/13, claims for DRD and ONDRD cases exceeded the monthly average
from May through October, falling below average during the other months.
TRAUMA cases, on the other hand, were above average in terms of share
during the summer months of June–September, as well as in January–April.
Monthly shares of MAPFRE ASISTENCIA UK claims by diagnosis type, 2012/13
DRD
TRAUMA
ONDRD
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
Monthly shares of MAPFRE ASISTENCIA UK claims by diagnosis type, 2013/14
DRD
TRAUMA
ONDRD
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
52
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
While the seasonal pattern was very similar in 2013/14, some interesting
anomalies emerge, begging a number of questions. By way of example, the
monthly TRAUMA shares fell were much lower in January-April in 2014 than in
those same months in 2013, also falling progressively through the four-month
period.
One likely contributing factor was the time shift of the Easter holidays. In 2013,
they were in March, resulting in greater travel that month, so perhaps
explaining the parallel rise in share of TRAUMA claims. While holidays in
March often still involve skiing, a later Easter period typically favours other
destinations such as cities or sun & beach resorts, in which cases of TRAUMA
are less likely.
With regard to DRD claims only – medical complaints related to the destination
– there was a big dip in the curve in July 2013.
Monthly shares of MAPFRE ASISTENCIA UK DRD claims, 2012/13 and 2013/14
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
Further investigation suggests that this was almost certainly due to a sharp
drop in demand for travel by the UK market – as with all other European
markets – following the coup d'état in Egypt the same month, which resulted in
widespread travel advisories warning against travel to Egypt. Arrivals overall in
Egypt fell by 26% in July 2013, with the sharpest declines from western
Europe, and the downward trend has continued ever since.
Egypt is a particularly important medium-haul destination for UK travellers,
especially holidaymakers, and 20% of total medical claims registered by
MAPFRE ASISTENCIA from the UK market in 2013/14 originated in Egypt. So
the impact of the coup is hardly surprising. Closer analysis confirms the
assumptions, as can be seen in this final chart.
53
Monthly shares of MAPFRE ASISTENCIA UK DRD claims originating in Egypt, 2012/13 and
2013/14
2012/13
2013/14
Average
16%
14%
12%
10%
8%
6%
4%
2%
0%
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
This example shows how important it is not to place too much importance on
raw data without a proper understanding of the circumstances and events to
which the data refers.
54
Appendices
Methodology
Time period selection
The data in the 2013 report relates to a 10-month period July 2012 to April
2013. This year, the analysis covers a full 12-month period May 2013 to April
2014 (hereafter referred to as 2013/14) and any comparisons made with the
previous year also refer to the same 12-month period in 2012/13, thereby
expanding the scope of the 2013 report.
Country selection
The database for analysis was created from individual country databases of
claims handled by MAPFRE ASISTENCIA – travel source countries / markets
in which MAPFRE ASISTENCIA's travel insurance policies are sold, both
directly and through third parties. Chile was excluded from the study due to a
lack of homogeneity in its database, as well as a significant volume of missing
information.
Data has been included for the following countries: Argentina, Australia,
Belgium, Brazil, China, Colombia, Germany, Spain, France, India, Italy, Malta,
Mexico, Philippines, Portugal, Turkey, the UK and Uruguay.
The analysis has focused on these travel source markets grouped by region –
Europe, Americas and Asia Pacific – and with a special analysis of the main
source countries in MAPFRE ASISTENCIA's claims database: the UK, Spain
and Brazil.
The sample for the study consisted of 97,059 claims / cases, of which 50,695
for the 12-month period May 2013 to April 2014.
Selection of variables
for analysis
For comparative purposes, three basic variables selected from our global
database: source country, destination country / continent / subcontinent and
also case date. For the UK, in addition, the diagnostics variable was of
sufficient quality to allow for a more in-depth analysis.
A different database containing non-medical claims – 'Other Personal Benefits'
(OPB) enabled us to perform an overall split analysis of the different types of
OPB claims handled by MAPFRE ASISTENCIA in 2013/14.
Selection of continents /
subcontinents
Countries were grouped by continent and subcontinent based on UNWTO's
definitions of geographic regions. The exception was Mexico, which was
included in Latin America in view of the Mexican market's greater similarities
with other markets of Central and South America than with its North American
Free Trade Association (NAFTA) partners.
Another difference with the 2013 Travel Insurance Observatory (TIO)
concerned Egypt, which is included in the Middle East in this 2014 TIO,
according to UNWTO definitions.
55
Criteria for comparison
Due to the big differences in individual country sample sizes, all comparisons
were made using relative values (% shares). The analysis for origin markets
for which there are few cases is clearly less reliable because of the random
component than that for markets that present a large number of cases. The
data should therefore be interpreted with caution.
Comparison were limited to those source markets and destination countries In
that present the highest shares of claims – whether the top three, top five or
top ten.
Diagnostics variable
The UK was the only source market selected for a diagnostics analysis, due to
the high quality of information relating to the different medical diagnoses
submitted for claims, as well as the large volume of claims and the very low
volume of missing information.
An initial problem concerning the heterogeneity of the diagnostics data was
overcome by grouping disperse and descriptive values into a smaller group of
specific types of diseases proposed by the medical director of this study.
Time series
The time series represent the share of total claims for each month, thus
reflecting the seasonality of cases through the 12-month period. The time
series presented as monthly shares retain the same shape as an a time series
of absolute values and makes it easier to compare changes in seasonality,
even if the total amounts vary over two time periods.
Data Sources
European Travel Commission's (ETC) – http://www.etc-corporate.org
including ETC's series of 'Market Insights'
Forwardkeys.com – http://www.forwardkeys.com/
Instituto Brasileiro de Geografia e Estatîstica (IBGE) –
http://www.ibge.gov.br/home/
Instituto de Estudios Tourísticas (IET), Spain – http://www.iet.tourspain.es/
Ministério do Turismo, Brazil / Embratur –
http://www.turismo.gov.br/turismo/o_ministerio/embratur/
UK Office for National Statistics (ONS) – http://www.ons.gov.uk/
including various publications such as UK Travel Trends, 2009-2013 –
www.ons.gov.uk/ons/rel/ott/travel-trends/2013/rft-travel-trends--section-3--ukresidents-visits-abroad--2009-to-2013.xls
VisitBritain – http://www.visitbritain.org/insightsandstatistics/
World Tourism Organization (UNWTO) – various publications and statistics –
http://www.e-unwto.org/home/main.mpx
56