Need to know:
- Health benefits must reflect local differences in state provision, regulation, employee expectations and culture.
- Taboos still exist around mental health requiring employers to ensure any support services are implemented in a sensitive manner.
- Employers can find themselves plugging the gaps in state healthcare provision, whether that is primary care in Nova Scotia or dental cover in Newcastle.
Healthcare costs are facing double digit increases around the world. But while medical inflation may be a global issue, employers must take a local approach when it comes to providing health benefits.
A one-size-fits-all approach is impossible, according to Adam Harding, executive director – international benefits at Howden Employee Benefits. “Employers can have a global health strategy but differences in state provision, regulation and culture mean the benefits they offer must reflect local employees’ needs,” he explains.
Health differences
Around the world, there are marked differences in the types of health conditions countries are facing. Developed markets continue to face pressures from chronic conditions and cancer but also, as populations age, neurodegenerative diseases, says Diego Ramirez, partner, global medical health consulting at Mercer. “Emerging markets, which include Latin America and Asia Pacific, are more likely to see infectious diseases and, where health and safety isn’t so robust, injuries from accidents,” he adds. “These countries are also getting our bad habits and seeing a rise in chronic conditions.”
These health trends can shape benefits provision. Screening programmes can help to detect chronic conditions earlier, when treatment is simpler and lower cost, while health and wellbeing apps can head off bad habits through behavioural change.
Cultural challenges
Cultural differences can also affect the health benefits an employee will expect. For example, it is normal to include Chinese medicine on a medical insurance plan in Asia or circumcision on a plan for Saudi Arabia but gender reassignment surgery would be excluded on policies for the Middle East, says Harding.
These differences can also affect the way healthcare is delivered. “Overtreatment is an issue in Singapore,” says Harding. “If someone has a headache, they can find themselves being referred for an MRI scan. Employers need to be aware of this to control costs.”
Mental health is another area where attitudes vary greatly, forcing employers to adapt support in each country. As an example, Paula Allen, global leader research and insights at Telus Health, points to South Korea. “There’s a strong cultural taboo around revealing one’s vulnerability regarding mental health,” she says. “Employee assistance programme (EAP) services must ensure confidentiality, and where a manufacturing [organisation] has counselling services onsite, these will be in a low-traffic area, such as underground, with separate entrances and exits so employees don’t bump into each other.”
Local provision
State provision can also determine health benefits. “Employers need to understand how the healthcare they provide aligns with state provision and the health risks of each country,” says Ramirez. “These challenges may mean additional costs.”
Canada is a good example of this. It is currently facing a primary care crisis, with more than 6.5 million people unable to access GP services. This has resulted in some employers and local governments offering virtual GP services to fill the gap.
It is not always an additional cost for employers though, with some state systems delivering health interventions that can help to reduce expenditure. Pharmacogenomic testing is one example, says Anthony Cabrelli, managing director at Bupa Global. “This analyses an individual’s DNA to identify which medicines would be most effective,” he explains. “Our pilot found that 99% of people have genetic sensitivity to common medicines, which can reduce effectiveness or cause more side effects.”
Bupa is offering this test but it is also available as part of the public health system in the UAE. Being able to personalise treatment in this way can reduce waste and cost associated with ineffective medicines.
Expats’ needs
Responding to local health needs and provision is one challenge but employers must also consider what they offer to expats working overseas. Increasingly, regulation dictates what an employer must provide, with health insurance mandatory across the Middle East.
Even where there is compulsory cover, a global medical insurance scheme can still be a consideration. “Local policies will be cheaper than a global medical insurance scheme, but employers must be sure the cover is appropriate,” says Harding.
Gaps do occur, especially where employees are based somewhere remote or in countries with less developed healthcare systems. “Employers may want to include evacuation through a global medical policy,” adds Cabrelli. “Overseas assignments are an investment and employers, and their employees, want the peace of mind that everything will be taken care of if they’re ill.”
Taking each country’s approach to healthcare provision into account, as well as local health risks and cultural differences, will enable employers to meet employees’ expectations around the world.
