The need for health care reform in our rapidly aging world is certainly recognized as a key and pressing issue in most countries. The reform of government health care systems and regulation is now common, including in the US and China – where extending coverage not only comes up against increasing costs and effective distribution, but also the long lead-in time it takes for additional resources and staff to become available. In the wake of the credit crisis, many governments are realizing that there are several years of financial constraint on the horizon and that the political importance of health care is such that, even when projecting austerity, politicians are keen to convince their constituents that they give priority to spending in the health care arena.

The second report, based on research by the World Economic Forum (the “Forum”) in collaboration with Mercer and the OECD, includes a challenge that sets out opportunities and collaborative strategies that will lead to more sustainable financing for health care. Different countries are starting from very different positions, but as we noted in our article following the first report, (see Global impact: Healthcare planning for an ageing world by Christine Owen Global Retirement, Risk & Finance Perspective, Special Edition 2008 ), the direction of travel on some of the most powerful drivers of change is the same around the world. The mix of aging, rising medical costs, growth expectations and stresses from the combined changes in patterns in both chronic and infectious diseases are a mix that led us in that article to paint “a somewhat bleak picture.”  For an essential service that is becoming increasingly costly to provide, the emerging theme will be that those who can pay should pay for themselves. This shift of responsibilities toward the private sector will lead large and multinational employers, in particular, to play a potentially crucial role. 

The Forum report outlines a number of strategies for improvement that have health care implications, some direct and some indirect. If individuals have access to more adequate retirement income going forward, and have the ability to draw on that retirement income at times of need in later life, this will also assist in the provision of the health care services needed for the elderly. Among the strategies outlined are a number of challenges for employers, and it is clear that, if the strategies are achieved, improvements will occur. However, the report rightly draws attention not only to areas of success but also to some of the barriers to implementing the strategies - barriers that need to be overcome. In this article, we review the main potential actions for employers across the suggested strategies for health care.

Encouraging older workers

A key concern for employers taking a mix of actions to encourage and motivate older workers to remain in the workforce is whether this carries health consequences. Research does demonstrate that the problems of disability and absenteeism are indeed greater with age.  However, more detailed analysis indicates that in the oldest age groups, the chances of disability among those still working decline. In our article "Ageing workforces: The inevitable challenge for Europe  by Leo Bil (featured in Issue 2, 2009, of the Global Health & Benefits Perspective ), we concluded that “the majority of [older] employees can be deployed well, although a higher probability of disability should be taken into account.” The opportunities presented by encouraging older workers to stay on, therefore, seem to be real, but the health and absence management issues need to be considered and integrated into any program for success. Initiatives are also likely to be more successful where the design of the job in terms of working arrangements, environment, nature of activity and training is considered alongside the health issues.

Patient-centered health care

Within this strategy, employers are encouraged to help employees use health care services more effectively. Examples include introducing access to health care coaches or to helping with care management by creating more extensive health care records for employees. Clearly, many employers will watch with interest for the outcome of the development of early projects using electronic records and should be able to take significant advantage of these approaches when initial problems are resolved.

The question of coaching employees to make the best use of health care resources is also relevant and crucial, particularly where defined contribution approaches to health benefits are in place. One finding from Mercer’s 2009 survey of US employer health plans was that more than a fifth of all respondents say they are likely to adopt a consumer directed health plan for the first time in 2010. This would represent an approximate doubling of the proportion of employers offering this type of plan. These plans typically lead to cost savings of more than 20 percent per employee (see "Managing health benefits in challenging times: a Mercer survey on recession and reform."Health & Benefits Perspective, July 2009). Efforts to give more responsibility to the individual employee to save money will be more successful if coupled with initiatives such as coaching. This can also be linked with other initiatives to improve health literacy and could reform the way in which advice is given. In this sense, there is a strong parallel with the strategy noted in the Forum report to encourage provision of financial education. We would argue that the development of health literacy is as important as financial education and that it faces some of the same barriers and potential stakeholder actions for improvement. 

Individuals’ understanding around health care must also extend from specifics about their personal situations and current interventions to information about longer-term health issues. This leads us directly into strategies to promote wellness.

Promoting wellness

In most countries, promoting the concept of encouraging and helping individuals to lead a healthier life is now gathering steam. Providing practical incentives to enable employees to adopt more healthful diets and increase their exercise might well be a base on which more innovative solutions to wellness can be built. It has been noted that even simple interventions like rearranging the presentation of different foods in a cafeteria can influence behaviors.

One action proposed is to ensure that better support is given to employees with specific chronic diseases. Such initiatives can undoubtedly help and, arguably, may reduce costs. Associated with this is a further specific option worth exploring, namely work-site clinics.

Onsite health facilities

In another article in 2009 (see "Worksite clinics: An old concept gets a new lease in the battle to control health care cost and improve workforce productivity" by Bruce Hochstadt, MD, Linda Havlin, Beth Umland and David Keyt, Health & Benefits Perspective, April 2009 ), we identified work-site clinics as “an old concept worth giving a new lease of life” to control health care costs and improve workforce productivity. Although not appropriate for every geography, onsite services have developed considerably, and a recent survey demonstrates significant shifts in the use of onsite facilities toward:

• Managing chronic illnesses
• Expanding health and productivity programs
• Managing workplace injuries

The following exhibit illustrates the evolution of onsite health management:

Where an employer can implement this type of facility – and bear in mind that “where” can now perhaps encompass the concept of a virtual onsite clinic – this is a practical initiative worthy of consideration. It offers support not only for strategies to promote wellness but also supports moves toward more patient-centered systems and the improvement of health literacy. In light of our theme of the demographic problems presented by aging, this type of vehicle might well  extend into specific areas of support for older workers and enable a path toward presenting helpful information and guidance to employees as they move into retirement and out of the workforce.

Investigate offshore opportunities

Multinational employers are likely to be at the forefront of the exploration of medical tourism and will build up direct experience of employee attitudes toward initiatives in this area. Significant advantages may also accrue to large multinational companies in relation to two other crucial areas:

1. In terms of health care costs, a significant proportion is always concentrated within a small number of very expensive cases. Identifying the best ways of dealing with these will always be of benefit.
   
2. One group that is crucial to the success of a multinational company is expatriate employees. Companies rightly spend considerable time on reviewing the conditions and benefits for such staff, smoothing out difficulties and keeping them and their families highly motivated. It is already a very natural extension to ensure the best and most effective delivery of health care services to the expatriate community.

Improve health care supplier incentives

The need and justification for employers to act to get effective value on health care contracts, where they have an interest in the cost being borne by them and/or their workforce, are very clear. In practice, employers may well find that this particular area is the most important and also one of the fastest to change in the coming years. Pay-for-performance programs coupled with developing preferred provider networks and more questioning employees can become a powerful force. This demonstrates the importance of both collaboration among employers and various service providers, as well as the significance of progress being made concurrently on multiple strategies going forward.

Innovation and collaboration are key

We started with some comments on the Forum’s first report, which led to a somewhat gloomy conclusion. While many employers will be forced to engage more with health care costs, some multinational companies are already engaging constructively. We hope that the challenge put forward by the Forum’s report also inspires governments and others to act and innovate, although we recognize that in many emerging countries, capabilities will need to be developed further in order to achieve these goals. Within such an environment, we are sure many employers will collaborate and be players in offering improvements. It is also clear that the strategies in the Forum report need to be interpreted and reinterpreted within different country situations and that there are undoubtedly synergies between the different strategies offered for both health care and retirement improvements. Employers need to be aware that the concerted and considered adoption of these strategies will lead to the best outcome and best use of money.