Health insurance coverage and employee health outcomes

Health insurance coverage and health outcomes article

We often hear people in the healthcare sector talk about ‘health outcomes’, but what does it really mean? According to World Health Organization, an outcome is “a change in the health status of an individual, group or population which is attributable to a planned intervention or series of interventions, regardless of whether such an intervention was intended to change health status.” In other words, a health outcome can be described as the efficacy of interventions (healthcare or health insurance coverage, for example) in improving the health status of patients, employees, or the society at large.

As populations continue to age, and Non Communicable Diseases (NCDs) continue to rise at alarming rates, a growing proportion of the world’s population are experiencing a decline in their health status. As such, it’s become more important than ever for governments, key decision makers, health care providers, insurers, and employers to focus on improving the health status of patients, employees, and populations. To shed some light on the issue, today’s article looks at the relationship between health insurance coverage and employee health outcomes.

health outcomes and health insurance coverage article

Health-related quality of life

Before we look at the relationship between health insurance coverage and health outcomes, we’d first like to address how outcomes are usually measured. While there exists many variations of definitions for the term health outcomes, one primary aspect that almost all concepts focus on are the central measures or indicators used to measure the health status of patients.

One such indicator is health-related quality of life, which is a multidimensional concept that encompasses domains related to physical, mental, emotional, and social functioning. Put differently, it refers to how physically, mentally, emotionally, and socially healthy people feel when they are alive. An oft-used measurement of health-related quality of life is “healthy days”, which is generated by asking people about the number of physically or mentally unhealthy days they experience per month.

Healthcare costs and health outcomes

In the past 20 years, consumer price inflation (CPI) has grown at an average rate of about 2.2 percent, whereas the price level of medical care has grown at an average rate of 3.6 percent – that’s about 70 percent faster. Explanations are not hard to find. In our International Private Medical Insurance Inflation – 2017 report, we looked at the main forces behind hiking healthcare costs and, subsequently, health insurance costs: new medical technology, an imbalance of health resources, increased compensation for medical professionals, and healthcare overutilization.

As healthcare spending continues to exceed economic growth at an unsustainable level, more and more people are finding it increasingly hard to afford and access quality care. Demographic changes such as ageing populations, and the growing incidence of NCDs, are further exacerbating the healthcare ‘cost crisis’. Some commentators believe the challenge of delivering better health outcomes with lower overall costs can be attributed to ineffective cost measurement processes, leaving better value care out of reach for both providers and patients.

If healthcare costs are better controlled, people (in theory) have a greater ability to access the care they need to live healthier lives. For instance, patients can undergo more frequent screenings and health check-ups to ensure early detection of cancer, diabetes, and other serious conditions. This can help ensure that less costly and complex care is needed in the long run, and can also limit health deterioration.

The role of health insurance coverage

Health insurance is a key tool for managing financial risk and offsetting the cost of care. According to an article in the New England Journal of Medicine, there is abundant evidence that suggests having health insurance improves financial security. For example, the article cited a US-based study on the ACA’s 2014 Medicaid expansion’s links to reduced bill collection and bankruptcies, thus confirming that health insurance reduces the risk of unforeseen medical costs.

From an employee benefits perspective, the annual Employee Benefit Trends Study has long reported the importance employees place on financial security. One of the key ways businesses address this need is by offering employer-provided health insurance as part of their employee benefits package. In addition to bolstering employee financial security, there’s also a good chance that implementing the right employee health benefits leads to better workforce health outcomes, which translates to lower healthcare costs for employers in the long run.

Health insurance and access to care

According to the aforementioned New England Journal of Medicine article, several studies have shown that health insurance coverage has been linked to higher rates of patients being able to afford care, a factor which is oft-associated with better health outcomes. In fact, the CDC states that health insurance coverage provides a strong indication of a population’s access to care.

In recognizing the importance of ensuring universal access to quality care, a growing number of locations have made or are in the process of making health insurance mandatory. For example, Abu Dhabi introduced universal health insurance coverage in 2006, which led to an immediate 40 percent increase in hospital and clinic visits by people able to afford care for the very first time. A rise in the utilization of care has also been witnessed in Dubai, where employers of all sizes are now required to provide compliant health insurance coverage to employees.

Access to preventative services

The New England Journal of Medicine study further revealed that the expansion of coverage benefits increases access to preventative services, which can help patients detect health issues early on so they can better manage their health.

To mitigate rising healthcare costs, a growing number of employers are also seeing the importance of offering preventative care cover in employee benefit plans. In fact, a Willis Towers Watson study found that 39 percent of employers throughout the world now offer some form of preventative care and wellness program, and this percentage is projected to grow significantly in 2018.

Self-reported health and wellbeing

There’s also evidence to suggest that health insurance coverage improves patients’ perceptions of their health. Why is this important? According to World Health Organization, subjective physical and mental wellbeing (i.e. the notion of feeling better or feeling healthy) is one of the key goals that medical care should aim to achieve. Additionally, people who report that their health is poor have been found to have mortality rates 2 to 10 times higher than those who report being in the healthiest category.

What about mental health?

In addition to addressing physical health, the issue of mental health has also been brought into the spotlight as a key factor that is closely linked to health outcomes. In fact, as employee stress continues to rise, 61 percent of global insurers now offer coverage for mental health treatment and stress in their standard health insurance plans.

Our recent article, written in partnership with Asia Care Group, further revealed a number of key findings which show the importance of addressing employee mental health. These include:

  • Demanding jobs increase the chances of physician-diagnosed illness by 35 percent, and long working hours increase mortality by almost 20 percent.
  • Job insecurity increases the likelihood of reporting poor health by 50 percent.
  • The global cost of mental disorders is expected to reach USD 6 trillion by 2030, which primarily includes the costs and strains to the healthcare sector.

While health insurance plays a significant role in enabling access to better mental health care, employers are advised to look beyond health insurance in order to employ a more holistic approach to employee benefits which includes considerations for wellness benefits that target mental health. Examples of what employers can do to address mental health include:

  • Inviting a mental health professional to talk to employees about various mental health topics
  • Providing mental health management resources, such as online counselling services.
  • Partnering with an employee benefits specialist like Pacific Prime, who can help devise, implement, and manage your company’s benefits and mental wellness solutions.

Looking to learn more about improving your employees’ health outcomes?

As employee benefits specialists, we’ve had almost 20 years of experience delivering employee benefits solutions to companies of all sizes and industries. Holding the unique ability to devise, implement, and manage the most optimal plans that improve employee health outcomes, while also ensuring that they remain sustainable and cost-effective year-on-year, it’s no wonder why we are the broker of choice for over 3,000 corporate clients.

What’s more, we’re an insurance intermediary, which means we are not beholden to any one insurance provider. As such, we work for you, and not the insurer, so you can rest assured that we’ll find you the best plan for your employee’s needs. To learn more about how Pacific Prime can help your company, contact us today! Our corporate team are standing by to offer their impartial advice, as well as give you a no-obligation, free quote.

Out of the shadows: Making mental health a priority for Hong Kong employers

mental health article

Mental health issues are pervasive across the world, in virtually every population; affecting all of us either directly or indirectly. Hong Kong, with its frenetic and competitive work culture, is no stranger to this phenomenon. In fact, it has been estimated that about 32 percent of employees in 2016 were classed as having unsatisfactory mental health – up from 29 percent in 2015.

A 2014 survey commissioned by the Mental Health Association (MHA) further found that a whopping 60 percent of Hong Kongers report job-related stress and anxiety. Despite these alarming figures, there still remains widespread social stigma towards those battling with mental illness, leading many in the city to suffer in silence.

To that end, this article by Pacific Prime and healthcare advisory firm Asia Care Group looks at the state of mental health and illness in Hong Kong, its implications for employers, and what companies can do to address the issue of mental wellbeing and health in the workplace.

mental health article image

State of mental health in Hong Kong

Talking about and addressing mental health in Hong Kong is something many don’t do, or refuse to acknowledge. Candace Albert from the Asia Care Group further explained, “Fear drives discrimination and myth, and prevents people from seeking care. Encouraging an open dialogue on these subjects and increasing the level of mental health literacy among the general public are established strategies to drive change. At a societal level, increased openness about mental health will reduce stigma, promote earlier identification of common mental disorders, and enhance the likelihood that individuals explore health resources”.

This stigma has only recently started to be addressed by the government, who conducted their first-ever territory wide survey of mental illness in 2010. The report’s final study findings, which were published in a peer-reviewed journal in 2015, found that the prevalence of common mental disorders among adults aged 16 to 75 was 13.3 percent.

Given these findings, Dr. Chan Chung-mau, Chairman of the Hong Kong Association for the Promotion of Mental Health, wrote in his EJInsight article that it is possible that well over one million people in Hong Kong are in need of some form of mental healthcare. Healthcare, which in many cases, is under-supported.

Mental illness support: How Hong Kong compares with other Asia-Pacific countries

In addition to the above mentioned findings, a 2016 Mental Health and Integration report by The Economist Intelligence Unit gave Hong Kong an overall score of 65.8 out of 100 with regard to  their effort to integrate those suffering with mental health illness into the community.

Hong Kong’s worst performance was in the area of governance – including efforts to reduce stigma and promote human rights of mental healthcare patients, where Hong Kong is said to lack “a formal overarching mental health policy”. While the Hospital Authority’s 2010 Mental Health Service Plan helps fill the void in bringing coherence to the service provision, “coordination remains spotty”.

mental health index

Source: The Economist Intelligence Unit

For example, the Food and Health Bureau handles medical care of mental illness patients, whereas community support is managed by the Labour and Welfare Bureau. This fragmentation has led to a key support structure, trained psychiatrists, being largely understaffed.

Shortage of psychiatrists in Hong Kong

As of the time this article’s writing, the patient-psychiatrist ratio here is about 4.5 per 100,000 people, whereas the UK has 14.63 psychiatrists per 100,000 people, and Australia has 9.16 psychiatrists per 100,000 population.

The low number of psychiatrists in Hong Kong hurts access to mental healthcare services. This is especially true in the public sector, where people wait as long as 166 weeks for an initial visit. This, coupled with short appointment times of around 5 to 10 minutes per patient, and hiking demand for mental healthcare services, all point to the fact that it is getting harder for public sector doctors to invest their time into treating and supporting patients and their families.

In November 2016, this pressing situation led the government to announce their intentions of further extending their public-private partnership model, which has been in place in general outpatient clinics to handle “suitable and stable” follow-up patients in order to relieve the overburdened public system. As the private sector currently handles about 10 percent of psychiatric patients in Hong Kong, many see the potential in private doctors taking up more patients.

The issue of stigma and mental illness in Hong Kong

Another important issue to address here is the pervasive stigma that still surrounds those with mental illness conditions in Hong Kong and much of Asia. As this issue is multi-faceted, it can be very complex.

To reduce this stigma, in 2010 the Hong Kong government invested HKD 135 million into setting up a community network for people suffering from mental illness. A number of public programs were organized to promote mental well being and foster a greater understanding of mental illness.

On the success of these programs, Candace Albert commented, “The investment initiative to expand the Integrated Community Centres for Mental Wellness is a positive first step. The programs can be enhanced over time by clearly defined referral pathways, both with the existing Hospital Authority services for current and ex- mentally ill patients, and with primary care. The value of community-based programs is strengthened when they operate alongside other services, in an integrated health system.”

Why employers should address the mental health of their employees

The issue of mental health can be a touchy subject that many employers might not be willing to address openly. After all, many hold the widespread opinion that an employer has no business getting involved with their employees’ mental state in the first place. That being said, while employees have every right to maintain their privacy about personal / sensitive issues, it doesn’t mean that companies should completely ignore their employees’ psychological wellbeing.

The reason is clear: an employee’s mental state, if poor and left unaddressed, will likely permeate into the workplace. In fact, its impact is wide-reaching and can be detrimental not only to the employee, but also the employer and society at large. A 2017 Deloitte UK report, titled: At a tipping point? Workplace mental health and wellbeing, delved into this point further and discussed the following key findings:

  • Impact on employees: 85 percent of employees reported symptoms of poor mental health attributed to work-related stress. Demanding jobs increase the chances of physician-diagnosed illness by 35 percent, and long work hours increase mortality by nearly 20 percent.
  • Impact on employers: Poor employee mental wellbeing also results in loss of productivity. The report found that job insecurity increases the odds of reporting poor health by about 50 percent. Absence, however, is not the only cost. Other costs to the business include presenteeism (the loss in productivity from working at less than full capacity), and turnover.
  • Impact on society: Poor mental wellbeing is also costly to society. According to the WHO, the global cost of mental disorders is expected to reach USD 6 trillion by 2030. This primarily includes the costs and strains to the public healthcare sector. In Hong Kong, for example, demand for psychiatric care has grown from 39,770 cases in 2009/2010 to 47,958 cases in 2014/2015, thus leading to an increasingly overburdened public system.

In addition to the above, the University of Hong Kong found in their new study of mental health conditions in the workplace that 90 percent of respondents (both employees and managers) said they needed better support at work. What’s more, 60 percent of respondents believe that mental health issues in the workplace play a large role in pushing away talented staff. “With productivity losses in workplace settings being as high as they are, there’s a strong business case for reducing mental health stigma. Forward-thinking employers stand to benefit by investing in employee mental wellness initiatives because these programs result in reduced staff turnover, lower sick leave, and better employee performance.”, said Candace Albert.

What employers can do to address employee mental health

By addressing and opening up discussion about mental wellbeing in the workplace, employers can offer the support and tools employees need without intruding on their privacy; not to mention create a more positive and productive work environment overall. Here, we’ve included several key ways to address employees’ mental wellbeing and health in the workplace:

Educate your staff

Given the prevalence of mental health issues in Hong Kong, chances are a significant proportion of your staff are already struggling with a problem. A general lack of awareness and pervasive stigma at the workplace, however, can mean that many employees are not willing to acknowledge their problem, or are confused about how they want to deal with it.

To add to this confusion, “mental health” is a broad term that not only refers to disorders and illnesses like schizophrenia or bipolar disorder, but also a construct similar to physical health. What this means is that, similar to how we take care of our physical wellbeing by eating well and exercising regularly, mental health is not only about treating mental illness, but also about taking care of our bodies, getting enough sleep, stimulating our brain, and managing our emotions.

As part of your employee wellness strategy, one solution is to bring in a qualified mental health professional to educate your employees about the wide range of mental health topics. Topic examples include:

  • Spotting signs and symptoms
  • Supporting colleagues
  • Coping with, reducing, and preventing stress
  • Getting quality sleep
  • Building and enhancing emotional resilience
  • And more

The key is to encourage open discussion that allows employees to feel comfortable and ask questions, so that stigma at your workplace will begin to fade. “It’s not enough just to hang up posters with a helpline or website to encourage people to get help,” Candace Albert commented. “We need to encourage people to think and talk about the issue in a workplace setting, such as through educational sessions and workshops. Many employees are afraid to seek help early on, but the majority of common mental disorders can be treated. With appropriate support, individuals can remain productive and efficient members of the workforce.”

Provide a range of mental health management resources

While putting mental health professionals on site can be very beneficial to your staff, some employees could feel too anxious or embarrassed to talk or open up about their issues. Offering additional resources like telehealth (e.g. online counselling services) can, therefore, be a good way to further support employees. By offering these extra resources, not only are more mental health treatment and/or management options available, but they also enable employees to feel more comfortable in reaching out to get the help they need.

Partner with an employee benefits and wellness specialist

From the above, it is clear that there are many advantages to supporting and addressing mental health in the workplace. With that said, there’s no such thing as a one-size-fits-all mental wellness benefits approach, which is why it can be beneficial to partner with an expert like Pacific Prime, who has the skills and experience to identify, devise, implement, and manage your company’s benefits and mental wellness solutions.

We’re also experts in all things insurance, and are able to deliver employee health insurance solutions that includes considerations for mental health. By offering these extra mental health support benefits, employers can ensure that their valued employees are both physically and mentally healthy, and are never left feeling like they don’t have the support they need.

Do you have any more questions? Contact our team today to get the answers to all your questions, as well as a no-obligation free quote.

About Asia Care Group

Asia Care Group Limited is a boutique healthcare advisory firm that focuses on major strategic change projects in the Asia-Pacific region. ACG works across the industry spectrum, with Governments, Public and Private Providers, Health Insurers and Development Organisations in pursuit of more effective and efficient healthcare systems.

About Candace Albert

Candace Albert is a Managing Consultant with ACG, based in Hong Kong. She holds a BA in Public Health Studies from Johns Hopkins University and a dual MPH and MSc in Sustainable Health Systems. She has spent several years working in the areas of chronic disease, health systems strengthening, and strategic planning at previous posts with the Department of Health (US), OECD (Paris), and the Johns Hopkins School of Medicine.

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mouth

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health insurance
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angelina jolie

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kate middleton

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Kim Kardashian

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Downton Abbey


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lungs

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