Global cover that counts - Aetna supplement part 2

15 November 2011

In mature health insurance markets, health cover has become the most important employee benefit, say Aetna managers.

Middle East: a holistic approach to health, wellness and productivity

The rising cost of medical care in the Middle East makes health insurance a must, but any plan has to accommodate the regulations and accessibility issues of each country, says Stuart Leatherby, Aetna's managing director for the Middle East and Africa.

Access to healthcare can be difficult and expensive in the Middle East, and costs are likely to keep rising as more sophisticated medical technologies are deployed and the incidence of chronic disease grows. Also, many countries are looking at shared accountability for health among employers, employees and governments as part of healthcare reforms. Health insurance and wellness programmes are, therefore, increasingly important to both employees and employers.

Local and international companies sending expatriates to the Middle East are expanding employee benefits schemes, particularly in the Gulf Cooperation Council (GCC) countries of Bahrain, Saudi Arabia, UAE, Kuwait, Oman and Qatar. Attractive benefits packages are a differentiator in finding and retaining top talent, as out-of-pocket expenses for the under-insured can be a huge financial burden.

"Within the GCC there are many issues we keep in mind regarding benefits solutions and services, including the fact that healthcare systems are still developing, and that there is a trend towards mandatory healthcare, as is the case for expatriates in Abu Dhabi and Saudi Arabia," says Leatherby.

"The region has an emerging economy with a generally younger population, yet healthcare spending consumes an ever-larger share of household income. High rates of out-of-pocket spending point to unmet needs.

"The region also has the highest rates of obesity outside the US, the highest incidence of diabetes, and there are ongoing issues with diagnosing and continuing medication regimes for chronic illnesses."

Legislation defining mandatory minimum levels of cover is spreading. This raises the bar on employees' expectations regarding healthcare benefit packages. Therefore, the onus is on employers to get greater value for the money spent on healthcare insurance and education for the workforce.

"Providing programmes and incentives to improve their bottom line and create a healthier workforce can be a competitive advantage," says Leatherby. "Driving employee engagement and accountability through health and wellness programmes can reduce costs."

Cost or value?

CEOs with employees in the Middle East face challenges such as maintaining productivity and reducing absenteesim and presenteeism. According to the Harvard Business Review, only 20% of companies' healthcare costs are direct, while 80% comes through lost productivity.

"Offering schemes that include health and wellness components coupled with features that provide peace of mind, such as evacuation services and high touch member services to help coordinate appropriate care, can improve productivity," says Leatherby. "Simplified and flexible plans like Aetna's International Healthcare Plan include access to wellness resources and services, which helps to achieve optimum health and productivity.

"Providing the right international healthcare scheme can help ensure successful expatriate assignments. The key considerations are maintaining stable premium pricing at a time of high medical inflationary trends. It is about access to quality care at affordable prices. This is where Aetna's active network and care management will help. Offering the right mix of medical benefits, and health and wellness programmes is a key component of a successful business strategy."

Alongside insurance cover, schemes that incorporate health and wellness resources and education can make a real difference in managing costs.

"Aetna's goal is to support companies in empowering employees to take charge of their own health and well-being - whether they are healthy, at risk of disease or injury, managing a chronic condition or experiencing a major health event," explains Leatherby. "We believe improved health leads to improved productivity, which can in turn improve an employer's bottom line."

South-East Asia: the growing importance of local knowledge

With a unique set of health risks and different standards of healthcare across the region, companies with workers in South-East Asia require healthcare benefits that are highly adaptable to local markets, writes Derek Goldberg, Aetna's managing director for Southeast Asia.

South-East Asia is home to countries that vary so much in their economic conditions and level of medical sophistication that it is a real challenge to ensure that employees working in the region have health insurance that meets their needs. This is one reason why employees value the right health benefits package so highly.

"After compensation, healthcare coverage is the first thing that candidates ask about when they decide to take a job, so it is very important at the recruiting stage, and it remains important for retention and productivity once a person is hired," says Derek Goldberg, Aetna's managing director for Southeast Asia.

"Some markets are less developed in terms of healthcare, so employees may want to travel to another country for treatment. Local healthcare plans may not cover that, so we provide portable coverage. Singapore and Bangkok, for example, are centres of medical excellence, so people often travel there from countries such as Indonesia. Our medical evacuation benefits also take on increased importance in this region due to the inconsistent availability of high-quality medical care in the locations where employees may work and live.

"With the flattening of the global economy, businesses span the water more and there are fewer that operate in just one country. So, the use of global healthcare plans is growing. This is accelerated by the rapid development of the middle class across this region due to fast economic growth.

"The challenge is to get the right plan for your objectives, weighing the benefits against the costs relative to your budget. You may want to tier your solutions so that they are more robust for those people who, for example, travel more or are based in remote locations. The goal is to spend wisely and get a good return, and it is our job to ensure that we give value for money from our policies."

Customised solutions

Whether it is insurance or wellness programmes, the customisation of healthcare solutions is especially important in a region where local standards of healthcare vary widely.

"Health and wellness programmes are included as part of our insurance policies or they can be delivered on a stand-alone basis," says Goldberg. "These programmes can be designed to ensure they are relevant for specific employee populations. With our insurance cover and our wellness programmes, we often put together a customised package of solutions to ensure that all aspects of the programme work in synergy towards achieving the employer's healthcare objectives."

There are very divergent economies, legislative frameworks, cultures and market conditions in this region, so Aetna must learn about each country one by one.

"The key is to get good local knowledge on board to help us adapt our global healthcare expertise to the local markets," explains Goldberg. "There are many health risks in this region, which has more mosquito-borne tropical diseases than other parts of the world. So, part of our task is to educate people about covering their skin and using insect repellent, along with hygiene and the importance of clean drinking water.

"Also, changes in lifestyle have led to rising figures for body mass index and, in turn, more obesity, which you might not have expected in this region. As wealth increases, so does the incidence of diabetes and heart disease.

"We are expecting demand for healthcare cover and wellness and healthcare management programmes to grow rapidly. Interest was initially driven mainly by US corporates pushing information to their Asian subsidiaries, but the interest has now moved beyond that first wave.

"The momentum is there now and all sorts of companies, local and multinational, are starting to access our programmes. CEOs recognise that people are their most important assets and that they need to invest in their health and well-being. Like a shipping company that needs to perform routine maintenance to keep its ships afloat, every company needs to take proactive steps to make sure its employees are healthy and productive."

Latin America: a different way of doing business

As well as understanding the issues around regulations and access to healthcare, global health insurance providers must understand the culture of the markets in which they operate, says Krishnan Sridharan, Aetna's managing director for the Latin America and Caribbean Region. In Latin America, providing insurance benefits is much more about personal relationships.

In Latin America and the Caribbean, economic growth is accelerating, and the region is home to a growing number of foreign companies and large home-grown multinationals. Healthcare cover is essential, but a sound policy rests on understanding how to do business in the region.

"The economies here are booming, so there is a shift in the way companies are purchasing healthcare," says Sridharan. "Local companies are expanding internationally through acquisitions, joint ventures and partnerships, so they are sending more people overseas. That is a dramatic change.

"They are looking at more ways to expand access to healthcare at a time when the cost of healthcare is rising. There is more pressure on employers to reduce the costs that are passed on to employees. The region is used to having cheaper healthcare than the US, so when they look at international cover they are price-sensitive. They want to ensure they balance the cost with the right level of cover."

As in other regions, health insurance is a competitive tool for both local companies and foreign companies with expatriate workers.

"The driver is to differentiate a company from its competitors in the battle for talent as it expands regionally or globally," explains Sridharan. "Employees are astute about the benefits offered and they clearly look at the healthcare package. At the same time, companies are concerned about the overall wellness of their staff, and the impact of absenteeism and presenteeism. The challenge for CEOs is to address these issues at a time of rising costs and provide the right balance of benefits."

Inbound and outbound

Foreign companies attracted by the region's growth opportunities are sending more expatriates and need an insurance provider that understands the market.

"The region is unique from a health insurance perspective," says Sridharan. "There is a particular way of interacting with brokers. The basis for buying healthcare is brand awareness, trust and face-to-face interaction. The right people need to see you and know you are here."

Aetna's brand reputation and its contacts in the local market enable it to offer cover specific to the demands of the individual countries within the Latin American region.

"If a company is sending an employee on an assignment in Latin America and the Caribbean, or a local company is sending someone overseas, then the benefits must cover them wherever they are," explains Sridharan. "They need to talk to the right advisors on healthcare issues. Aetna can develop benefits packages to suit a particular population in light of different trends and pain points. It has focused solutions for each region.

"In Latin America and the Caribbean, the big issue is the rising prevalence of chronic diseases, which have contributed to the rising cost of care. We are working to reverse this trend by driving employee engagement and accountability. Technology plays a big role in the region where some countries have more sophisticated technology than others. The increasing rise in online and mobile tools aids consumers in making more informed and timely healthcare decisions. Advances in regional technology also allow companies to manage insurance benefits online. In less sophisticated countries there needs to be more hand-holding."

The current challenge is to gather data to show the positive impact on productivity of a healthier, happier workforce. Sridharan recognises that CEOs and CFOs want hard numbers on how wellness programmes and healthcare insurance provide value in dollar terms, so this research is a priority.

"When a company sends employees overseas, the lack of an appropriate healthcare package is a major cause of project failure, so there needs to be more engagement from CEOs with healthcare issues in the long term," he says. "We need to get data for each individual country regarding the risks so that we can provide benefits, wellness programmes, case management and insurance cover that is appropriate.

"We are constantly developing programmes and ways to show the benefits and cost savings. We don't believe that one size fits all. Everything is tailored to a company's population, its benefit requirements and its price sensitivity."

Stuart Leatherby, Aetna’s managing director for the Middle East and Africa.
Derek Goldberg, Aetna’s managing director for Southeast Asia.
Krishnan Sridharan, Aetna’s managing director for the Latin America and Caribbean Region.