Funding health expenses is not the same as providing health benefits.
Unfortunately many people in the business of processing claims or selling insurance do not see the distinction. When large employers do an analysis of their "health" benefits spend and try to equate expenditures to health outcomes there is disappointment.
This should not be a surprise.
First, the metrics for measuring health outcomes are either non-existent or vague at best.
Secondly, even if metrics exist, base line data is usually not available.
Third, and the most important issue is that favourable outcomes to an organization have no bearing to what an individual employee perceives as good health.
Most employer "health" initiatives are cost containment strategies. They focus on averaging down the average cost of a claim. This metric usually has no bearing on improving the health of the employee.it is focused on maintaining the same level of health for a "sick" individual but at a less expensive cost.
While short term financial gains may be realized by focusing on the few individuals who meet the employer's definition of "sick", long terms gains to improving employee health will not result using the current "benefits" model.
Three important philosophical changes are required for employers to impact on their employee's health via the benefits program.
First is the admission that vast majority of employer funded benefits are financial benefits, not health benefits. Providing tax effective compensation to fund health care costs are important but they are not health interventions.
Ironically funding poor health may make it easier for employees to delay behaviour changes that will improve their health simply because the financial consequences of poor behaviour are absorbed by employers and not employees.
The second is that restricting financial assistance to health conditions defined by the employer as important is paternalistic and probably counter-productive. We know the 80% of the claims costs are incurred by less than 20% of the population. Does this suggest that 80% of the population is healthy and does not deserve employer support to improve their health?
The third is the industry's focus on supporting sick employees to be sick at a cheaper price. The industry needs to evolve to providing a benefit program that encourages all employees (both those currently suffering from a chronic condition and the majority of employees who are not claiming or absent from work) to maintain or improve their health before the consequences of poor habits decrease the quality of their lives.
The only real solution to prevent or treat chronic disease is to make sustainable lifestyle change. In fact, if we exercise more, eat better, don't smoke and drink moderately (or not at all) we can prevent;
- 90% of type II diabetes,
- 80% of cardiovascular disease,
- 70% of stroke and colon cancer
- 40% of other cancers.
If it's that simple, why are we not doing it? Well that's simple too - Change is hard!
Perhaps providing a corporate culture that supports healthy living is the closest employers will come to providing "health benefits".