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Healthcare
Wednesday, July 1, 2009
Wellness booster

Corporate wellness and disease management are terms frequently used by employer and medical schemes. It purports to seek to improve the financial, mental, social and physical wellbeing of the employee, whilst medical schemes seek to intervene proactively to address and contain risk factors of lifestyle diseases such as cholesterol, hypertension and diabetes.

“There are well-documented cases, both in South Africa and internationally, that demonstrate the positive impact of corporate health and wellness programmes in reducing the risk factors and consequences of lifestyle diseases,” says Dr James Arens, Clinical Operations Executive at Pro Sano Medical Scheme.
“It is clear that there is room for co-operation between companies and medical schemes, particularly since some employers have a large number of workers who belong to the same medical scheme. A great deal of desire has been expressed for a need for meaningful partnerships between corporate and medical schemes. However the results, both in terms of the extent of engagement of the parties, and the outcomes of current engagement, have been less than inspiring,” he comments.
The following may be some of the reasons hampering a successful partnership:
1. Mal-aligned objectives. Organisations are governed by the Occupational Health and Safety Act 1983, which states that “Every employer shall provide and maintain, as far as is reasonably practicable, a working environment that is safe and without risk to the health of his employees”. This compels the employer to create an environment safe from physical, chemical and other external harm, but places no obligation on the employer to intervene in the prevention of lifestyle diseases. On the other hand, medical schemes are governed by the Medical Schemes Act 1998, which outlines that a medical scheme must make provision for the obtaining of any relevant health service and, where applicable, of rendering the relevant health service, in addition to being a health insurance. Organisations, therefore, may hope to benefit from schemes’ disease-management programmes to contain levels of absenteeism, while medical schemes hope to latch onto the organisations’ infrastructures to execute their disease-management programmes.
2. Unequal partnerships. Organisations may dictate how they envisage medical schemes’ involvement in corporate wellness programmes, which may even be linked to whether a scheme will be retained as the medical scheme of choice. This may lead to schemes feeling coerced into programmes they do not co-own.
3. Who pays for the programmes? Corporate health and wellness programmes, when implemented properly, can be costly. A typical example is Wellness Days that companies host with their associated health-promotion programmes, such as health education, basic examinations, blood tests and flu vaccinations. Organisations may demand that schemes pay the cost of such activities whether or not these are part of the scheme’s benefit structure. Schemes often feel obliged to participate as some aspects of the programmes are related to their disease-management programmes.
4. Lack of information sharing. Employee confidentially needs to be maintained at all times during such partnerships. The opportunity to identify and act on individual cases is often lost under circumstances of confidentiality, as relevant information cannot be transferred to the scheme disease management unit without the employee returning for the results and consenting to the transfer of information. This prohibits the scheme from proactively contacting employees and registering them on the programmes.

So what’s the solution?

“The state sector will benefit enormously from successful corporate health and wellness outcomes as not all employees belong to medical schemes,” says Arens. “Government needs to overtly encourage corporate wellness efforts and partnerships to an extent that good performance and healthy lifestyle choices are incentivised. Unions are also well placed to be the custodians of corporate health and wellness programmes.”
The Medical Research Council report on the Burden of Disease in South Africa suggests that out of the 17 risk factors, unsafe sex, interpersonal violence, alcohol, tobacco smoking and excess body weight are the top five factors adding to the disease burden in this country, with high blood pressure, diabetes and high cholesterol coming in at numbers eight to ten.
“It is therefore imperative that corporate wellness activities be structured and coordinated so that national priorities can be adequately addressed,” he says.
 

Copyright © Insurance Times and Investments® Vol:22.7 1st July, 2009
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