Author: Jorge D. Sterner

Corporate health screenings are a growing trend for companies seeking ways to reduce expenditures and provide a better quality of health for employees. By encouraging and maintaining the wellness of workers, the possibility of preventing potential health problems increases, which can result in lowering medicals costs associated with treating a condition in its advanced stage. Implementing preventive health care programs that include regular health screenings, immunizations and education is the first line of defense against health problems and rising health expenditures for businesses.

Chronic illnesses and health conditions can decrease employee productivity and increase absenteeism and presenteeism, which greatly impacts a company’s bottom line. In fact, The Human Resources Policy Association puts the annual cost of reduced productivity for businesses between $87 and $127 billion. Diabetes, high blood pressure, heart disease, high cholesterol and complications from obesity are listed by The Center for Disease Control as illnesses most commonly uncovered during health screenings. If undetected and left untreated, problems resulting from these conditions can disrupt every aspect of an employee’s life, including productivity in the workplace.

“Preventive health care is an efficient and effective method of identifying and treating possible health conditions before they have the opportunity to develop or worsen,” says Dr. Jeffrey Greiff, founder of Flu Busters, a third-party provider of on-site preventive health care for businesses. “When a potential health condition is diagnosed in its early stages, it can be easily remedied and can prevent more serious conditions, resulting in a much healthier patient over time.”

An Employer Health Benefits Survey found from 2002 to 2007, health insurance premiums for businesses increased approximately five times faster than inflation and four times faster than wage growth. As health insurance premiums continue to increase throughout the 2008 – 2009 fiscal year, analysts believe health care costs are a threat to the financial success of American businesses. Businesses are discovering the economic benefits of preventing and identifying employee health problems before they become serious ailments by offering annual on-site health screenings that improve and protect employees’ current and future state of health.

A common deterrent for employees against receiving health screenings and immunization by a primary care physician is that the medical services can interrupt an employee’s busy day resulting in wasted time and energy. Third-party health care providers are gaining popularity in the business world due to their ability to provide on-site services to companies of any size. So, how does it work?

Health screenings are available to companies of all sizes and can be provided on-site by a team of experienced health professionals. Prior to a health screening, information sheets are provided to make recommendations on what screenings would be most beneficial for an employee based on individual circumstances, such as, age, sex and family history. The actual screening takes only minutes and employees receive most screening results within minutes of the actual screening. A post-screening consultation with a registered health professional, as well as an online customized wellness program is offered to address any existing or potential health issues that may have been uncovered in the screening. From the initial screening to the post-screening consultation phase, the screening participants are actively assisted in developing solutions that will enable them to lead healthier, more productive and fulfilling lives.

Even through economic hardships, businesses can still provide employees with quality health care by focusing on prevention. Routine health screenings and immunizations can identify and prevent illnesses, resulting in healthier employees, lower insurance premiums, increased productivity and decreased absenteeism. Businesses that establish a comprehensive wellness plan are investing in their employees, and ultimately, the company’s success.

There is much debate about the type of insurance proposals that will be required in the new health system currently being negotiated in Congress. President Obama has just come out in support of a public health plan, which is opposed by private insurers who say that they could not compete with a public health plan that didn’t have to make a profit. Supporters of the public plan proposal correctly say that it would give people more choices and create more competition. Opponents argue that private health plans would go out of business, leaving only an entirely government-run health care system.

Of course all sides are exaggerating and taking up extreme positions. They will all in time compromise and hopefully reach some form of agreement. The sad part is that at present they don’t seem to be thinking of the person at the center of all this – the patient. It is widely acknowledged that health care costs far too much in this country, while at the same time at least 47 million Americans are uninsured. So, from a patients perspective, if you do have health insurance, you are paying way too much for it, and getting poor value, and if you don’t have it, then you just continue to suffer. What a dreadful choice. What an indictment of America.

The goals of overhauling the health care system are to lower costs and extend care to the uninsured. Obama wants a bill on his desk in October at the latest. Where can Congress begin to compromise, and why is it that Republicans in particular, believe that public health plans are likely to be so dreadful. What is the evidence for this belief beyond their own philosophical ideas. They regularly bring up the supposed ogre of “socialized medicine” whenever public plans are discussed, but there is no evidence whatsoever that countries with more federal control over their health systems, especially in Europe, have worse health outcomes that the USA. In fact the contrary is true, health outcomes are much better overall, and cost a lot less money per capita of population.

As a physician who has lived and worked in the USA, Australia and Britain, and who has an interest in how health services are organized, I think America could move forward in a relatively simple way as long as we always keep the patient at the center of any health system we plan. It is essential that we do not design a health system primarily to protect profit levels for some or all of the various constituents, whether they be providers, health insurers or pharmaceutical companies. We have the opportunity of picking the best parts of other health systems from around the world and including these in the eventual plan to reform American health care, and we should learn from other countries.

What should we do?

Firstly we need a public-private partnership philosophy. Australia is a good example where this works excellently. That means public and private, not just private. American core business and social philosophies are based on capitalist principals so any new approach to health care must combine the need for profits in certain sectors of the health system, with the need to develop a number of core public health services that may be less likely to ever achieve a profit. Funding for care has to involve choice and should be provided in many instances through payment for annual or episodic whole of person care, rather than on individual piece rates as at present. These capitated payment systems work well for Kaiser Permanente, and in Britain. The primary gain from this approach is that it tends to force more resources into the prevention of illness and wellness promotion, rather than into the treatment of illnesses that have already commenced.

The public component of the health care system, seemingly strongly supported by President Obama, would include universal basic health insurance as well as catastrophic care insurance. We know that this type of system works well in America and is widely accepted and popular, because we have the very successful example of Medicare for seniors. Effectively broadening the base of Medicare for other populations would prevent many of the bankruptcies caused by healthcare costs, and would cover many of the current uninsured. Public insurance would then be likely to pay for many emergency and geographically isolated health services, as well as public health services, pre and postnatal and early child care as well as care of some special populations who cannot afford private health insurance such as the unemployed, and certain impoverished or geographically isolated groups. Medicare for seniors would of course continue. These are areas where there will be less competition from private insurers who have typically kept away from them, but of course any private health insurers would be able to enter these markets and compete if they wished.

The private component would be funded with the aid of broader tax incentives or similar financial tools to encourage most people (or companies) to take out private insurance. The aim should be that at least 80-90% of the population should have private insurance, whether it be comprehensive insurance, or top-up insurance to support core government provided insurance. It is important to reach this level of insurance to ensure that we all are financially responsible for at least a reasonable proportion of our health care costs. Here the Republicans are right as it is important that we do not see health care as something that is provided for free. The private sector should offer a full range of services from birth to death, but the industry should be more carefully regulated so that they would, for instance, be prevented from excluding patients on the grounds of pre-existing conditions. They should also have the ability to charge extra for certain “non-essential” services such as cosmetic surgery.

These ideas are taken from what I consider to be the best parts of the American, Australian and British health systems. No country has a perfect health system, and no country ever will. America can afford to choose the best from other countries as it debates how to improve its health care system. Lets hope that Congress can be creative, look outwardly, and not get bogged down in political dogma.

All Americans should have the right to save for current and future healthcare expenses with pre-tax dollars. Health Savings Accounts provide some Americans with precisely that opportunity, but it is too limited in its scope to benefit the majority of the US. I love the concept of Health Savings Accounts (HSA), if you’re not familiar with them they are savings accounts in which money can be put away for future medical expenses on a pre-tax basis. In order to be eligible for an HSA you must be covered under a qualifying high deductible health insurance plan (HDHP). These are health insurance policies that typically cost less because they require their holders pay a high deductible (typically greater than $1000 annually). Unfortunately, the eligibility requirement to participate in a health savings account precludes the majority of the population from receiving a privilege that should be as basic as saving for one’s own retirement.

In a recent response from my Congressman, he suggested I consider using a sister product, the Flexible Spending Account (FSA). Although beneficial, the benefits of an FSA fall short of the benefits in an HSA; primarily because the balance of unused money in an FSA expires annually where an HSA rolls over from year to year. This is a monumental difference. With an HSA I have a means to cover current and future medical expenses which can accumulate to a retirement vehicle which becomes available for any purpose at age 65.  The rollover benefit becomes an even greater benefit when you consider the funds in Health Savings Account are eligible to pay the premiums on Cobra. Contributing to an HSA provides financial resources to use should one lose their job. Americans can use their HSA to pay the necessary 102% of their health premiums through COBRA or they may roll the money into a less expensive high deductible health plan (HDHP) with the resources to meet the high deductible.

Let’s look at a couple of case studies.

Dick and Jane

Dick and Jane are engaged. Jane has been submitting $2600 into and HSA for the past five years. During that time she has only consumed $1600 in health care costs that means Jane has been able to build up a health nest egg of $11,400. After they are married Dick begins carrying Jane as a dependent on his health care plan which does not qualify as a high deductible health care plan. Under current laws, Jane would be forced to discontinue contributing to her HSA, but it if all Americans were eligible for this savings incentive she wouldn’t have that problem. Instead they could increase their contribution $5,150. After a year, Dick may lose his job, but the family has been able to save $16,550. Their healthcare nest egg provides Dick and Jane with additional options. They may select to continue their current coverage through COBRA or they can select an alternate health care option. If COBRA were to cost $400 a month they can utilize their HSA funds. With these funds they would have the means of paying for coverage for 41 months. They could also choose to purchase independent health coverage. Their $16,550 nest egg minimizes their risk on a high deductible healthcare plan. They could conceivable absorb a $10,000 deductible and reduce their monthly payment to about $200, or half the cost of their cobra payment.

Scott and Laura

In the scenario of Scott and Laura, Scott is a severe asthmatic. His condition leads to a hospital stay about once a year costing about $3000. He must also have continuing medication at a monthly cost of $112. Scott and Laura are both on her employer’s group health plan. They pay $112/month with a $500 deductible and a 20% coinsurance. Their annual healthcare responsibility is approximately $2610 with insurance or approximately $4340 without insurance. Their insurance saves them approximately $1700 annually from paying full price on their medical care. Their FSA saves them about 20% (their tax bracket) on their prescription charges. Because Scott and Laura will lose the money in the FSA if they don’t spend it by the end of the year, they only save the cost of Scott’s prescriptions. Now, if Laura loses her job their healthcare future becomes much less secure because Laura’s plan was not HSA eligible, they do not any residual savings from their health care expenses nor were they granted guaranteed tax savings from their medical expenses. If they keep the medical insurance they clearly need through COBRA they now need to pay $400/month. These annual premiums total $4000 alone meaning that Scott and Laura only save about $340 a year by having health insurance. This does not include the cost of any of the co pays. Keeping the insurance could increase their medical expenses to about $6000 a year or $550/month at a time when the family income has been reduced. Scott and Laura have a very difficult choice to make in regards to their healthcare. Should they continue with coverage or should they let the family health insurance lapse?

Had they been able to contribute to an HSA, their scenario may have looked a little different. Scott and Laura would still have the same policy but chose to contribute the maximum allowable to their HSA. From the $5150 they withdrew $2610 for healthcare expenses leaving $2540 to accumulate over for the next year. Over the course of 5 years they have accumulated $12700 in the HSA. If Laura loses her job their options look much more promising. They can more easily absorb costs of COBRA and provide for the costs of their existing coverage for their entire 18 month term of eligibility. By making wise decisions in time of plenty, Scott and Laura would be able to prevent financial devastation or public dependence in the future and still provide the means to maintain their health needs. All health consumers should have the option to participate in an HSA and receive the corresponding tax benefits. The opportunity to participate in an HSA should not be tied to a high deductible health insurance plan. As it is written an HDHP with an HSA discriminates against most Americans, namely, consumers whose employers don’t offer a qualified high deductible healthcare plan and those who may have regular health needs which require a more generous health plan including young families who may need maternity or well child care.

Ironically, those ineligible to participate are doubly discriminated against. Not only do they lose the opportunity to financially prepare for the future healthcare needs, but it actually results in having higher healthcare costs. Here’s how:

1. High deductible health care plans often attract the healthiest segment of society, and when you remove the healthy consumers from the general insurance pool, rates rise to cover the lost revenue and higher payout per consumer.

2. Non participants must pay deductibles and uncovered health care from post tax dollars or they must try to forecast their annual health expenses through a flexible spending account (FSA). If they underestimate, they are again paying for expenses with post-tax dollars and if they overestimate they lose the unspent balance.

3. Individuals who have continuing healthcare needs are at the mercy of their employer for continued coverage. The loss of employment often means the loss of health care and can bring great personal risk and financial hardship.

By eliminating the requirement that an individual have a HDHP plan, you open the door for many more participants. These are people who need to hedge against risk in their health and financial well-being. When you allow people to pay their insurance premiums with their HSA, you grant them a means of planning for their health future, without discriminating based on their health care needs. Nationally, you increase the savings rate, sending more money into banks, and driving down your uninsured among the unemployed. Fewer people are dependent on government healthcare subsidies because they were able to plan during times of plenty. You open a door for increased retirement savings and, by giving people access to their funds when healthcare is needed, you limit some of the draw on government resources because they don’t end up on state sponsored plans.