The world of healthcare benefits is evolving. The introduction of new and often expensive treatments presents a growing challenge to employers who want to provide modern healthcare benefits to their staff but in an affordable and compliant way.
Healthcare has moved on. Medical and technological advances mean that we’re living for longer but many more of us will live with chronic conditions than ever before. And as a result, increasing numbers of employers are reporting demands for treatments beyond those traditionally included within their corporate medical schemes.
A good example here is what is often referred to as the ‘Angelina Jolie effect’. When the Hollywood star revealed that she had undergone a Prophylactic mastectomy to reduce her risk of developing Breast Cancer, genetic testing facilities revealed that demand for BRCA1/2 testing had almost doubled and there were also many more enquiries for the risk reducing mastectomy. But, should it fall to the employer to cover the cost of such treatment?
And what about gender dysphoria? Once a taboo subject, recent high profile transgender figures have increased public awareness of gender identity issues. Diversity & inclusion teams within businesses are having to consider such areas.
Modern medicine provides us with greater choice and the ability to take control over our healthcare. For many organisations, providing corporate medical schemes is an essential part of their overall benefits and remuneration strategy and is critical to keeping their workforce fit and active. But what happens when an employee wants access to treatments that aren’t covered in their policies? In many cases, the insurer will refuse to cover them.
I believe that insurers need to offer a wider solution than simply just saying ‘no’. There will always be treatments – be they preventative, provided in extremely expensive facilities or excluded from the policy – that members will want to have access to. I feel insurers should look at these situations more creatively rather than saying they are ‘excluded’. Instead they need to help members with advice on possible care pathways. Insurers should also be able to offer a self-pay facility if the benefit is not covered by insurance.
In a world where we are increasingly able to push the boundaries of medical care maybe we should see a three pillar healthcare solution:
1. An NHS facility paid for through taxation and available to all – subject to NHS guidelines
2. A private sector providing access to acute illness and injury care to help you get better at a private facility and consultant of your choice
3. A personal pay sector where care not funded by the NHS or medical insurance policies is easily accessible, regulated and outcomes are measured.
With organisations increasingly moving towards a health trust solution and able to amend the rules of policies to include benefits not historically insured – chronic care and preventative surgery as examples – insurers and administrators should look at the self-pay sector as an increasingly important area where they can really support those with complex health needs.
Soraya Chamberlain is director of corporate healthcare & wellbeing at Punter Southall Health & Protection