Health Plans: Wellness Goes Global

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Perks and incentives vary by culture and country.

The struggling economy is forcing many U.S. employers to review their health offerings, which is leading health insurers and population health companies to look beyond this country's borders to help offset possible losses.

Global wellness programs are an area managed care companies are viewing for expansion, but that kind of growth comes with some pitfalls, particularly cultural differences, language, and reasons for offering wellness to employees.

U.S. employers have traditionally signed up for wellness programs as a way to contain healthcare costs, but global health companies have found that other countries are not as interested in the bottom line. Without the U.S. employer-based insurance system, employers in other countries implement wellness programs as a way to stay competitive in the marketplace, increase productivity, and improve morale.

For instance, Canadian organizations view wellness programs as a way to become the place to work, Europeans seek better work force morale, and Asian and African businesses want to cut absences, according to Barry Hall, principal at Buck Consultants, an ACS company, a human resources and benefits consulting firm, in Boston.

Though the U.S. remains the hub of workplace wellness programs, Hall says many Canadian and European countries have implemented programs.

Asia and Africa prefer biometric health screenings, while Europeans like gym/fitness club member discounts.Not surprisingly, the fastest-growing wellness initiatives are technology-driven tools, such as Web portals, online programs, and personal health records. Workplace wellness competitions, driven by the popularity of TV shows like "The Biggest Loser," are also helping people get more active, lose weight, and stop smoking. Buck Consultants expects wellness competition programs to grow by more than 100% outside of North America over the next three years.

While incentives for employees who participate in wellness programs are on the rise in the United States, that trend is not happening in other parts of the world. U.S. employees like receiving money and gift cards for completing health risk appraisals and participating in workplace challenges, but a mere 17% of non-U.S. employers have created similar incentive programs, according to Buck Consultants.

The reason is that while Americans are often motivated by financial incentives, other countries find it crass. "The U.S. is just more financially focused, but I think also from a cultural perspective, it's more culturally acceptable and probably more common in the U.S. to motivate people with direct incentives," says Hall.

One obstacle any U.S. healthcare entity faces when it goes global is dealing with different cultures. Aetna Global Benefits, the international business of Aetna, Inc., offers health services and products to global members in nearly 100 countries. The company purchased Goodhealth Worldwide, a managing general underwriter for international private medical insurance and provider of expatriate benefits, as a way to benefit from the company's global reach. Goodhealth has employees located in Bermuda, Miami, London, Indonesia, Hong Kong, and Shanghai.

Initially focused on providing health benefits to U.S.-based multinational companies, AGB has added a line of products available to European large corporate groups and has applied for a license in China to expand the scope of the company's product offerings.

This global touch also means the U.S.-based company must change with its memberships' varied preferences and cultures. AGB has a staff made up of many multilingual, multicultural employers who speak 29 languages in five different global offices.

To create global programs, Tim Blevins, head of medical and network operations for AGB, says the company researched clinical standards of care across the globe to find commonalities. By using the common standards as a basis, AGB is able to advise global members in the medical areas where there is commonality and tell members to contact their local treating physician when there is not, he says.

Blevins says AGB has learned that different cultures prefer different interactions, such as e-mail/Web-based, face-to-face intervention, and telephonic health coaching. "As it relates to wellness, it is probably most important for companies to be culturally sensitive and to understand the specific media/format which will be most appealing to employees in different locations," says Blevins.

Regardless of the direct reason for wellness programs, employers see them as a way to show employees that they care about their health. "Frankly, that's the competitive boost for any employer to have: to have a really engaged, motivated work force. If wellness is even a piece of that formula, I think a lot of employers would really like to figure out how to leverage that," says Hall.

Les Masterson

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