ACA s Spirit Can be Seen Unfolding Across the Globe

While health care is still — mostly — local, there’s no denying that for most organizations there is a trend toward taking a global perspective on health. As public health systems absorb the strain of aging populations and health care cost inflation, regulators and employees will turn to the private sector for support. In addition, the value of health benefits in the drive for talent and productivity is being redefined due to new health issues and demographic shifts.

It is no surprise that the ACA is just one example of regulatory activity unfolding worldwide. Employers with growing employee populations in emerging markets as well those with globally mobile employee populations are responding by implementing systems and processes that keep them ahead of the trend rather than responding to it. The US is not unique in facing escalating health care costs and pressures to reform the health care system. Global employers must comply with regulations that not only differ from one country to the next, but are in a seemingly constant state of flux. The challenge is to craft proactive and meaningful strategies to regulatory change that focus on improving the health of employees and helping the organization better compete on an international stage.

One common emerging issue in workforce health is stress. In both employee and employer surveys stress ranks high as a source of discontent linked to low productivity and poor engagement. A number of government ministries of health in both Western Europe and Asia have taken note and made public statements regarding the need for employers to address stress in the workforce. In most locations, established EAP services, management training, and other focused worksite programs are available to help them respond.

Of course the biggest story in health for 2014 was the outbreak of the deadly Ebola virus, which served as a poignant reminder of the vulnerability of many public health systems and a warning that there are health threats to our workforce that defy country borders. Active and ongoing pandemic planning can help employers respond quickly and responsibly to cross border health issues.

There is  also increasing awareness of the importance of managing non-communicable diseases (NCDs) such as diabetes and cardiac conditions globally. The World Health Organization (WHO) estimates that 14 million people globally between the ages of 30 and 70 — prime working ages — die from NCDs, and that 85% of these deaths occur in developing countries. The WHO has released an updated report that profiles 178 countries in relation to NCDs. The report highlights the risks, prevalence and — importantly — the capacity of existing infrastructures in each country to respond to NCDs.

Although the global workforce constitutes diverse populations and cultures, collective data and experience (such as the Diabetes Prevention Programs) is providing guidance on how to confront and prevent chronic conditions. Given the impact on productivity, employers should consider whether their employees have adequate coverage for chronic conditions either through the public system or other coverage. Just as the ACA opened the discussion of what constitutes “essential” coverage, multinational employers are recognizing that in some countries where they do business, typical coverage is inadequate for a 21st century employee population. Examples include supplemental health plans that don’t cover vaccines or diabetes drugs, or have exclusions for certain diagnostic groups, such as those who are HIV positive or pregnant.

Looking ahead, as employers seek to centralize and standardize their total-rewards philosophies in an increasingly competitive global economy, we see them beginning to adopt a more creative approach to understanding how health and health benefits play a role in recruitment and retention for a globally informed and globally mobile employee population.

Mercer has assembled a panel of experts to reflect on key health care reform developments and share their expectations for the future. Lorna Friedman, MD, is a Partner in Mercer's Global Health Management business, as well as a board-certified physician specializing in pediatrics and licensed in New York.

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