Expat Focus International Healthcare Update February 2018

Sending Staff Overseas 'More Complicated'

The process of sending an employee overseas has become more difficult and complicated from a duty of care perspective thanks to travel risks increasing, a survey of HR professionals reveals.

The findings from the Collinson Group show that 54 percent of HR professionals say that while issues have become more difficult over the past year, they will become more difficult and complicated over the next year. Just seven percent of respondents said this process will not become more complicated this year.However, despite the increasing risks and complexity of sending expat staff overseas, 59 percent of those responding said that employers had a corporate travel policy in place which included a risk management strategy.

The firm’s head of product, Randall Gordon-Duff, said it is becoming increasingly important for employers to use appropriate solutions and tools to effectively prepare expats and protect them while they’re working overseas. He added that some employers may be compromising with limited resources as well as overrating some risks and overlooking others that might be more relevant to the expat employee’s real-world experiences.

He said: “We believe employers should take an opportunity to simplify and consolidate their approach to duty of care and ensure there is a clear statement about who is responsible within their organisation.” One of the issues highlighted by the survey is that an employer may be assuming that their travel management company is fulfilling the issues of duty of care as part of their duties when, in fact, the agent may have no specialism or expertise in these areas.

Why iPMI Is Increasing

Most employers will be used to seeing increases in their international private medical insurance (iPMI) premiums, with many experiencing larger increases recently than the usual 10 to 15 percent. The Health Insurance Group states that there is a growing demand for quality private healthcare, with expats wanting greater choice in where and how they are treated when this is necessary.

In addition, there’s more opportunity for hospitals in some locations to offer experimental or cutting-edge treatments, which tend to be more expensive for expats to use. This means that premiums in Hong Kong and Singapore are higher, since hospitals there are more willing to offer this type of treatment.

The Health Insurance Group offers three tips for employers wanting to control their iPMI costs:

– Consider whether it would be cheaper to have a single policy covering all locations or local cover when an expat employee is being moved to a high cost location.
– Look at those providers who offer access to better value medical facilities at competitive prices.
– Review what the employee’s insurance offer should include and exclude.

Employers should consider what the needs of expat staff needs for insurance should be. For example, childbirth can be a costly item to include and may not, in some circumstances, be relevant.

The Health Insurance Group’s head of international, Sarah Dennis, said: “It is essential that employers discuss how to control costs. With expert advice, the premiums may be reduced through local centralised policies, changing what’s included and seeking providers who offer access to less expensive medical services.”

Failure To Consider Expat Wellbeing

Around one in 10 expat assignments will fail because of personal reasons. However, a survey from one healthcare provider reveals that employers are not recognisng the impact on an expat’s mental wellbeing when they are sent overseas. The AXA findings highlight that 35 percent of employers think global mobility is critical in achieving their core business objectives, while half of employers say they need expat staff to improve operations.

However, the survey also reveals that global employers may not be recognising the impact of expat wellbeing on their success. It found that of the expat assignments that fail, on average 11 percent were because of the expat’s personal reasons. This figure rose to 23 percent in the US.

The top three reasons given for failing assignments include family concerns (54% of respondents), the expat’s own health worries (42%) and the expat having issues adapting to their new country (28%). Only eight percent of expat assignments fail because of commercial reasons, Axa says.

Risk Of Failure

Even though more assignments fail for personal reasons than commercial, nearly one in three global employers said there were unconcerned about the risk of assignments failing because of staff suffering with mental health issues.

Axa’s chief executive of global healthcare, Tom Wilkinson, warned that mental ill-health among expat staff could manifest itself in other ways, such as making a social situation more challenging. He added: “If employers do not re-evaluate the importance of mental health, it could be an expensive mistake to make as firms confirmed it costs, on average, more than $50,000 (£35,674) to send an employee overseas, and that is not including their salary.”

The findings also highlight that 36 percent of employers struggle to help expats align their overseas work with family life and 32 percent said there was challenging to help expats and their family members adapt to their new life.

Expat Priorities

Whether moving to work or retire, expats heading overseas have revealed what their priorities are. Healthcare and worries about health topped the list of those questioned by Aetna International. Findings reveal that 77 percent of expats said they were ‘very concerned’ or ‘concerned’ about the health and wellbeing of their family.

That was closely followed by 71 percent saying they were concerned over their personal health and wellbeing, while 67 percent said they were worried about the cost of living. The fear of political unrest and terrorism threat was a concern for 68 percent, and a similar number said they were worried about climate change.

Aetna’s chief executive for the EMEA region, David Healy, said the survey should make interesting reading for employers with expats working abroad, since the results provide an insight into what expats value most when being sent overseas.

Of those questioned, 76 percent said they were employed to work overseas, and around half of them said they were earning more than $100,000. Another issue that reflects the changing trends of healthcare provision for expat is that 48 percent of respondents said they were relaxed about consulting a doctor or medical professional via a smartphone, while 52 percent said the future of healthcare provision will increasingly rely on virtual support.

The Cost Of US Healthcare

All expats heading the US will appreciate that healthcare premiums are going to be expensive. A new analysis of what the average hospital stay in the country might cost them helps reveal why.

The Healthcare Cost and Utilisation Project says that the average hospital stay in the US will cost $10,700 (£7,634). However, this amount varies depending on the medical condition being treated. The organisation analysed the data and found that patients are spending more than $381 billion every year.

The organisation says that the top 20 most expensive conditions for hospital stays account for half of all hospital costs. The most days in hospital are for childbirth, with around 3.8 million. The most expensive condition was for septicaemia, also known as sepsis, which cost insurers $27 billion.

The data also highlights who pays the hospital bill, with Medicare paying 46 percent of costs and Medicaid accounting for 17 percent, while private insurance paid 28 percent. Five percent was paid by patients who are uninsured.

Employers Offering Health Benefits

In the US, health coverage provided by an employer is important not only for recruiting workers but also for retaining them. A new survey from America's Health Insurance Plan found that 71 percent of workers are happy with their employer-provided health coverage, while 56 percent say that the coverage is key to remaining in their current job.

When asked which available benefits will benefit them the most, respondents said prescription drugs, emergency care as well as preventative and wellness care were their top three choices. In addition, 58 percent said they would prefer comprehensive health coverage from an employer over affordable coverage.

Ditching Health Coverage

Meanwhile, it has been revealed that both expats and Australians are increasingly ditching health insurance coverage because of rising premiums. New figures reveal that more than 12,000 decided not to renew hospital coverage in the last quarter of 2017. The figures highlight that around 46 percent of people in Australia have hospital cover, the lowest it has been for seven years.

The news comes as a consumer group reveals that 70 percent of those without health insurance say they have gone without because it’s simply too expensive for them to buy.

Healthcare Insurance In India

Expats working in India may not need to buy healthcare insurance soon thanks to what will be the world’s largest public health insurance scheme. The aim is to deliver a safety net for millions of Indian people and others living in the country who cannot afford quality medical care currently. The country spends one of the lowest levels of GDP on healthcare, while paying for health and medicine pushes five percent of the population below its poverty line.

Round-The-Clock Medical And Security Assistance

The international travel and operational risk outfit, Anvil Group, has launched an in-house medical assistance offering for clients. This will see expats receive multilingual security and medical assistance around the clock. Their aim is to offer cover in any event that would impact the health, wellbeing or safety of an expat or corporate traveller. This is a response to a growing demand from organisations wanting a joined-up security and medical assistance provision.

Anvil’s managing director, Matthew George, said: “It’s taken investment to bring our own clinicians on board. This is something we are passionate about and we are proud of the service we provide.” The team will manage all medical cases from pre-deployment screenings to clearance for travel, local treatment and repatriation and also post-travel care.

In Other News…

Max Bupa Health in India has unveiled its ‘Go Active’ health insurance plan for everyday use. The aim is to meet the needs of expats and locals in the country with better out-of-pocket and health per healthcare expenses being reimbursed.

The rising cost of medical services and goods, plus higher Medicaid costs, will see US healthcare spending growing by 5.3 percent this year – and this rise will be reflected when health insurance premiums are up for renewal.

A survey of health insurance customers in the UK has revealed that half believe their exercise and diet patterns should be considered when their healthcare premium is calculated. They say their lifestyle choices should be reflected in lower healthcare costs, according to Vitality Health. When questioned, 75 percent of respondents said they would attempt to lead a healthier lifestyle if it led to a reduced health insurance premium. This was strongest amongst the youngest respondents.

A survey from Munich RE has revealed that 56 percent of those applying for health insurance are unable to answer accurately complex medical questions, while 67 percent said they would have greater confidence when applying if the responses were checked. Now the firm says automated underwriting using electronic health records could be a big help in boosting take-up of health insurance.

Health insurer Axa says that 41 percent of workers in the UK have experienced mental health issues, while 51 percent say they would wear a health tech device in order to detect early symptoms if the device was provided by an employer for free. The survey, Health Tech and You, also revealed that 45 percent of workers said the data could be shared to boost wellbeing strategies in the workplace.

The UK government has announced plans to double the health surcharge for non-EU students and expats staying in the country. Students currently pay £150 for the surcharge; this will increase to £300. The levy will give students access to NHS services which are free at the point of care. The new levy should raise an extra £220 million to help support the health service.