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Well-being will take precedence over curative


Alain Thériault

10 July 2018 07:00

Marie-Josée Le Blanc

Mercer predicts that by 2025, the pane curative group insurance plans gives way to an offer of coverage more individualized and focused on the support of the health, both in the public and private sector.

The health care system comes at a decisive moment. It requires a drastic change, said Marie-Josée Le Blanc, head of innovation, a field in health of Mercer Canada. “The current regime is unsustainable “, was launched at the Congress class 2018 to be held in Montreal on April 18, by Segic.

“While 50% of provincial budgets are dedicated to the health, we come in sixth in the world among countries that invest the most in their health-care system “, says Ms. White. In return, she cites another study published last summer, which Canada ranks 9th out of 11 developed countries in terms of health care, with France and the United States. This is not the quality of care that is the problem, she said, but access to care and waiting time.

Transformations are in the offing, both in the private and public sectors, believes the specialist of Mercer. Challenge for employers : the government reacts to the current trends in transferring little by little, the expenditure of the public health system to plans offered by employers.

“There are no public announcements of service cuts like in the 1990s. The changes are still there, but more subtle. “

She gives the example of a day-surgery, after which patients retain at home the care of a private nurse, which the insurer private collective will refund the cost. It also points to the problems of “non-health” in business and in the general population, as well as the rise of chronic diseases.

“The expectations of plan members are constantly evolving,” added Ms. White. It recalled that the labour force now consists of five generations. If the employee does not engage more with one employer for his entire career, the employer must also consider redefining the paternalistic approach to cover the employee until his retirement, she said.

The promise to the population change

To explain the revolution that will hit health care by 2025, Marie-Josée Le Blanc went seven predictions from recent research by Mercer

“The promise made to the citizens has to change. The generosity of the governments will not be infinite, in a context where the population is aging and living longer and longer. “At the same time, the pool of payers of taxes decreases, does it.

If there has been generous recently, they have been more of the nature of elections, said Ms. White. Discussions on the feasibility of the national plan of drugs, for example, promise to be long.

“It is necessary to bring together all the provincial ministers of health, around a subject of provincial jurisdiction. A national scheme will affect the plans of each province are very different from one to the other. The consensus is not for tomorrow “, does it.

The medication is extremely expensive intended to treat rare diseases threaten the private plans, even in large companies. “There’s a reflection on the coverage of these drugs, says the head of innovation at Mercer. If generous, the national scheme will not cover all medications. This is not the panacea to all problems. “

It is going to hurt !

“We’ll see a return to the costs of health increases annually by 10 % among companies that do repenseront not their plans. We are around 8 % in recent years. We approach quietly from this brand. To do nothing for seven years, this will give 130 %. The message is not necessarily the number, but the trend. Start thinking now to avoid this increase in costs is coming ! “

There is a profound reflection on the model of the insurance collective, launched Ms. White. “The model established 50 years ago as the pension plan, in which the promoter promises an annuity to the employee at the time of his retirement, according to a predetermined formula. The employer has no idea how much it will cost him in the end. This was not a problem 20 years ago, when the cost of the drug average hovered around $ 50. With the major claimants of today to more than $ 10,000 per year, that changes a little the gives. “

A hybrid model will appear

She believes that the insurance collective will adapt more and more on the model of the pension plans to a defined contribution plan. These plans deliver to the participants the responsibility to grow its assets at the option of its choice of investment options. It thus assumes the risk of performance of their group plan. “We will not be fully defined contribution tomorrow morning. A hybrid model will appear, which refocuses the insurance of financial risks essential, on the protection against costs of financial resources. “

There will always be a need for life insurance, disability and diseases critical. “The level of paternalistic benefits will decrease. While 47% of insured say they are dissatisfied with their insurance coverage collectively, the young people did not see it as a health coverage, but as a blanket to help stay healthy. “According to her, there is a need to rethink the philosophy of the schemes, and for example allow the employee to receive an allowance that he can allocate according to its needs.

Mercer predicts that by 2025, the sector of group insurance will be disrupted by the innovations of specialized suppliers, with which employers will want to treat them to reduce their bill.

I’ve seen employers who are trying to manage budgets and shop around when the premium is too high, has noticed Mrs. White. Change of insurer can make its effect for a period of time, but not on a sustained basis. The problems of cost that we observe today are the problems of non-health. The best way to adjust is to manage the claims costs and the health of employees. “

Digital : a door opens

In these circumstances, the insurer is the only partner with whom you can do business to fix your problem, asks Marie-Josée Le Blanc. “A door opens onto a whole universe of providers in digital health. At Mercer, we meet two of these providers each week. This is only a microcosm of what exists. “

It cites, among other figures of the study Digital Health in Canada : Exploratory Analysis of Canada’s Domestic Health ICT Sector, by 2015. According to this source, there were approximately 800 to 1,000 start-up businesses specialized in health technology. Ms. White said that about 1 000 companies from this sector start each year. She notes that these technologies create in Canada income estimated to be $ 3.4 billion (G$), and participate in its gross domestic product (GDP) to the tune of$1.5 billion.

“We’re in a world where medicine and the treatments will be more and more specialized. The plans may be more, to adapt to the personalization of care, ” says Ms. White. A mapping of the human gene which cost millions of dollars can now be performed for a few thousands of dollars.

Pharmacogenetics will allow to know ahead of time how to react to a person’s metabolism of a drug or a treatment. Patients will receive adequate care from the first time, according to their genetic profile.

“You could know if you’re part of the 3 % of individuals who react poorly to a drug. These tests are becoming more and more accessible, sometimes less than $ 300 when they are well targeted. “

Applied to the regime of a company, pharmacogenetics would quickly get a return on the investment, in the area of mental health, ” she said. It is a sector in which care is provide often by trial and error, ” she adds. “Over the course of trials of different antidepressants, we pass from a period of short duration to a period of long duration. If a test pharmacogenetics helps to avoid a week of disability, it is already profitable. “

The employees will want to benefits in their own way

“Perhaps it is our prediction the more futuristic. The data will begin to accumulate on the platforms of digital health that you will attend and you will be able to receive a flexible offering that goes beyond the medical expenses healing. We are moving towards a model of benefits predictive, with a support much more focused on the management of the health on the reimbursement of expenses after the damage is done. ”


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