Wellness programmes, previously run by human resources departments as slimming clubs for overweight executives, have evolved into sophisticated health and loyalty programmes that are integral to the offerings, and profitability, of many medical aid administrators.
Most European national-health systems enforce preventative health care and governments pay for crucial investigations such as bone-density tests. But wellness programmes offered by administrators are a relatively new feature of SA's private health-care landscape.
Under SA's historic fee-for-service system, where providers were remunerated according to the volume of services provided rather than their quality, there was little incentive to encourage preventative health-care programmes.
Schemes focused on paying claims when members got sick, but didn't consider the value of keeping their members well. As the private health-care system became increasingly cash-strapped in the 1990s, the value of wellness programmes became harder to ignore. Whereas in the past, a scheme would never consider paying for members to quit smoking, now they reward members for doing so. The reason is that it is cheaper to pay for a simple intervention now than a triple by-pass later.
Large administrators may offer comprehensive wellness programmes, but many schemes are unable to afford them.
"If there is one thing the health-care industry is guilty of, it's of being reactive rather than proactive," says Mx Health CEO Neels Barendrecht.
"It makes financial sense to invest in the physical wellbeing of medical-scheme members because it is in the interest of the scheme that they stay well for longer," he says.
The challenge is not only to ensure these programmes are properly implemented and encouraged through legislation, but also that there are criteria that can be used to evaluate them, he says.
Administrators are quick to assert that wellness programmes make members healthier and therefore reduce claims costs and worker absenteeism while raising productivity. Ask them to substantiate these claims, however, and they are generally unable to provide hard data.
Medscheme Life integrated risk management executive director Debbie van den Heever says studies prove wellness programmes do work.
Research conducted by the Managed Care Information Centre in the US found wellness programmes improved employee morale in 91% of cases, increased productivity in 42% of cases and resulted in a decline in absenteeism in almost 48% of cases.
Other studies have found that more than 56% of South Africans have at least one risk factor for chronic disease. Individuals with health risks are likely to have a 10%-32% higher absenteeism rate than their healthier colleagues and for every 1% of the workforce absent, productivity falls by 2,5%.
In an absenteeism audit of the mining sector, covering 10 000 employees, Medscheme found that workers were absent 5,3% of working hours during a six-month period. Reducing absenteeism by only half a day/employee over a year would have resulted in about 5 000 work days gained.
Preventable diseases of lifestyle can also have a devastating effect on medical scheme expenditure. In October 2001, Medscheme calculated the cost of providing medication to 200 000 members with chronic diseases. For the 42% of the sample with one health risk factor, it cost the scheme R2 800/person a year. This rose to more than R20 000/person a year for the 14% of members with three risk factors.
University of Cape Town exercise and sports science chairman Tim Noakes agrees that wellness programmes achieve large savings for medical aid schemes. The problem, he says, is ensuring people comply with the programmes.
"The world's best programme is only as good as the number of people it can attract and retain," he says.
"For wellness programmes to work they must attract the right people," says NMG-Levy Consultants & Actuaries MD Tyrone Farinha. "The problem with employer-run programmes is they tend to attract the young and healthy."
After running a health day at his own establishment, Farinha was amazed to discover that at least 15 out of 120 employees had health problems they weren't aware of.
"People don't go for tests and don't understand their health status," he says.
The importance of wellness programmes is not only to indicate to an employer whether there is a health issue in the workplace, but to provide employees with personal health information they can use.
Farinha says most employers are good at raising employee awareness around wellness, but not at ensuring employees get the help they need.
Glenrand MIB Health Risk Management Consultants business management director Janette Clark says the challenge for employers is how to generate stability and security among employees who are often fatigued, disillusioned and cynical.
"Encouraging scheme members to change their life choices helps them adopt healthier habits that lead to reduced absenteeism, fewer disability claims, increased productivity and more harmonious relationships in the workplace," she says.
