Transcript Sales Meeting Presentation

China and India
Medical Issues for Expatriate and
Local National Employees
PAUL GRUNDY, MD - Director, Healthcare, Technology and Strategic
Initiatives IBM Global Wellbeing Services and Health Benefits
LYNDON E. LAMINACK, MD - Medical Director, CIGNA International
LORNA FRIEDMAN, MD, MBA - Senior Medical Executive, CIGNA International
CIGNA International
Expatriate Benefits
• CIGNA International Expatriate Benefits is the world’s
largest provider of employer-sponsored health care
benefits and services for expatriate employees
• The expatriate benefits solution for more than 40% of the
Fortune 100 and 25% of the Fortune 500
• Truly International Perspective
– Operational Presence in More than 20 Countries
– Understanding of Daily Challenges of Living/Working
Abroad
– Knowledge of Local, Customs, Health Care Practices, Laws
and Compliance Issues
– World-wide Compliance- Fully Compliant with all ERISA,
COBRA and HIPAA rules; Country Specific Compliance
IBM
• IBM is the fourth largest employer and is the largest
information technology employer in the world. IBM
remains the most profitable IT company and holds more
patents than any other U.S. based technology company
• IBM has engineers and consultants in over 170 countries
and IBM Research has eight laboratories worldwide.
• IBM employees have earned three Nobel Prizes, four
Turing Awards, five National Medals of Technology, and
five National Medals of Science.
China: Specific Health Threats
1.Infectious Diseases
Tuberculosis, Hepatitis B
Hepatitis A
Japanese Encephalitis
Cholera
Emerging Diseases
• SARS
• Avian Influenza
2.Respiratory Illness (pollution)
3.Gastro-intestinal
4.Motor Vehicle Accidents
5.Heart Attacks
China: Notes on Health Care
• Rapid improvement in medical infrastructure in
major cities
• No concept of primary care
• High cost and no care without payment
– Cash (not credit cards)
– Poor cooperation with insurance
• Long hospitalizations
• International accreditation (JCI) of a few
private hospitals
• Inefficient local ambulance system
China: Issues for “Western” Expats
• Quality of Care
• Access to care (Language, payment, aesthetics)
• Air Quality
– Implications for employees with respiratory problems
– lead levels a concern in children
• Pharmaceuticals
– “Imitation” more common than counterfeiting
– Tamiflu purchased outside reputable pharmacies is
probably fake
– China will allow up to one year’s supply of
prescription meds to be brought in (a practice CIEB
encourages)
–
Source: CIEB Medical Advisory Council
Best Practices: Western Expats
• Carve out health insurance
• Strong Assistance Provider
• Experienced EAP
• Pre-departure Preparation/Screening
• Pre-departure Medical Screening/Prep
China: Issues for Asian Expats
• Chinese-speaking expats are better able to access the
system, but are accustomed to high levels of hygiene
and quality
• There is a very strong distrust of Chinese hospitals for
emergency and serious care (TCNs are happy to get
acupuncture and try traditional medicine for routine
treatment, but don’t trust the hospitals for emergencies.)
• Some Asians, such as Japanese, will have as much or
more difficulty with Chinese healthcare as do Western
expats.
• Culture-specific IEAP-most Asian plans exclude mental
health, so there may be a heavier reliance upon EAP
services if it is available
•
Source: CIEB Medical Advisory Council
Best Practices: Asian Expats
• Similar to expats, but recognizing that many
coming from Asia have some familiarity with
China (which is both good and bad)
• Adjust insurance plan design to better fit their
expectations (100% coinsurance, lower
deductible, limited access to US care)
• Assistance plan is very important – Most will
want to be evacuated for serious problems
• EAP important for this group, too
China: Issues for Chinese Nationals
• Quality of care/Distrust of public hospitals
• Hepatitis B, HIV testing/workplace
discrimination
• Mobility issues (highly mobile society with
people migrating to major cities)
• Health Promotion
•
Source: MAC
Best Practices: Local Nationals
• Health insurance / access to Private system
• Occupational health focus for factories –
keeping the workforce healthy
• EAPs
• there is a real culture clash between the
traditional way of life (slow) and the new
corporate life (fast)
• New found wealth leads to concerns about
responsible financial habits
India: Medical Concerns
• Drug-resistant TBc
• HIV
• Chickungunya fever
• Malaria
• MVA’s/public transport
• Diseases of affluence: obesity, diabetes, CAD,
tobacco
India: Notes on Healthcare
• Many excellent doctors available. Also many
charlatans. Little regulation.
• Vast improvement in private hospitals in past
decade: can handle both emergencies and
routine.
• Government hospitals crowded, inefficient,
dirty.
• Ambulances not reliable or well-equipped.
Medical Care In India
• Prior to 1990 there were no hospitals of
international standard
• ’90’s saw boom fueled by returning (NRI)
doctors
• Now on verge of regional centers of
excellence, promoting medical tourism
• Accreditation
• JCI
– ISO, other
– QCI (India)
Benchmarking Quality of Care:
A World Bank Study
• Adults in rural Rajastan visit a doctor
once/fortnight
• In Urban India, the poor visit doctors more
often than the rich
• Doctors in study completed only 26% of tasks
required for pt with TB; 18% for child with
diarrhea
• Doctors in private sector know less but do
more vis-à-vis public sector doctors
• Private sector doctors in rich areas were far
more competent than in poor areas
Das & Gertler “Variations in Practice Quality in Five Low-Income Countries” Health
Affairs Mar 2007
Prevalence of coronary heart disease and risk
factors in an urban Indian population
• Male %
•
•
•
•
•
•
•
•
•
•
CAD prevalence
Smoking/tobacco
Physical inactivity
Hypertension
Diabetes
BMI >27
Truncal Obesity
Total Cholesterol>200
HDL<40
LDL>130
•
Gupta, et al Indian Heart J 2002
Female%
• 6
10
• 36.5
12
• 28.5
23
• 36
37.5
• 13
11
• 24.5
30
• 57
68
• 37
4
• 55
54
• 37
46
“Significant” increase from
similar study 10 yrs earlier
Health Risks: Public Transport
NEW DELHI (Reuters) – Jul 12 2007
“Delhi's Blue Line buses killed 59 of the 1,023 people who
died on the city's roads in the first six months of this
year”
Police have found a Blue Line bus in serious breach of
regulations and ordered it to stop running on more than
6,000 occasions so far this year.
Many buses are halted for lacking the mechanical limiter
to keep its speed below the 40 kph (25 mph) limit, for
having a driver without a full license and government
permit, or, like much of Delhi's traffic, for ignoring the
rules of the road “
Corporate Wellness in India
•
Significant number of corporations are spending money on "Wellness"
•
The pressure does not seem to come from any new legal requirement (Old
Factory Act)
•
The changes concern mostly new technologies and financial sectors involving
white color workers (and no longer the blue collar workers as in the past)
•
* Foreign investment/presence and an attempt to comply with headquarters
International standards (ISO 9001, 14000 or more recently OSHA 18001)
•
* OH/Wellness activities are particularly visible in Delhi, Mumbai, Bangalore and
Chennai
•
The original approach taken by these corporations is to use the OH agenda as a
retention tool against high turn over in an increasing volatile and competitive
labor market where white collar talents are in high demand locally. It is very
common to see employers offering an Intl. standard sport/gym set up with
professional trainers (outsourced) at the workplace coupled with primary care
setting (on site) and OH services showing that employers do care for the wellness
of their workers.
Olivier Lo, ISOS, Personal communication
Corporate Wellness in India
• Sickness absence is not a topic
capturing any interest in the corporate
market in India as far as we could see
(unlike in UK/Europe)
• We do not see much activity around
environmental work i.e. Health Impact
Assessment (unlike for our corporate
clients operating in Africa or Indonesia)
Olivier Lo, ISOS, personal communication
Conclusion
• Dynamic changes
• Great potential
• Challenges and caveats
Questions
Lyndon Laminack, MD
Medical Director
CIGNA International Expatriate
Benefits
Phone 302.797.3167
E-Mail [email protected]
http://www.cignaexpats.com