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Eight challenges facing the workplace: the aging of the workforce and a trend toward shifting healthcare costs to employees may drive increases in some health conditions, but could lead employers to hold insurance carriers more accountable.

Every employer is dealt a unique hand of cards in terms of its employee population, and the health benefits strategies any given employer should pursue depends on the cards it is dealt. There is no "one size fits all" solution to health care and productivity issues in the workplace.

At MetLife, we sit on one of the largest workplace disability databases in the country and have the ability to mine our database with state-of-the-art data navigation tools. We realized there was a need for a resource that would provide information and facts and figures to help individual employers determine the health benefits and productivity strategies they should pursue. From that realization sprang A Year in the Life of a Million American Workers.

Putting together A Year in the Life reinforced for me the surprising heterogeneity of employer populations. The size of your company, the industry you're in, and who your people are--specifically with regard to demographics--are going to drive your health benefits needs, and these needs will vary significantly from company to company to company. The more I look at the different "slices and dices," it never ceases to amaze me that one company may experience a lot of low back disorders and need to consider smarter lifting techniques, while another company may experience higher levels of stress and depression in the workplace and perhaps need to consider investing more in employee assistance programs. Still another company may experience higher levels of chronic disease in its workforce and decide that it should beef up its attention to prevention and wellness programs and strategies.

These differences in employee populations and needs are going to be exacerbated over the next several years by two trends, the first of which is the aging of the U.S. population. Actuaries have been telling us for years that as workers get older--as they advance from age 30 to 50 to 65 and beyond--their likelihood of incurring a disability (especially due to a chronic condition) increases. So the aging of baby boomers in the workforce is likely to drive increased incidences of both short- and long-term disability.

The second trend is that as healthcare costs continue to increase, employers are likely to transfer more and more of the cost and risk of health care to employees. Consumerism is a good example of this. Consumerism--which, to my mind, involves transferring risk, responsibility, and a certain level of economic burden to the individual employee--is the managed care of this decade.


One of the potential dangers of transferring costs is that people may be pennywise and dollar-foolish with healthcare expenditures as they begin to shoulder more of the financial burden. If people don't spend their money wisely, they can end up with conditions that could have been prevented with more careful spending. The challenge of consumerism, then, is to help people get the most value from the money they spend.

Another potential danger of transferring costs is that as more of the financial burden of health care falls on workers, access to and consumption of healthcare services may go down. This concern arises from what I believe to be the direct correlation between the availability of healthcare services and employee absence and disability Higher healthcare costs decrease access to healthcare services, especially in lower-income workers. As utilization of healthcare services decreases and people put off seeing doctors and other healthcare providers, morbidity is likely to increase. An increase in morbidity ultimately should drive an increase in disability.

I'm not saying employers shouldn't ask workers to shoulder some of the financial burden of their health benefits. What I am saying is that if employers want to significantly reduce their expenses for health benefits, they should focus more attention on the money they spend Specifically, employers can look at the conditions driving their absence and disability patterns to determine if there is a minimal investment in specific health benefits they could make that would provide a substantial return in employee productivity. That's the kind of focused, intelligent health benefit investment I advocate, and a company's disability experience can really help an employer understand that.

For example, if you look at a working population, approximately 10 percent of that population in any given year will typically generate a short-term disability claim--a situation where someone is out of work for more than a week as a result of a health condition, illness, of injury. That 10 percent of the population, however, will drive more than 50 percent of the healthcare costs of the workforce. This fact holds two keys for employers looking to contain their healthcare costs and increase the productivity of their workers.

The first key is to recognize that your short-term disability experience is really a fingerprint of your overall healthcare consumption patterns. If you benchmark that against what would be expected, given the age and gender distribution of your workforce as well as the experience of your industry, you can fine-tune your understanding of where you're out of line with the norm. You might say, "In my industry, 10 percent of short-term disability claims are for psychiatric conditions, but for us it's 16 percent. So I have to invest more in the mental health of my workforce, whether it's by stepping up the level of benefits available through my EAP or purchasing a behavioral health managed care organization."

The second key is to recognize that when an employee submits a short-term disability claim, that person is crossing a threshold to where a health condition is beginning to take a sizable toll on his/her life. That's the point at which an intervention can make a big difference. For example, if an employee submits a claim for asthma, an employer's benefits administration could respond, "Did you know that your employer has invested in a program for people with asthma? If you call 1-800-I-HAVE-ASTHMA, you can get help with your condition. They can help you understand your medications, find a provider, explain how to use your inhaler, discuss which exercises you you should avoid and which should pursue, how to improve the indoor air quality in your home, and so on."


These two keys are going to become all the more important in light of eight challenges I foresee arising in the workplace during the coming decade. The first three of these developments will be driven by older workers--in 15 years we will have roughly 25 percent more 65-year-olds among us, and in that time the percentage of 65-year-olds who will have to work for an additional five years is going to increase greatly Together, these eight challenges will substantially increase the imperative for employers to track their short-term disability experience to help themselves better understand their healthcare consumption par terns and make more focused and intelligent investments of their health benefits dollars.

First, the prevalence of arthritis is going to increase. In fact, based on current trends, I believe there will be twice the incidence of arthritis in the workforce 15 years from now. Employers may benefit from thinking carefully about their workspace design and job tasks and tools and focusing specifically on accommodations that will enable jobs to, say, use a smaller range of motion. An example would be the shoe department of a large store. Such an employer might ask itself what types of physical effort are required for workers to retrieve shoes from high shelves.

My second (and related) prediction involves what I believe is the potential for an increase in the rate of cancer. As we get older and our bodies age, our cells are dealing with a greater biologic legacy. The/re more likely to mutate, and that's really the genesis of cancer. In fact, of the 10 leading causes of cancer, nine increase with age, and that increase tends to accelerate between the ages of 55 and 65. Because of this, I believe the aging workforce could drive a doubling of the incidence of cancer in the workforce in the next 10 years. Cancer is very costly from a health benefits perspective, but many cancers are preventable and there are early interventions that can make a big difference for cancers that aren't preventable. Employers may want to consider investing more in prevention efforts to offset the effects of cancer on their workplaces.

The third challenge is heart disease. If we include hypertension in this category, I believe the aging workforce could drive three times the prevalence of heart disease in the workforce over the next 10 years. I foresee the potential for increased intolerance of sedentary lifestyles, obesity, and smoking amongst employees.

Fourth, as productivity demands continue to surge in the blue-collar sector and blue-collar workers face greater technical complexity in their work, I believe there is a potential for a significant increase in the prevalence of stress, anxiety, and depression in the blue-collar workforce. Today, the rates of short-term disability claims are almost double for white-collar workers than for blue-collar workers. I believe that blue-collar workers are going to start confronting higher levels of stress, anxiety, and depression. This presents an opportunity for the behavioral health industry to push for greater de-stigmatization of mental health care, especially of men. The healthcare-seeking behavior of men lags greatly behind the healthcare-seeking behavior of women, and nowhere is that discrepancy more pronounced than in behavioral health.

My fifth prediction relates to infectious disease. As the pharmaceutical industry continues to put out better antibiotics, antibiotic-resistant strains of bacteria are on the rise. Add to that the growing ease of international migration, and what you have is a scenario whereby if you want to protect babies in Chicago from smallpox, you have to vaccinate babies in India. I believe that new epidemics of infectious diseases could be a notable problem in the workforce.

My sixth prediction involves something I've already touched on in this article: consumerism. As individuals become increasingly responsible for managing and paying for their health care, there will probably be greater discrepancies between the haves and have-nots. Often, individuals of higher socioeconomic status use their dollars wise]y, and we could even see a decrease in disability incidence among these workers. In comparison, individuals of lower socioeconomic status, are likely to be at greater risk of disability. Industries with large populations of middle age workers will face rising disability and healthcare costs, and employers' ability to provide comprehensive healthcare coverage tot these workers may ultimately be in jeopardy.

The seventh challenge concerns accountability. In the next five years, I look for employers to hold their medical carriers more accountable to deliver on absence and return-to-work strategies as part of the value they provide to employers.

Finally, as the obesity epidemic becomes increasingly well known, I believe Americans will become more aware of the attendant risks and hazards and change their behaviors, I believe these changes could significantly curb the upward trend in obesity rates. For example, think of how many people you see today fogging on sidewalks and in parks, then think of how many you saw 30 years ago. I can't get my kid to not wear a seatbelt, while I can't get my parents to wear them. These examples my evidence that behaviors do change over time. I believe that similar behavioral changes relating to obesity will occur as well.


I think the predictions I've outlined offer employee assistance professionals some real opportunities to reduce the incidence of absence and disability and increase workforce productivity. First, they can use these developments to help raise awareness among employers and benefits specialists of the value they can provide. Second, they can develop "tiered" levels of service that allow them to better market the kinds of services that really deliver value back to employers and employees. Third, they can use absence and short-term disability data as a very good barometer of the overall need for their services and a specific indicator of certain types of services. Finally, they can link what they do with the process by which companies manage absence and disability and recognize that if an employee has to miss more than seven days of work because of an anxiety disorder of depression, that person needs EAP services and presents a ripe opportunity to make that critical connection.

While the trend may be for employers to shift more of the risk and cost of health care to employees, this could drive excess absences and disability incidences if workers do not spend their money smartly. There may be some incentives here for EAPs to help employers find solutions that counter the tendency of some workers to spend money in a penny-wise, dollar-foolish manner.

Ron Leopold is national medical director and vice president of Group Disability for MetLife. He is a board-certified occupational medicine physician and an active member of the American College of Occupational and Environmental Medicine. He is author of A Year in the Life of a Million American Workers (MetLife, 2004).
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Article Details
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Author:Leopold, Ronald S.
Publication:The Journal of Employee Assistance
Geographic Code:1USA
Date:Sep 1, 2004
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