©  Copyright 2002 Rogers Media. The following article first appeared in the March 2002 edition of BENEFITS CANADA magazine.

>Viewpoint: Teamwork key to the future of healthcare
>E-Poll: To what extent do benefits plan sponsors have any influence on the evolution of Canada's healthcare system?

The future of work

When talking about the workplace of the future, many experts, including pension and benefits managers, overlook an important factor--young workers. This is a group aged 15 to 24 years old, who work part time or are just entering the workforce full time.

"Much like we know family experiences affect the way individuals' personalities are formed, early work experiences affect how young workers feel about work," says Catherine Loughlin, assistant professor of organizational behaviour at the Joseph L. Rotman School of Management at the University of Toronto. Loughlin has studied this group of employees and her research provides human resources professionals with a sense of what's to come in the workplace.

One issue that is dominant with this group is work-life balance. Loughlin says young workers will demand time off to go back to school and flexible work hours to accommodate their families. Employers need to consider how their benefits, pensions and compensation programs address these needs. Loyalty is another issue. Many young workers witnessed their parents and relatives being laid off in the early 1990s after decades with one company. "Increasingly, they are saying, 'if I'm not going to be employed for a lifetime then I'm not going to invest everything into this company and I want more immediate payoffs,'" she says.

Another interesting finding is that young employees will be sought-after because they are comfortable with state-of-the-art technology, educated and fairly sophisticated. "We're going to see changes in the demographics in the workplace and who's holding positions of power," says Loughlin, adding that younger workers will surpass older workers with more seniority on the corporate ladder. At the same time, though, Loughlin's research shows young employees will likely refuse promotions because they don't attach much status to positions of authority, and they don't want the added stress and longer hours.

The best way for employers to retain and promote these valuable workers is to rethink work and incentives, says Loughlin. She says the mistake many employers make is offering more pay or benefits as incentives when, in fact, that's not what these individuals want.

"They want to know that they're going to get something out of their work right now. They're not willing to put in 40 years for the gold watch." This means HR managers will have to be open to meeting new needs in diverse ways.

Between 1990 and 1997, annual real funding increased, on average, by 1.3%. This resulted in real spending shortfalls throughout the mid-1990s, reaching an estimated 25% by 1997. Annual funding increases have since been restored to 4% and above, but little--if any--real ground has been made up.

The fallout is evident in access to acute care services, unacceptable waiting lists, emergency room overcrowding, inadequate nursing and physician staffing, and so on. The human cost of these issues is all too tangible for patients and families who suffer, or even die, as a result of inadequate care.

There are also human costs associated with medicare's failure to pick up alternative healthcare services, including new medications. With costs escalating, provincial drug formularies are slow to add new products. This places pressure on employers, insurers and individuals to absorb the costs or do without. Homecare is another problem area as people released from hospital find their provincial coverage won't meet their needs.

Escalating demand and costs are by no means limited to the public sector. Customers expect private insurers to keep supplemental insurance premiums affordable. Traditional measures such as fixed-dollar limits on benefits and patient-cost sharing (user fees) are helpful, but don't go far enough. We must be prepared to change the way we approach the private funding of healthcare by responding with approaches to health management that eliminate wasteful expenditures. This means only reimbursing patients for newer medications in circumstances where the new medication will be more effective.

It's unlikely we can dedicate enough public money to sufficiently relieve the pressures on our system, but we do need the public system to commit to reliable terms of coverage. We need to clearly define, at a sustainable level, what benefits medicare will cover and how soon the public can expect access. We need to establish rules for what services the private sector can cover and to promote better clinical and administrative integration, including common data standards (with appropriate privacy protections) to encourage networking among provincial health plans, private insurers, hospitals, physicians, pharmacies and other providers.

By more clearly defining the respective roles of the public and private system we can ensure Canadians are more likely to get the healthcare services they need. Only then can we bridge the gap between the expectations for accessible, high-quality healthcare and our collective ability to ensure its long-term financial sustainability. BC

At the table

Twenty-six per cent of respondents say employers have a great deal of influence on Canada's healthcare system, 37% say they don't have much influence and 7% say they don't have any influence at all.

Employers may be wondering what their role is in shaping the public healthcare system. In this month's E-poll, 26% say they have a great deal of influence on the public system, while 37% say they do not have much influence and 7% believe they have none at all. In addition, 30% say they can somewhat influence the public system.

David Minifie, senior manager of benefits at the Bank of Montreal in Toronto, hopes governments will be interested in hearing plan sponsors' opinions. If they don't invite employers to the table, he says "private enterprise will have to start taking steps to protect itself in terms of financial exposure." That could range from freezing plans to charging premiums for more generous benefits.

Cyril Theriault, executive director of the Public Service Employee Benefits Division in Fredericton, says governments don't realize how often plan sponsors pick up the tab for services and drugs that are delisted from public coverage. For that reason, he says, employers want to be recognized as playing "an integral part" in the healthcare system.

Theriault adds that employers can influence the healthcare system through education. When they offer programs on managing diseases such as asthma, the result is fewer emergency room, outpatient and doctor visits.

Another Ontario plan sponsor, who asked not to be identified, adds that when unions negotiate specific coverage of services or drugs, it may influence other collective agreements in other industries to do the same.

The fear among all employers is that governments will delist more services to save money, forcing plan sponsors to foot the bill. "I'm sure there's going to be a push [in that direction]," says the plan sponsor who wished to remain anonymous. "But it makes it more expensive for companies to do business in Canada."

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."