Benefits Spending

Fully grasping the ins and outs of your various insurance policies can be difficult, especially if you have a life. This may not be because they are needlessly complicated; it may in fact be because the designing insurance policies in the first place is a somewhat difficult matter. Trends in health insurance spending are perhaps less intuitive than you would imagine.

Consider a 2014 report from Green Shield Canada. It seems natural that children on the edge of learning to speak should have a healthy proportion of their claims taken up by speech therapists (12.28%). This is dwarfed, however, by chiropractic treatments, which make up a whopping 35.69% of all health insurance claims by children aged 0-1. To the average schmoe, like this author, that is a surprising figure; after all, such tiny humans haven’t yet had their bodies wearied by the Culture of Uncomfortable Chairs that obtains in nearly every working environment available, or the Culture of Agonizing Footwear that characterizes all the others.  But chiropractic work can, the industry’s advocates claim, be used to treat a range of common ailments among infants, including colic, ear infections, and asthma. Though this topic merits further scientific study, anecdotal evidence among many parents may be a reason why chiropractic treatment is so popular with babies.

In point of fact, chiropractic, massage therapy, and physiotherapy dominate plan spending in every age group, so much so that insurance companies have invented a little semi-affectionate name for them, the Three Amigos. Taken together, they represent a full 62.70% of benefits spending for 11-20 year-olds, which catapults to 72.05% by the time folks reach 50.

This might indicate many things, not least of which being that perhaps benefit users are shifting their focus to a more prevention-driven healthcare practice; after all, an ounce of prevention and all that. As such, Green Shield Canada, for one, admits to shifting policy ratios from “what used to be a pretty traditional 70/30 cost split between drug and health benefits” to something closer to 60/40.

Still, these changes may be coming too slowly. As the pharmaceutical company SANOFI reports in one major survey, “53% of plan members state that their health benefit plan meets their needs extremely or very well,” a reduction of 20% over the last 15 years. The presence of chronic illness – some of which can be treated by massage or chiro – is consistently underestimated by employers who offer benefits: most believe about a third of their employees have one, whereas more than half do.

This is could be related to the overall trend discovered by Green Shield: that benefits users might be looking for prevention over cure. 62% of plan members, SANOFI found, value their plan “for its coverage of routine healthcare costs rather than unexpected costs.” It stands to reason, then, that they might prefer a drug/benefits ratio that favors expenses on more common treatments (including massage), rather than the emergency surgery to remove the bot fly larvae from their inner ear, having acquired it several weeks previous after three too many Chumbawumbas and a midnight swim in a de Janeiran “natural spa” run by the same farouche guy who sold them a pair of basket-weave flip flops, not that I’m speaking from experience.

Overall, the increasing popularity of the Three Amigos is having a clear influence on how insurance companies design policies, and should give anyone who imagines this is an easy process some cause to reflect.

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