Access to health care is hindered by inequities around the world. In some countries, access is affected by whether a person receives coverage through the private or public health system. These barriers can lead to unmet health needs, delays in receiving appropriate care, the inability to get preventive services, financial burdens and preventable hospitalizations. Mexico is an example of one such country.
While employer- sponsored private insurance is available in Mexico, according to a report by Mercer, typical practice is that eligibility is limited to salaried employees. Hourly (union) employees may sometimes also be eligible, but that is dependent on the terms of any collective bargaining agreement. As a result, often the majority of a company’s workforce in Mexico may not be covered by the employer-sponsored plan, leaving the public health system as their only means for health care coverage and access.
Even for those employees eligible for the company- sponsored medical plan, some critical limitations are common, such as exclusions for preexisting conditions and restrictions on when hospitalization is covered. For instance, if a patient is not in a hospital for a minimum of 24 hours receiving care, the stay and services will often not be covered by the plan.
A New Dimension to an Old Problem
The current COVID-19 global pandemic has illuminated the shortcomings of this longstanding reality. To preserve hospital capacity and stem the spread of the disease, the practice has been to limit the amount of time people spend in public hospitals unless longer stays are acutely necessary. This has meant that many patients may visit a hospital briefly and then be sent home for continued care. As cases grew, however, hospital capacity became reduced. A private hospital proved not to be an option for most people. Even if a private hospital had capacity when a public hospital did not, someone without access to private insurance may find that access to a private hospital is either impossible or impractical.
To ensure that both business continuity and the health care needs of their local workforce are met, working with Mercer, some companies have explored options related to plan design and eligibility and implemented unique solutions to address these gaps:
- Design: Developed a self- insured COVID-19 treatment fund program that leverages existing insured carrier networks or paramedical networks.
- Eligibility and Coverage:
- Those not eligible under the employer- insured program were provided access to facilities such as private hospitals that have capacity.
- Those eligible under the employer- insured program were provided coverage for hospital services excluded under the insured program due to the 24- hour minimum rule.
- It may also help to address the challenge of some hospitals requiring significant deposits from patients prior to providing care. (Situations like this also occur frequently in China.)
Employers are often cited by employees as their most trusted source for information and support in some countries such as Mexico. Implementing a program like this allows a company to address practical health care needs of their workforce while ensuring improved business productivity. Although these enhancements are specific to COVID-19, it remains to be seen whether the idea of expanding equitable care throughout all levels of the workforce will gain momentum and be applied more comprehensively in the future.