Tag Archives: ebola

Ideas Transforming Developing World

The recent refugee crises in Southeast Asia and the Mediterranean demonstrate how developing world problems are increasingly becoming the problems of the developed world. Instability and economic weakness in poorer countries are leading to significant challenges for richer nations.

Aon’s Political Risk Map analysis finds significant instability across much of the developing world, compounded by cycles of war, famine, drought and disease, and this is only likely to get worse as climate change and rising populations make sustaining poorer countries more difficult than ever.

But the developing world also has huge potential. According to a recent PWC report, leading up to 2050, the 10 fastest-growing economies are all likely to be developing countries, while many developed economies will find their growth hampered by slowing productivity and the needs of their aging populations.

For the health of the global economy — as well as to relieve pressure on developed world countries’ ability to cope with increased migration — helping the developing world become more stable and sustainable is in everyone’s long-term interests. Yet, until recently, most attempts to help had been based around charities and aid.

This is starting to change. Below, we round up some interesting, innovative projects — many driven by the private sector — that could have a significant positive long-term impact on the developing world.

In-Depth

The reasons for the slow growth of the developing world economies are well-documented: poor infrastructure, lack of education, lack of money, high levels of disease, susceptibility to extreme climate events, political corruption and instability.

Solving this is a long-term challenge, not something that can be fixed with a bit of international aid to mitigate the effects of the latest crisis. With governments often focused on the short-term periods before the next election, it is increasingly business that is starting to come up with innovative and effective solutions.

Improving access to knowledge

It might seem strange to suggest technology-based solutions to education in societies where many struggle to earn enough to feed themselves. But to build viable societies and thriving economies, we need to provide the workforce of the future the skills it needs. Everything starts with education — but how can we provide access to reliable, quality education in underfunded countries with poor infrastructure and a serious lack of trained teachers?

According to recent Pew Research Center data, a majority of people across the developing world now have access to a mobile phone. This is a real game-changer.

Access to a mobile means having access to information, and access to information means having the ability to make improvements to your way of life. Even basic feature phones can improve literacy rates, according to the World Bank, while smartphones, computers and tablets have the potential to radically change the educational landscape of developing countries.

By enabling access to the internet, a single connected device shared by a community can provide access to structured remote learning programs, as well as all the knowledge on the World Wide Web. And while internet access may still be a challenge for the most remote communities, there are several initiatives under way to provide universal global Internet — Google’s Project Loon, which uses high-level balloons to provide wireless connectivity, and Facebook’s satellite-based Internet project are merely two of the most high-profile.

Access to the internet can also bring significant health benefits. Connected devices are increasingly being used for some remote medical examinations through organizations such as Peek and CardioPad. Education campaigns to improve knowledge about nutrition and basic hygiene via mobile could also have immense impact; improving knowledge about child nutrition in the poorest countries could boost their GNP by 11%, cut child deaths by a third, and increase wages by up to 50%, according to the Scaling Up Nutrition movement. Even simple text message alerts about disease outbreaks, such as those used in Sierra Leone during 2014’s Ebola outbreak, have the potential to save tens of thousands of lives.

Improving access to finance

Technology could also help tackle the developing world’s funding challenge. According to the Bill and Melinda Gates Foundation, only 41% of adults in developing countries have bank accounts. Without bank accounts, saving for the future — to invest in improving farms and businesses and to weather unexpected financial shocks — becomes much harder, as well as far less secure. It can also restrict the ability to buy products and services that people need to improve their lot in life.

Access to physical banks remains a serious challenge for remote communities — which is where mobile phones again come in. Vodafone’s M-Pesa money transfer system is one of the best-known examples of mobile-based payments, reducing the need for a traditional bank account, but there are plenty of alternatives (such as Africa’s Airtel Money, or Bangladesh’s bKash). “The mobile phone is becoming ubiquitous and is a natural distribution channel,” says Aon’s latest Global Insurance Market Opportunities report. “It offers the promise of more efficient distribution and an improved ability to scale quickly.”

Yet the ability to make payments is one thing, but getting hold of the money to pay them is quite another. This is where microfinance comes in.

First established in the 1970s, the microfinance concept is simple: provide reliable, low-interest loans of relatively small sums to the poorest in society to enable them to invest in essential equipment or materials to start or improve their businesses. With the rise of mobile, the logistics have become considerably easier — and the concept has been spreading exponentially. With basic seed capital becoming more accessible to small businesspeople across the developing world through organizations such as the Nobel Peace Prize-winning Grameen Bank, the potential for economic growth is stronger than ever.

But while loans are a good start, the next phase in microfinance is set to focus on providing additional financial security through microinsurance. Funded by low payments, if crops fail, natural disasters strike or illness or injury hit, low-cost insurance for the world’s most vulnerable can help them recover — where previously they may have had no safety-net. People with microinsurance have also been shown to invest more in developing their businesses. This has been shown to encourage the use of healthcare services, prevent the spread of diseases and help reduce the burden on government budgets for pensions, healthcare and aid.

Teach a man to fish

The key to both these approaches is to help the world’s poorest help themselves — not merely teaching them to fish rather than giving them a fish but providing them with the ability to buy their own fishing nets, rods and boats and with the security of knowing that if any of these are broken, they will be able to replace them.

Where previous efforts at helping the developed world to develop have focused on providing vital infrastructure, healthcare or nutrition one community at a time, the shift in recent years toward helping the developing world help itself is proving a revolutionary innovation. It’s still early days, but the signs are that by focusing on improving access to knowledge and finance and empowering communities to focus on building sustainable improvements, the developing world is starting to have a better chance of developing than ever before.

Talking Points

“From better health to increased wealth, education is the catalyst of a better future for millions of children, youth and adults. No country has ever climbed the socioeconomic development ladder without steady investments in education.” – Irina Bokova, Director General, UNESCO

“There has been a strong social mobilization to use cell phones, television and whatever technology the government and private health care sector can to disseminate public health messages… Modern technology is vital here, and it can be this simple.” – Ladi Awosika, CEO, Total Health Trust

“The problems and risks facing low-income populations are vast and complex. Offering microinsurance to these segments brings with it all the complexities of their daily life which need first to be understood and then addressed by microinsurance stakeholders; education levels, house-hold budgeting, behavioral economics, choice, priorities and inconducive infrastructure to name but a few. These barriers change from community to community, from region to region and are often vastly different to those faced by the more traditionally served clients in developed insurance markets.” – Marco Antonio Rossi, President, Brazilian Insurance Federation

This article originally appeared onTheOneBrief.com, Aon’s weekly guide to the most important issues affecting business, the economy and people’s lives in the world today.”

Further Reading

‘Un-Healthcare’ Work Deserves Focus

Some, like me, who have dedicated their lives to the maintenance and improvement of physical and mental health, may not consider themselves traditional, clinical “healthcare workers.” We may feel as if we work on the fringe, on the outside. We are not nurses or physicians. We work in public health, wellness, nutrition, occupational safety, health economics, fitness, risk management, pharmacy, laboratory, research, insurance and other similar non-traditional clinical professions. We may feel we make a lesser impact on patient care and overall community wellness and vitality. Given historical reference, however, this is absolutely untrue.

The term “healthcare” (whether one word or two) has not been used at all in books, papers, references or published text over hundreds of years, until the mid-1980s. But since the late 1700s, those of us “living on the fringes” have been healthcare workers in the true sense of the practice.

We may not provide bedside patient care in a healthcare or hospital setting, but we do:

  • Prevent infectious disease by promoting the use of vaccines;
  • Protect the public from pathogenic organisms through water and food sanitation;
  • Prevent addiction and antibiotic resistance through pharmaceutical stewardship;
  • Manage repercussions from post-traumatic stress with mental health interventions;
  • Research global disease trends to stop them in their tracks;
  • Manage risk by improving safety, security and improving quality;
  • Decrease work-related injury and illness by creating safe workplaces, and
  • Prevent heart disease and weight-related cancers by promoting regular exercise.

Those efforts ensure that a population’s health (both physical and mental) does not suffer, that it is either maintained or, better yet, improved. We are the “Un-Healthcare Workers.”

It is especially important that traditional healthcare organizations and healthcare workers know this now. As healthcare systems around the world are caring for patients with emerging infectious diseases like Ebola and re-emerging vaccine-preventable diseases like measles, they need to consider that we un-healthcare workers have responsibility for protecting our communities. If we can prevent diseases from becoming epidemic in our communities, healthcare providers working in healthcare settings like hospitals can focus more on providing needed care to those with emergent injuries and chronic disease.

The American Public Health Association (APHA), which has represented people protecting the public since 1872, announced a policy in November on preventing Ebola and “globally emerging infectious disease threats” that marked a significant change in the recognition of the “un-healthcare worker.” The APHA identified the need to focus efforts on preventing infectious disease in the community and workplaces as a means to protect healthcare systems from exposure to diseases that may change the overall landscape of inpatient care. In the process, the APHA advocates for the role that we “un-healthcare workers” have in maintaining and improving the physical and mental health of our population so that healthcare workers can focus on medical interventions for those who really need it.

Sound, science-based public policy and fiscally grounded public health funding can do what it did for the hundreds of years prior to the mid-1980s; it can protect our communities from disease, so that we can protect the vitality of our healthcare systems.

OSHA Should Help on Infectious Diseases

OSHA’s promulgation of an infectious disease rule/standard to protect healthcare workers and employees in healthcare facilities from microorganisms that cause illness and infection would be a welcome expansion of the work OSHA has already done related to bloodborne pathogens.

A standard of national caliber would not apply any more pressure to healthcare employers than they already place on themselves to protect the patients and healthcare workers they serve. On the contrary, a rule would highlight the importance of the safety and health of healthcare workers.

However, just when we, as a nation, are designing programs to protect healthcare workers from exposure to emerging infectious diseases, like Ebola virus, small businesses say, “No thanks, OSHA, we’re all good.” Just recently, the Small Business Advocacy Review (SBAR) Panel issued a report to OSHA Assistant Secretary Dr. David Michaels that said small healthcare businesses (to include ambulatory surgery, doctors’ offices, dental offices, specialty clinics and dialysis centers, to name only a few) weren’t interested in better protections for their workforce.

Small entity representatives (SERs) decided that the guidance that is already in place is good enough and that OSHA would just be adding more requirements. The SBAR report stated:

Many SERs felt that this rule would overlap with and/or duplicate other relevant guidelines and regulations, including, for example, materials issued by the Centers for Medicare and Medicaid Services (CMS), the Joint Commission and other voluntary accrediting organizations, and state accrediting boards.

SBAR has a point: Guidance is in place from CMS, the Joint and others, like CDC. But the guidance is almost completely to protect the patient, not the worker.

The American Public Health Association (APHA) disagrees with the SBAR panel and firmly believes that an OSHA standard should be fast tracked to protect the working public. The APHA issued a national policy statement just last month.

We learned from the Ebola exposures in Dallas that those infected after exposure were the healthcare workers, not other patients. If a patient enters an emergency department feeling generally ill, it is not typically the other patients who are potentially exposed to a yet-to-be-identified pathogen; rather, it is the string of healthcare workers with whom the patient comes into contact. Those include workers who examine the patient, take vitals, take blood or other specimens, assess, diagnosis and eventually treat. In the case of the Dallas Ebola victim, that was dozens of healthcare workers both in and outside of the hospital over more than a week’s time.

The population of healthcare workers that a standard like OSHA’s infectious disease standard could protect is vast. It is typically in smaller healthcare settings that greater protections are needed, as these operations often intersect more closely with the community and have lesser controls in place compared with hospitals or larger health systems. In fact, nearly 10% of the U.S. working population is employed in healthcare settings of all sizes, and healthcare will generate millions of new jobs through the next decade (Bureau of Labor Statistics 2013). This sector of the workforce represents the largest segment of employment growth in the U.S. and serves the largest proportions of Americans, ensuring proper and timely diagnosis, treatment and care. Healthcare employment is marked as the industry sector with the largest growth (2.4%).

Better controls to protect our most important healthcare assets — its workers — are needed now.

OSHA’s bloodborne pathogens standard (BPS) alone will not address these important and constantly emerging occupational risks associated with hazards that are not often visible to the naked eye.  Promulgating an infectious disease role nationally, much like CalOSHA did with its aerosol transmissible diseases standard (ATD, §5199), would provide OSHA the opportunity to work with healthcare facilities and providers of care to develop standards that protect their employees from not just physical or chemical hazards, but biologic ones. Healthcare facilities would have the ability to control the environment of patient care and make it safer for all who enter: patients, family, friends, volunteers, contractors and caregivers alike.

This standard, if done right, has the potential to provide the following benefits:

–       Prevent transmission of microorganisms that cause illness and infection

–       Improve safety for healthcare workers

–       Make care for patients safer

–       Increase the viability of the healthcare work force and the healthcare economy

–       Reduce costs associated with workers’ compensation, time away from work, staff turnover

–       Provide a collaborative, bridge-building role with other U.S. agencies like CMS, CDC and the Food and Drug Administration (FDA)

–       Serve as a model for other countries

OSHA’s continued journey down the path of promulgating an infectious disease standard illustrates the role that it can play in bridging the gap between infectious disease and occupational safety and health experts.

Workers’ Comp Issues to Watch in 2015

Tis the season for reflections on the past and predictions for the future. As we kick off 2015, here are my thoughts on the workers’ compensation issues to watch this year.

What Does TRIA’s Non-Renewal Mean for Workers’ Compensation?

Thanks to congressional inaction, a last-minute rewrite added this subject to the issues for this year. I’m not about to predict what Congress will do with TRIA legislation in 2015, as there are no sure things in the legislative process. We have already seen the reaction from the marketplace. Back in February 2014, carriers started issuing policies that contemplated coverage without the TRIA backstops. We saw some carriers pull back from certain geographic locations, and we also saw some carriers change the terms of their policies and only bind coverage through the end of the year, giving themselves the flexibility to renegotiate terms or terminate coverage if TRIA wasn’t renewed. But while some carriers pulled back in certain locations, others stepped up to take their place. While some carriers tied their policy expiration to the expiration of TRIA, other carriers did not.  Going forward, some employers may see fewer carrier choices and higher prices without the TRIA backstop, but ultimately most employers will still be able to obtain workers’ compensation coverage in the private marketplace. Those that cannot will have to turn to the State Fund or assigned risk pool.

Rising Generic Drug Prices

The opioid epidemic, physician dispensing and the increased use of compound drugs are issues the industry has faced for years. While these issues continue to be a problem, I want to focus on something that is getting less attention. Have you noticed that the costs for generic prescription drugs are increasing, sometimes significantly? In the past, the focus was on substituting generic drugs for brand names, which provided the same therapeutic benefit at a fraction of the costs.  But now the rising costs of these generic medications will drive costs in 2015. These price increases are being investigated by the Federal Drug Administration (FDA) and Congress, but I do not expect this trend to change soon.

Medical Treatment Guidelines

Another issue to watch on the medical side is the continued development of medical treatment guidelines and drug formularies in states around the country. This is a very positive trend and one that our industry should be pushing for. There is no reason that the same diagnosis under workers’ comp should result in more treatment and longer disability than the same condition under group health. One troubling issue that I see here is the politics that come into play. Sorry, but I do not accept that human anatomy is different in California or Florida than in other states. I feel the focus should be on adopting universally accepted treatment guidelines, such as Official Disability Guidelines, or “ODG,” rather than trying to develop state-specific guides. The ODG have been developed by leading experts and are updated frequently. State-based guidelines often are influenced by politics instead of evidence-based medicine, and they are usually not updated in a timely manner.

How Advances in Medical Treatment Can Increase Workers’ Comp Costs

There is one area in which advances in medicine are actually having an adverse impact on workers’ compensation costs, and that is in the area of catastrophic injury claims. Specifically, I’m referring to things such as brain injuries, spinal cord injuries and severe burns. Back in 1995, Christopher Reeve suffered a spinal cord injury that left him a quadriplegic. He received the best care money could buy from experts around the world, and he died less than 10 years after his injury.  But as medicine advances, we are now seeing that a quadriplegic can live close to normal life expectancy if complications can be avoided. Injuries that used to be fatal are now survivable. That’s great news. The downside for those paying the bills is that surviving these injuries is very costly. The cost of catastrophic medical claims used to top off around $5 million, with a $10 million claim being a rarity. Now, that $10 million price tag is becoming more the norm.

The Evolving Healthcare Model

For years, workers’ comp medical networks focused on two things: discount and penetration.  Sign up as many physicians as you can as long as they will agree to accept a discount below fee schedule for their services. I’m happy to say that we are slowly, finally, evolving away from that model. Payers are realizing that a better medical outcome for the injured worker results in lower overall workers’ compensation costs, even if that means paying a little more on a per-visit basis. We are now seeing larger employers developing outcome-based networks, not only for workers’ compensation, but for their group health, as well. Employers are also starting to embrace less traditional approaches such as telemedicine. Finally, more and more employers are recognizing the importance that mental health plays in the overall wellness of their workforce. In the end, we are slowly starting to see is a wellness revolution.

The Need for Integrated Disability Management

The evolving healthcare model is tied directly to an evolving viewpoint on disability management. More employers are realizing the importance of managing all disability, not just that associated with workers’ compensation claims. Employees are a valued asset to the company, and their absence, for any reason, decreases productivity and increases costs. I feel this integrated disability management model is the future of claims administration. Employers who retain risk on the workers’ comp side usually do the same thing with non-occupational disability. These employers are looking for third-party administrators (TPAs) that can manage their integrated disability management programs. And make no mistake: Having an integrated disability management program is essential for employers. Human resource issues such as the Americans With Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA) cross over into the workers’ compensation realm. The same interactive process required on non-occupational disability is required in workers’ compensation. Employers must be consistent with how they handle any type of disability management, regardless of whether the cause is a workers’ compensation injury or non-occupational.

Will We See a Push for ‘Opt Out’ in Other States?

Most people know that non-subscription, or opt out, has been allowed in Texas for many years. The Oklahoma Option that started last year is viewed as a much more exportable version of opt out. Under this system, employers can opt out of workers’ compensation, but they must replace it with a benefit plan that provides the same (or better) benefits available under traditional workers’ compensation. While some view the Oklahoma Option as the start of an opt-out revolution, it is just too early to tell what impact it will ultimately have. But, make no mistake, discussions about opting out are spreading to other states. A group called the Association for Responsible Alternatives to Workers’ Compensation is currently investigating the possibility of bringing opt out to other states. I expect to see opt-out legislation in a handful of other states in the next three to five years.

Marijuana

Marijuana legislation is a very hot topic these days.  In national polls, the majority of Americans favors legalization of marijuana in some form.  Recreational use of marijuana is now legal in four states (Colorado, Washington, Oregon and Alaska), and 23 states allow medical marijuana. When it comes to workers’ compensation, much of the attention has been focused on medical marijuana as a treatment option for workers’ comp because a judge in New Mexico allowed this last year. My concern is around employment practices. Employment policies around marijuana have been centered on the fact that it is illegal, so any trace in the system is unacceptable. That is going to change. I fully expect the government to reclassify marijuana from Schedule I to Schedule II in the next few years. When that happens, zero-tolerance policies in the workplace will no longer be valid. Instead, the focus will have to be like it currently is with alcohol: whether the person is impaired.

The Next Pandemic

Another hot topic these days is Ebola. While the threat from this particular disease seems to be subsiding, the concerns about Ebola last year showed we are not ready for that next pandemic. People who were exposed to the disease were allowed to interact with the general population and even use commercial travel. Government agencies debated whether travel to certain countries should be limited. The problem is, diseases don’t wait for a bureaucracy to make decisions. While this threat didn’t materialize, you can see how easily it could have. With work forces that travel around the globe, the threat of a global pandemic is very real. You know where you send your workers as part of their job, but do you know where they go on vacation? As an employer, are you allowed to ask about what employees do during their personal time? Are you allowed to quarantine an employee who traveled to an infected country during vacation? These are very complex legal questions that I cannot answer, but these are discussions we need to be having. How do we protect our employees from the next pandemic?

Rates and Market Cycle

You cannot have a discussion around issues to watch without talking about insurance premium rates in workers’ compensation. After several years of increasing rates around the country, the National Council on Compensation Insurance (NCCI) is projecting that, in 2014, workers’ compensation combined ratios were below 100% for the first time since 2006. This means that, as an industry, writing workers’ compensation is profitable again. So what should buyers expect in 2015? Well, it depends. California continues to be a very challenging state for workers’ compensation costs. New York is challenging, as well. Given the percentage of the U.S. workforce in those two states, they have significant influence on the entire industry. Some employers will see rate reductions this year, and some will not. In the end, your individual loss experiences will determine what happens with your premiums. That seems to be the one constant when it comes to pricing. Employers with favorable loss experiences get lower rates, so it pays to stay diligent in the areas of loss prevention and claims management.

Will We See More Constitutional Challenges Similar to Padgett in Florida?

While I don’t think the Padgett case will be upheld on appeal, I am concerned that the case is the first of many similar ones we could see around the country. Look at the main arguments in Padgett: The workers’ compensation system is a grand bargain between injured workers and employers. Workers gave up their constitutional right to sue in civil courts in exchange for statutorily guaranteed, no-fault benefits. Over the last 20 years, many workers’ comp reform efforts around the country have focused on lowering employer costs. Standards of compensability have been tightened. Caps have been put on benefits. The judge in Padgett looked at these law changes and ruled that workers’ compensation benefits in Florida had been eroded to the point where it was no longer a grand bargain for injured workers. He ruled that the workers’ compensation statutes were unconstitutional on their merits because the benefits provided are no longer an adequate replacement for the right to sue in civil court that that the workers gave up. Attorneys tend to mimic what succeeds in other courts, so I expect we are going to be seeing more constitutional arguments in the future.

Impact of the Evolving Workforce

One of the biggest issues I see affecting workers’ compensation in 2015 and beyond is the evolving workforce. This takes many forms. First, we are seeing technology replace workers more and more. When was the last time you went to a bank instead of an ATM? I have seen both fast food and sit-down restaurants using ordering kiosks. Also, we are seeing more use of part-time vs. full-time workers. Some of this is driven by concerns around the Affordable Care Act. But part-time workers also have fewer human resource issues, and their use allows employers to easily vary their workforce based on business needs. Unfortunately, part-time workers are also less-trained, which could lead to higher injury frequency. Finally, the mobile work force is also creating concerns around workers’ compensation. Where is the line between work and personal life when you are using a company cell phone, tablet or computer to check e-mails any place, any time? Where do you draw the line for someone who works from home regularly? There have been numerous court cases around the nation trying to determine where that line is. This is a very complex and evolving issue.

To view a webinar that goes into these topics in more detail, click here: https://www.safetynational.com/webinars.html