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Expat and international employee health care trends 2021

The COVID-19 pandemic has impacted everyone in different ways, and expats have their own set of unique factors.

Many health care trends are universal, yet some emerge regionally or through individual companies. This article explores the health care trends affecting expats and, importantly, what we can expect to see emerging in the post-COVID-19 world.

To help us in this quest, we spoke to Dr Hemal Desai, Global Medical Director for Aetna International.

Trends summary:

  • Virtual health adoption will continue to grow
  • National health systems will change as governments adapt to COVID-19
  • The burden of delayed care is on the horizon
  • Insurers will struggle to manage the impact of COVID-19 long term
  • Chronic disease management will become a priority
  • Mental well-being needs will increase
  • Physical fitness polarisation will continue into 2021
  • Expat health benefit demands will increase – so will adoption
  • Employers are more attuned to employee health than ever

How has COVID-19 impacted expat health care?

To talk about the future we must first understand the present. Dr Desai describes four key areas in which expat health care demand, access, adoption and provision has been affected by the pandemic:

1. Seeking medical care

“Many expats have been reluctant to go and seek medical attention, whether for suspected COVID-19 or other conditions. This is universal, but particular to the expat community as they may be less familiar with health care system in their new home. As such, they may not trust it. And this is affecting whether they seek medical attention.”

2. Health care quality

“As well as whether they should seek local care or not, expats are questioning the quality of that health care more than ever. This is also impacting people’s decisions to move abroad: ‘will I be able to access quality care when I get there?’. This is driving a desire to understand health and health care systems in their new homes more than ever.”

3. Health care security

“People are becoming more receptive to the idea of some health care security. They want to secure their health care provision — not just hope they’ll be fine, that care in their new home will be ok. People are looking at reviewing their health care insurance coverage and the benefits they have because they feel they need more or different coverage. And this can play an important role in the decision to move abroad.”

4. Mental health

“Expats are focusing on mental as well as physical health. Expats are recognising that these are stressful times, certainly when moving abroad and taking on assignments and stress can compound mental health issues.”

Virtual health adoption will continue to grow

Virtual health has quietly been revolutionising access to primary care, allowing those who cannot access care to do so remotely – wherever they are, whenever they need. As such it has played a key role in helping expats in less developed countries access quality care.

“Adoption was growing but it accelerated because of COVID-19,” says Dr Desai. “Our parent company, CVS, witnessed a 3,000% increase in virtual consultations for mental health conditions, and 400% for physical health conditions. Our virtual health service vHealth has witnessed double-digit growth in India — Dubai and Thailand growth is similar.

“What’s key is that while people may have adopted it because of COVID-19 fears, they are not using it for COVID-19 queries. In Dubai, nine out of 10 consultations have been non-COVID-19 related so demand has increased for general health care needs.”

While Dr Desai expects adoption to fall away a little after the pandemic, he suggests that underlying growth will continue in the expat community.

National health systems will change as governments adapt to COVID-19

There is a relationship between governments, expats and health insurers. Where health care is free to all at the point of access, expats may choose not to seek medical cover. For most expats, quality health care may not be free, cheap or even available in their new home.

The pandemic has reduced government tax revenues and health care systems have been overwhelmed in many nations. How will this impact expats and their need for insurance?

Dr Desai explains that the effects will be different in different regions.

“In Africa, access to quality health care can be difficult in some places and the impact of COVID-19 has been profound — especially where capacity was already low. The private sector has also been impacted because of capacity issues and, in some cases, governments have used their own infrastructure to provide care for COVID-19 patients.”

In many countries around the world, particularly in the Far and Middle East, things are slowly returning to normal — particularly in terms of health care capacity.

As Dr Desai explains, what has impacted private hospitals is non-attendance which impacts revenues. “A lot of hospitals have been empty, particularly in the private sector.”

Governments are only too aware of the intertwined health, social and economic impacts of the pandemic. Public health policy makers and private hospital groups have implemented crisis response measures and are now focused on long-term sustainable strategies to address the challenges facing populations.

The burden of delayed care is on the horizon

Dr Desai says there is a ‘hidden burden of illness’, fuelled by people’s reluctance and/or inability to seek and/or find health care in person.

“One study has shown that there's been also almost a 50% reduction in attendances for cardiovascular disease in hospital emergency rooms. Other studies show that between 20% and 30% of people in the U.S. have not been going to hospitals for cardiovascular disease and for heart attacks. People have been dealing with this at home which can have a massive impact on the health outcomes.”

“There’s been a short-term dip in claims, but it’s only a lag. The burden of health care is on the horizon and the care people are going to require is going to be significant.”

“Governments are currently trying to maintain the health of their populations - getting people to actually go and access health care when they need it.”

Insurers will struggle to manage the impact of COVID-19 long term

Dr Desai explains that many insurers are struggling with how they’re going to manage the impact of COVID-19 in the longer term. In many cases as a knock-on effect of struggling governments and private facilities as well as the burden of delayed care.

“At Aetna we’re looking at how we support our members to seek the right support to get the right care and put the right checks in place so that they don't miss anything and get treated when they have confirmed symptoms or an illness. These are important factors that matter to people.”

Chronic disease management will become a priority

As and when things return to normal, chronic disease management should become a priority for patients, and will become a priority for insurers.

“We need to make sure that people with chronic diseases engage with health care providers so that they don't develop complications.”

Read about Kaia the pain management app

Mental well-being needs will increase

With their unique context, expats can also suffer increased pressures such as stress, and existing mental health conditions can be exacerbated by inadequate global mobility support, regional stigma, a lack of access to appropriate care or a familial support network. Layering on lockdown, travel restrictions and family and social pressures has left expats even more vulnerable.

“Mental well-being is also an important aspect for insurance companies because it has such a wide-ranging impact on the member and their family - particularly in the expat context,” says Dr Desai.

“We’re looking at a lot of mental health and well-being support for our members. This ranges from access to digital health tools such as Wysa to our employee assistance programme (EAP), which includes Mindfulness Based Stress Reduction. Aetna itself is developing at pace but this is an industry-wide trend.”

Read about Wysa, the mental health app

Physical fitness polarisation will continue into 2021

As Dr Desai explains, the pandemic — and in particular working from home — has sent many people’s physical fitness in one of two directions:

  • Reduced fitness (often including weight gain) due to a more sedentary lifestyle with reduced exercise due to lockdown or increased work pressures
  • Becoming healthier due to increased control of food (possibly driven by the urge to get healthier due to fears of infection).

Every expat context will have its own influences on this. For example, heat and potential sun damage can affect expats’ ability to go for a run in UAE — especially during the summer months. Without access to gyms, many expats in the Emirates may find exercise difficult. Similarly, expats in countries in the far north may find it too cold to exercise outside in the winter months.

“Some expats have found their fitness worsening because of the inability to maintain physical activity or due to a lack of time due to an increase in work-related pressures,” he says. “While others have found they have more time to do physical exercise because of a reduced commute — unconstrained by office lifestyle.

“I think we’ll see these two trends continue into 2021.”

Dr Desai adds that the musculoskeletal repercussions of working from home have yet to be measured but are a concern. This is because people do not have the same ergonomically designed workspaces at home that they might have in the office which may lead to musculoskeletal problems. “We'll see a longer-term impact of that through 2021”.

Helping home-working employees set up ergonomic workspaces should be a priority. Read our work space advice here.

Read about ClassPass remote gym sessions and classes

Expat health benefit demands will increase — so will adoption

Our survey data from 2019 and 2020 shows how COVID-19 has helped to reduce employee health inertia, encouraging people to engage with their corporate health benefits – often demanding more.

“Expats are demanding more from their employers,” says Dr Desai. “And insurers across the board are starting to respond. There is a wealth of support that insurers can provide and it’s increasing year on year.

“Here at Aetna for example, we’ve substantially increased the level of support we're providing our members, including a range of digital tools and professional services.”

A lack of employee engagement with wellness programmes in previous years often meant employer choices were harder to make due to a lack of insight and a deep understanding of workforce needs. With increased demand and, as Dr Desai explains, “very specific demands,” employers will be able to tailor benefits for their workforce — because, as any employer of expats will know, one size does not fit all.

Employers are more attuned to employee health than ever

“Companies are becoming much more aware that their employees could be impacted by the various aspects of the pandemic and lockdown — and this is an important change. They’re looking for help around physical health, physical fitness and mental health.

“In many cases, insurers like us will have ready-made solutions ready to go, so it may not even be an increase in the number of solutions on offer, but increased adoption by employers and their employees – who are now really seeing the value.”

If you’re interested in corporate wellness, why not subscribe to our Fit For Duty podcast? Or you can listen right now.

Why not contact us to see how Aetna International can support your employees’ physical and mental health now and after the pandemic? Get in touch in your region.

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