September / October 2000 Table of Contents
Update on the Insurance
Lobby — Obtaining coverage of occupational therapy under extended
health benefits
by Darene Toal-Sullivan
Over 20 million Canadian employees, pensioners and their dependents receive health care protection through their employer.
CAOT, along with its provincial partners*, want to increase Canadians access to our services through employee insurance plans. In the past two years we have learned much about this important sector which will enable us to target this market
effectively.
The National Awareness Campaign which is targetting women 30 to 55 years of age will reinforce the key messages promoted in the insurance lobby.
If a demand for our services comes from the consumers and their employers then our position is strengthened considerably.
What issues are employers facing that provide
opportunities for occupational therapists?
Canadian employers are paying progressively more of their workers' health care costs because of changes in government health funding. "Philosophical decisions need to be made from an employers' perspective around this issue as to how much will be picked up by the benefits plan" (Benefits Canada, 1999a, p. 3). Consequently employer coalitions are being established in some provinces as a voice in federal and provincial health care decision-making. Employers Committee on Healthcare in Ontario (ECHCO), and the Alberta Employer Committee on Health Care, are two examples of groups that are lobbying government for change.
According to the International Foundation of Employee Benefit Plans (IBEBP) the three elements that are driving the costs of health care include:
- an aging work force,
- an increase in stress at home and work, and
- an increase in new drug releases.
There is growing recognition that more money has to be spent on ensuring a healthy work force by all of the stakeholders including the government (Negel, K. F., Schmitz, M., & Cutt, J., 1998). Illnesses resulting in short-term disability (STD) and long-term disability (LTD) claims have changed in the past three years, so that they now include more mental health disabilities, such as depression. This combined with an increase in use of antidepressant medications is forcing employers to look at employee stress and wellness programs. Early intervention is critical to the management of depression and in prevention of LTD claims. The most common approaches that appear to be used by businesses to reduce absenteeism and health costs include:
- health promotion and wellness programs,
- stress and disease management,
- health risk assessments, and
- disability case management.
Similarly a comprehensive benefits package that includes non-traditional benefits such as elder care can reduce caregiver stress and mitigate against lost productivity.
Although occupational therapists are involved in all of these four approaches, they face competition from other health professionals. The challenge is to position occupational therapy as the number one choice. Increasing the demand for our services places pressure on the insurance companies to include occupational therapy on their list of available services.
What types of insurance products cover
occupational therapy?
Insurance companies offer various types of products and services including life insurance, extended health care coverage, and short and long-term disability. Insurers offer these plans through an employer-sponsored group benefit program or through associations such as professional or alumni groups. Group health plans supplement services offered by the particular provincial government's medical plan. Provinces are required to meet the principles of the Canada Health Act which covers mainly hospital and physician care.
Disability insurance provides employees with partial replacement of lost income during periods of total disability, complementing workers' compensation benefits by covering injuries and illnesses not related to work. Rehabilitation services may be offered to assist the employee in reducing the duration of disability, and promoting return to work.
Extended health insurance helps employees and their dependents pay for medical expenses that are not covered by the provincial health plan. Extended health care plans vary according to the services that are covered in a core, optional or flex plan, and the amount of coverage for services.
Who needs to know what about occupational therapy?
There are many critical, decision-making groups that need to be aware of the health and cost containment benefits of occupational therapy. Some of these include:
- employees,
- insurance companies,
- employers,
- human resource professionals,
- benefit management professionals, and
- unions.
Typically, occupational therapy services are not included in an extended health insurance package. This presents two problems:
- people may not be aware of the health benefits of occupational therapy because it is not an available option to them, and
- people may be financially unable to access occupational therapy services that are required either for themselves or a family member. As a result, they may have to use alternate health services that may not meet their needs from an occupational performance perspective.
There is a shift to placing the responsibility of health care on the individual plan member. Employers are educating employees about what their benefit plan includes and why. In order for employees to request occupational therapy as part of the extended health benefits package they need to be aware of the services we provide. "It is important to educate and provide incentive for residents [employees] to seek the most appropriate service providers within the health care system" (ECHCO, 1995, p. 18).
Through consultation with occupational therapists and insurance industry professionals we have made great strides in learning about this sector. However, there is still a great deal to learn and this can only be accomplished by sharing our knowledge and understanding.
What can you do to assist in the insurance lobby?
1. Determine if your own employer benefits package includes occupational therapy coverage.
Every occupational therapist could contact their insurance company and request inclusion of occupational therapy in the extended health benefit plan.
2. Identify major industries and employers in your community to promote occupational therapy messages which may include:
- Occupational therapy makes good business sense.
- Occupational therapy reduces the costly effects of employee stress and injuries.
- Occupational therapists' knowledge and training enables them to complete a comprehensive job analysis. This covers not just the physical and environmental aspects but also the social and mental factors that affect an employee's health and well-being.
- Occupational therapists are university-trained, regulated, health professionals whose expertise is recognized by both federal and provincial governments.
- Occupational therapists provide the skills for the job of daily living. They can help employees and/or their families to lead more productive and fulfilling lives.
3. Measure outcomes to demonstrate the value of occupational therapy services.
The ability to measure effectiveness of health services is important to employers who must justify their financial costs. Potential outcomes include:
- health measures
- decrease in the cost of disability and medical claims,
- lower absenteeism rates,
- increased job satisfaction, and
- reduced injuries.
4. Develop case studies that emphasize the benefits of occupational therapy to employee and family wellness.
Recent studies in the area of work life have shown that support of a balance between work and personal life can be the best preventative measures for workplace failures (Benefits Canada, 1999b).
5. Write success stories that demonstrate the value of occupational therapy that can be promoted to consumer, insurance and human resource publications.
6. Create consumer tips illustrating the role of occupational therapy in different practice areas.
To date, CAOT has created a number of Occupational Therapy Skills for the Job of Living Tips. Some of these tips appear in each edition of Occupational Therapy Now and more are available from OT Works: The Canadian Occupational Therapy Resource site at www.otworks.com.
7. Use the CAOT lobby letter with clients to encourage insurance companies to recognize our services. A copy is available on both www.caot.ca and www.otworks.com, as well as in the CAOT Insurance Lobby ToolKit. If you would like a copy faxed to you, please contact publications@caot.ca or 1 (800) 434-2268, ext. 242.
Consumer tips, case studies and success stories can be shared with National Office and compiled as resources for individual occupational therapists and organizations to use in their lobby efforts. Alternatively if you would like assistance in developing these resources that can then be shared nationally, please contact me at 1 (800) 434-2268, ext. 237 or e-mail: dtoalsullivan @caot.ca.
CAOT Resources
Canadian Association of Occupational Therapists (2000). Private Insurance Lobby Toolkit. Ottawa, ON: CAOT Publications ACE.
OT Works: Skills for the Job of Living Marketing Brochure includes a description of our unique approach, qualifications and case studies to demonstrate the effectiveness of occupational therapy.
Skills for the Job of Living Pamphlets These are based on the tips found in Occupational Therapy Now or on www.otworks.com. (Contact: publications@caot.ca for the current list or 1 (800) 434-2268, ext. 242.
OT Works: The Canadian Occupational Therapy Resource Site contains not only more skills for the job of living tips but more in depth information regarding occupational therapy outcomes, our qualifications and how to hire us.
References
Benefits Canada. (1999a). Benefits: Evolving for the future. Part 3: Frustration. Retrieved April 28, 2000 from the World Wide Web: http://www.benefitscanada.com.
Benefits Canada. (1999b). The wellness package. Retrieved May 8, 2000 from the World Wide Web: http://www.benefitscanada.com/Content/1999/01-99/ben019901.html.
Employers Committee on Health Care-Ontario. (1998). Towards integrated delivery systems: An employer view. BCE Place, 161 Bay Street, P.O. Box 501, Toronto, ON M5J 2S5
Employers Committee on Health Care-Ontario. (1995). A perspective on health care. BCE Place, 161 Bay Street, P.O. Box 501, Toronto, ON M5J 2S5
International Foundation of Employee Benefits Plans. (1999). Employee benefits in the future. Retrieved April 19, 2000 from the World Wide Web: http://www.ifebp.org/ichotcnh.html
Negel, K. F., Schmitz, M., & Cutt, J. (1998). Corporate strategies: Reducing absenteeism and health costs. Employee Health and Productivity, 6 (4), 24-41.
Toal-Sullivan, D.(1999). Health insurance lobby. Occupational Therapy Now, 2, 18.
Toal-Sullivan, D.(1999). CAOT's Insurance lobby: Establishing private funding for occupational therapy services. Occupational Therapy Now, 4, 21.
Toal-Sullivan, D. (1999). Insurance lobby update. Occupational Therapy Now, 5, 3-4.
* Members of the Professional Alliance of Canada's project team include: The British Columbia Society of Occupational Therapists (BCSOT), the Ontario Society of Occupational Therapists (OSOT), and l'Ordre des Ergothérapeutes du Quebec (OEQ) and CAOT
Publications Department Expands at CAOT
This past July, the Publications Division of CAOT was restructured and expanded to accommodate the increase in our publications and communication activities. Lisa Sheehan our former Publications Representative was promoted to Publications Administrator and the following new staff were hired.
Lisa Wallans joined CAOT in the position of Publications Assistant as of July 10, 2000. Lisa works half days at CAOT office. Her primary responsibilities include the sales and distribution of CAOT publications and subscriptions. Lisa came to CAOT from the Child Maltreatment Division of Health Canada. Lisa is bilingual in English and French.
Susan MacEachern joined CAOT in the full time position of Desktop Publishing Administrator as of July 17, 2000. Susan's responsibilities include the layout of CAOT publication and communication products. Susan is a recent graduate of Algonquin College and Acadia University. Susan is bilingual in English and French.
News from the
Canadian Occupational Therapy Foundation
Upcoming competitions
September 30
Goldwin Howland Scholarship 1 x $2,000
Thelma Cardwell Scholarship 1 x $2,000
Masters Scholarships 2 x $1,000
Doctoral Scholarships 2 x $1,000
Janice Hines Memorial Award 1 x $500
November 1
COTF/CIHR Fellowships for
full-time Masters studies in pediatrics 2 x $19,530
MSOT Mary Judd Research Grant 1 x $1,000
November 30
Part-time Masters Pediatric Scholarships 2 x $5,000
Recent award winners
Sheryl Klein
COTF Research Grant ($5,000)
Evaluating Activities of Daily Living from an Occupational Therapy
Perspective.
Mary Egan
Publication Grant ($3,000)
Understanding occupation: a workbook to assist occupational therapy students in developing an understanding and appreciation of occupation.
Pediatric award available
The Janice Hines Memorial Award is available to members of CAOT to support
the transfer of knowledge of best practices in pediatric occupational
therapy. The award, valued at $500, can be used for travel, conference
presentations, equipment development or continuing professional education.
The deadline for applications is September 30, 2000.
COTF Information:
Tel. 1 (416) 487-5438
Fax. 1 (416) 487-5407
www.cotfcanada.org
September / October 2000 Table of Contents
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