IN THIS ISSUE...My Three Wishes for A Healthier Health Care System

My Three Wishes

- The common threadis the disconnect inour medical system

Holiday Hours

123 Benefit Plan

- Rates for 2008

Standard OrthoticPlan

- Revisions effectiveJanuary 1, 2008

A few things caught my eye thismonth… 'Unhappy EmployeesGet Sick' was the headline in onenewspaper; another article touted the revelation that 'HighDrug Costs Could Be Cut'; andyet another espoused the virtuesof e-medicine. The commonthread, and this isn't news, is thedisconnect in our medical system."Soaring drug costs could be cutin Canada if doctors paid atten-tion to the cost of the medica-tions they prescribe", says a federal report. The study, commissioned by IndustryCanada, found that Canadianphysicians are generally oblivi-ous to drug prices and often pre-scribe an expensive drug when acheaper one would do. “Therereally isn't a formal mechanismthat credibly brings cost into thephysician's decision-makingprocess when issuing prescrip-tions”, says a report by IMS

Health Consulting Inc. TheUnited States and Britain do usehealth management systemsthat take drug prices intoaccount, thereby helping toreduce pharmacy bills.Incorporating appropriate costconsiderations into the medicaldecision-making process couldoffer reduced costs to the health-care system and shouldbe considered by each of theprovinces.The study examined what happens to drug sales whencheaper generic versions ofpharmaceuticals go on sale afterthe expiry of Canada's eight-yearpatent protection for the brand-name equivalent. After severalmonths, the generic version typically supplants the brand-name, and brand-name drugcompanies stop promoting theirown version. This process is driven by the fact that provincialdrug formularies allow pharma-cists to quietly substitute thegeneric version even though adoctor may have prescribed abrand name, allowing theprovinces to save on pharma-care programs.Doctors are bombarded withmarketing materials promotingbrand names. They don't havethe time to consider the cost burden to the patient or to government pharmacare planswhen writing prescriptions.Perhaps we need a mechanismto make them aware? How aboutcomputer systems that allowdoctors to check drug pricesbefore they prescribe?Brand name drug companies

need revenues to invest inresearch. Government, employ-ers and patients will save moneydue to the savings that are creat-ed due to an e-drug system.Surely there is a fix here?Speaking of electronic sys-tems… Sapphire Health Group,a Waterloo-based private healthfirm, has created a plan to man-age health files for patients thatraises issues that doctors andpatients might like to consider.They are promoting the idea ofaccumulating patient healthrecords and then making themavailable to whichever doctor orhospital needs them. The infor-mation could include test results,adverse drug reactions, past procedures and 'do-not resusci-tate' orders.The idea has some merit fromseveral different perspectives.From a patient's perspective, theadvantage of having a doctor ornurse with more information,rather than less, would seem tobe undeniable, providing that thepatient can rely upon theprovider of the information to notrelease it improperly. The elec-tronic transfer of records wouldspeed up the usual ‘question andanswer’ method of obtaininginformation that doctors andnurses have used when theyneed to understand a patient'sproblem.This proposal has to be looked atfrom a broader perspective thatgoes beyond legal issues. Why,in an age when just about everytype of information is availableelectronically, are medicalrecords not among them?

Mon. Dec. 24 - Closed -12:30pm

Tues. Dec. 25 - Closed all day.Wed. Dec. 26 - Closed all day.Mon. Dec. 31 - Closed -12:30pm

Tues. Jan. 1 - Closed all day

The staff at RWAM Insurance Administrators Inc. would like

to wish you a safe holiday season& the best of health

and happiness in 2008.

continued on reverse...

DECEMBER 2007

Disclaimer: "Insights" is published as a service for our clients and others. As a general summary or commentary, it is not to be relied on as a statement of fact,

advice or opinion on any topic. Commentary reflects the opinion of its author(s) and in no way constitutes official or unofficial policy of RWAM or any affiliate.

RWAM Insurance Administrators Inc. 49 Industrial Dr. Elmira ON N3B 3B1 519-669-1632 www.rwam.com

DECEMBER 2007

Ontario Conservative leader John Tory didraise this question a few months back.He's not the first person to do so. E-healthrecords were recommended by theRomanow report in 2002. Alberta andPrince Edward Island plan to have electronic systems by 2008 and BritishColumbia hopes to have its system running by 2009.Setting up an electronic network for main-taining health files won't be cheap, butthen... what in health care is these days?Lastly, "Unhappy workers get sick". Again,not a shocker, but with a New Year soon tobe upon us, it's worthy of revisiting.Giving workers a sense of control overwhat they do is the key to reducing healthproblems. Employers tend to focus on thesymptoms, such as high absenteeismrates, when they should deal with theunderlying cause - the design of the jobs."If you're a company that is spending yourtime wondering how you will reduce

employee absence by a quarter of one percent, you are looking at the problem com-pletely backwards", says Stephen Bevan,a director of research at the WorkFoundation in the United Kingdom. Hesays people with low-status jobs and with alow level of control over their work environ-ment are the ones who suffer the mostfrom serious health problems such as cardio-vascular disease and mental stress.

Job satisfaction is the biggest factor inpredicting how quickly a person will returnto work. Everything I've read suggeststhat any health initiatives that employersput into effect will have little impact if theydon't provide people with a greater senseof control, autonomy and flexibility. On anyworking day, between three and five percent of the workforce will be absent fromwork because of a physical problem ormental stress, and a further twenty-fiveper cent of workers may be at work, butwill be performing sub-optimally.

When employees are highly satisfied andcommitted to their jobs, it leads to greatercustomer satisfaction. Giving employeesgreater control over their work environ-ment is one way employers can make adifference. One way to give employeescontrol is to design 'teams'. Every individ-ual is given the big picture and their con-tribution is broken down and seen as partof the overall plan.The biggest barrier to change continues tobe ourselves. Maybe the answer lies inlooking outside the nine dots? As a greatcoach once said, "Yesterday’s touch-downs don't win tomorrow’s footballgames".Connecting makes sense, whether it isfrom an e-system of some kind, or by cre-ating teams to ease the stress at work.Step back, take stock, and plan thechanges you would like to make for your-self, your family and your job.Make 2008 the best year you can.Until next year…

As part of RWAM's ongoing efforts to manage and control the costs of plan sponsors' groupExtended Health Care benefits packages, we audit claims data for trends and possible overusage.Orthotics awareness is on the rise. If an employee requires orthopedic shoes or just orthoticinserts, your Extended Health Care plan does provide a valuable benefit. However, as orthotics usage has risen, the risk to a plan sponsor’s overall costs can be signifi-cant. Many plans currently have no dollar limit for orthotics. Reference to the EHC Schedule of Benefits in your Employee Benefits Booklet will probablyindicate a "2 pair per calendar year" maximum for orthotics and/or orthopedic shoes, withoutany dollar limit. Historically this has been the standard. There are claims controls as described in the EHC Details section of your Employee BenefitsBooklet, such as requiring a prescription by an orthopedic surgeon, podiatrist, pedorthist, or chiropodist. Unfortunately, based on today's trends and the increasing prices of just one pair oforthotics, these controls no longer sufficiently address the escalating risk to your plan's costs.Therefore, effective January 1st 2008, your standard 2 pair per year benefit will have theadded control of "$500 total per calendar year". For most employees, this additional control should not affect their ability to still enjoy some significant cost relief for their prescribed orthotics.Please note you will see this change reflected in any renewed supplies of Employee BenefitsBooklets you order after January 1st. Please contact RWAM's Group Administration Department with any questions or concerns.

* Rates are subject to Provincial Sales Tax* $10.00 per month Standard Administration Fee

per group, subject to GST* Rates effective Jan. 1, 2008 and are reviewed annuallyAn employee may opt out of Health Care &/or Dental benefits ONLYif he/she has coverage under a spouse’s Health Care &/or Dental plan.

RENEWAL RATES - Designed specifically forthe Self-Employed & Small Group Employer

MANDATORY BENEFITSLife Insurance, Dependent Life, AD&D, Extended Health Care & Out-of-CanadaAll Eligible Employees

Single Coverage $ 65.00 /monthFamily Coverage $ 139.90 /monthExempt Coverage $ 14.00 /month

OPTIONAL BENEFITSDentalAll Eligible Employees

Single Coverage $ 43.40 /monthFamily Coverage $ 107.00 /month

Long Term DisabilitySome occupations are not eligible for Disability coverage due to the nature of the risk.All Eligible Employees $2.85/$100 of benefit

Revision to Standard Orthotics Benefit For All RWAM Groups Under 25 Livesl Effective Jan. 1, 2008

My Three Wishes, continued