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Report on health benefits use misses the point

don_suit.jpgWhat follows is a letter to the editor I recently sent to The Toronto Star’s Adam Mayers, in regards to Mayer’s article published on April 13 titled, The Rise of the Three Amigos of Health Care.

May 29, 2015  By Don Quinn Dillon

Dear Mr. Mayers.  I’m writing in response to your April 13th article, The Rise of the Three Amigos of Health Care.   In the article you present valid and serious concerns regarding how employer-sponsored benefit plans are utilized.  You quote Green Shield VP David Willows defining specifically physiotherapy, chiropractic and massage therapy as “the three amigos of health care” in providing “soft benefits,” i.e. harder to measure.

I appreciate your intention was to highlight how people use their employee health benefits at different ages and stages of life. While your article could have referred to more data – and indeed in a more objective way – I suspect many in the mentioned professions found your article arcane and purposefully inflammatory.  

I read Mr. Willows’ report you referenced, Employee Benefits Plans Not Reflecting Canada’s Health Challenges According to New Study. The report presents clear concern with how health benefits are utilized. We collectively would do well to heed this advice. However your article focuses on comments not included in the report…I’m assuming made in a private conversation. Mr. Willows’ comments are portrayed as skeptical and ignorant when referring to massage therapy “as a lifestyle,” “a special treat” and “considered something for the wealthy.”

Mr. Mayers, you may be unaware of the surprising lack of health care funding for treatment of the components of the body that help us to move – muscles and connective tissues, bones and joints.  Chiropractic and physiotherapy were removed from the provincial health plan in 2004 – presumably to shunt dollars to treatments for heart disease, cancer, diabetes and other chronic illnesses associated somewhat with lifestyle habits. Massage therapy – despite being regulated as a health profession in Ontario since 1919 – has curiously never been covered under OHIP.


Provincial funding for orthopedic treatment of osteoarthritis or severely traumatized joints is not extended to strains and sprains affecting the everyday function of people. It appears these injuries and ailments hold low priority, and employers and their employees – rather than our health-care system – are mandated to pay for them. Case in point: a person experiencing soft-tissue and joint injuries in a motor vehicle collision must exhaust their employer-paid benefits first before applying for claimant-paid auto-insurance benefits. It’s surprising employers aren’t up in arms over this policy.
Your article provides me with the impression that the sharing of data or trends from Green Shield’s study – indeed helpful and useful information for workers, employers, insurers and health-care providers alike – is shadowed in a pall of antagonism and distrust for the intentions of these health-care providers.

There was so much good information that could have been extracted from the Green shield paper.  For example, Mr. Willows describes how only 1% of benefits are utilized on dietitians and nutritionists. He hints at the social determinants of health, and sets up an opportunity to discuss how worker benefits could be better prescribed and directed, perhaps in line with personalized medicine.

I wonder if Green Shield in their data review has considered that rising expenditures in these areas are a shift from drugs to physical/psychological therapies as a reflection of the population preferring less invasive or dangerous interventions to pharmaceuticals or surgery. Judicious treatment of soft-tissue injuries may preclude or limit the need for more invasive interventions, or obviate the serious side effects associated with the long-term use of pharmaceuticals such as non-steroidal anti-Inflammatory drugs.

True, there is a lack of accountability on how employee benefit plans are invested. Employers trust employees to search out practitioners in the open marketplace that can help them address various symptoms affecting health and wellness. There is currently no measure in place to assure the employer that the benefits have been well directed or effective.  

Practitioners – the vast majority ethical, compassionate and competent – are penalized for excessive or unnecessary billing only if there is an investigation by their regulatory body or a criminal conviction. No question, a few unscrupulous providers are casting a dark pall over the reputations of the majority of these regulated professionals. Accountability in how employee benefits are consumed is long overdue.

Without accountability, there’s no incentive for employees (or practitioners) to use plans with judicious consideration of where and how the money is spent, and no deterrent against insurance companies to deny claims or discredit credible services to improve profit margins. Stakeholders can turn “soft benefits” into hard by establishing clear health and productivity outcomes – reduced time off work, increased job satisfaction and sense of well-being – and ensure workplace benefits are used toward these outcomes.

We must all ask the question: if workers are not making the right choices with their available benefits, how can we ensure best evidence and health policy direct them? Perhaps there is a way to align the interests of workers, their employers, insurers and health-care providers. This focus is where your article could do the most good.

Massage therapy has been regulated in Ontario since 1919 as a health profession, and demonstrates effectiveness in the treatment of headaches, lower back pain, arthritis-related stiffness and pain, muscle discomforts related to pregnancy, and most recently efficacy in the treatment of anxiety. Mr. Willows may be unaware of the evidence favouring massage therapy to address a number of health concerns.  Ironically, employees in the insurance industry – along with the technology and finance industries – are cited as some of the largest users of employee benefit plans.

In your article, Mr. Willows exclaims some incredulity for benefits used by people of younger ages.  I suggest this usage is reflective of the societal impact on health at younger ages, and I certainly see this in my practice.  Perhaps investment should be on correcting the social-economic mechanisms that affect quality of life and trigger repeated stress responses rather than precluding care to populations simply because they appear novel. Mr. Willows may be interested to learn that, beyond the treatment of strain and pain, massage therapy is implicated for health enhancement and wellness, which can contribute to lower health costs.  

C.K. Andrade in her seminal book, Outcomes Based Massage, recognizes benefits beyond injury rehabilitation, and points to improved energy and sleep, better social functioning and family relationships, a sense of well-being, improved mood, relaxation and coping skills, mindfulness and greater life satisfaction, positive attitude and empathy towards others. Cultivating these health benefits could go a long way to addressing the serious, insidious illnesses Mr. Willows references.

It would be helpful if Green Shield and other insurers – in collaboration with research and educational institutions as well as the professions in question – explore how physiotherapy, chiropractic and massage therapy may be utilized to offset costs typically borne by the provincially funded health care insurance plan.  

The insurance industry may complain of the rising use in employee benefit plans, and employers are justifiably concerned about shouldering these costs. However, without study, we won’t know if in fact expenditures for these “three amigos” may actually be saving the provincial health care plan a considerable expense. Job-related stress, for example,e is estimated to cost the Canadian economy $16 billion dollars a year. If these professions are providing care that is cost-effective and efficacious, perhaps they need to be better integrated in the larger system of health-care delivery.

No question, resources are limited and more accountability is required in the judicious utilization of employee health benefits. I suggest not inflaming the relationship between insurers and health-care providers through provocative media coverage, but instead using the media to foster a dialogue on how to better care for workers and improve efficacy of interventions prescribed.

Don Dillon, RMT April 16, 2015

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