Where coverage falls short plus other findings from the 2023 Benefits Canada Healthcare Survey

Half of plan members (51 per cent) reported that the coverage level of at least one of their health benefits limited their ability to seek treatment, jumping to 84 per cent among those with a major injury in the past year, reports the 2023 Benefits Canada Healthcare Survey.

As well, “heavy users” (11 or more times a year) of paramedical services were far more likely to report that coverage maximums curtailed treatment plans, namely for mental-health services (82 per cent), massage therapy (82 per cent), physiotherapy (78 per cent) and chiropractic (75 per cent).

Plan members were also asked to specify where coverage fell short in the past year for seven listed benefits. They most often cited dental services (25 per cent), followed by massage therapy (19 per cent), prescription drugs (16 per cent), mental-health services (14 per cent) and physiotherapy (13 per cent).

In response to these findings, members of the survey’s advisory board suggested that new reporting on the percentage of plan members hitting coverage maximums would be useful information to guide decisions on plan design.

The survey also asked about out-of-pocket spending. It found that plan members personally spent the most for mental-health services ($1,739). For all seven benefits, members spent an average of $3,515 out-of-pocket in the past year.

Despite these findings on where coverage may fall short, 72 per cent of plan members agreed they appreciate their health benefits plan more today than they did before the pandemic. Similarly, for the past two years, 77 per cent described the plan’s overall quality as excellent or good, up from 68 per cent in 2021 and 2020. The nine-point gain came from fewer members describing the plan as “adequate.”

The following factors boosted this quality score even higher: the inclusion of virtual health services in the plan (86 per cent), a high level of understanding of the plan (83 per cent), a workplace culture that encourages wellness (81 per cent) and job satisfaction (81 per cent).

TELUS Health is proud to be a platinum sponsor of the 2023 Benefits Canada Healthcare Survey. This year marks the 26^th year surveying plan members and 16 years surveying plan sponsors. The report breaks down results into three main areas: personal health, the health benefits plan and workplace wellness supports. Additional highlights include:

• Eighteen per cent of plan members described their mental health as poor over the past year, compared to 22 per cent in 2022.
• Stress levels were at their highest since 2018, with 38 per cent reporting extreme or high levels of daily stress over the past three months, up from 27 per cent in 2022.
• Fifty-four per cent of plan members currently live with a diagnosed chronic condition. The top diagnosis is a mental-health condition (18 per cent).
• Chronic pain is new to the list of possible conditions and is tied with diabetes and hypertension (all at 10 per cent) as one of the top diagnoses.
• Thirty-four per cent of plan members received health services virtually in the past year, down from 41 per cent in 2022. The use of virtual care is higher for those with a major injury (68 per cent), with caregiving responsibilities (45 per cent) and with poor mental health (43 per cent).
• Twenty-nine per cent of plan sponsors reported including a virtual-care platform in their benefits plan, unchanged from 2022. Results varied little by size of employer.
• Eighty-five per cent of plan sponsors have at least one major concern about their health benefits plan. The top concern is the impact of inflation on the effectiveness of their plan (36 per cent).
• Seventy-eight per cent of plan sponsors are satisfied with how their insurance carrier is responding to claims for higher-cost specialty drugs; however, 88 per cent agreed that more needs to be done to reduce the cost burden of these drugs on private drug plans.