Once upon a time it might have been considered compulsory to ensure a trade union presence at a conference on “HIV/Aids and Business in Africa and Asia — building sustainable partnerships”.
There were no union representatives at the conference on this theme before the World Economic Forum in Durban this week, hosted by the forum, UNAids and Harvard University. In contrast, a range of employers and employer organisations were represented.
The panellists offered various explanations for labour’s absence. Unions were not as active in other parts of Africa as in South Africa, they said. Unions in South Africa had not always taken an appropriate lead on Aids.
The absence of a labour voice sheds light on why the uptake of Aids programmes in the workplace is so low. From the medical scheme perspective, employers do not fully understand the minefield of employee health-care benefits — and have even less of a grasp when it comes to HIV/Aids.
Take medical schemes. Most CEOs looked at Aids for the first time only recently because costs began to escalate to the point that they affected the bottom line. This followed a change in accounting practice that forced companies to account for future liabilities on their balance sheets.
Companies with large potential pensioner health-care liabilities promptly wiped them off their books by bribing and cajoling current staff, and some pensioners, to drop their future claims to health care.
Many employers decided to stop subsidising staff contributions to medical schemes altogether, or by capping the expenditure at a defined level.
This was not prompted by greed or heartlessness, but by a felt need to keep costs in check. Human resources departments or financial directors were asked to find a scheme that did not maul the bottom line.
The move was described as “best practice” — often a myth created to justify the large amounts of money paid for the advice of brokers whose interests differ from the company’s.
Of course, the employers continued to claim the tax break for subsidising the scheme while the payments flowed from payroll — a system likely to change soon.
Lower-paid employees often suffer the worse consequences of removing their dependants from schemes to cut costs. Sometimes employees with specific medical conditions find they are not adequately covered.
Employees can discover hidden co-payments down the line, and promises of reasonable premium increases can be undermined by a deliberate policy of trimming benefits, or dealing with say, pharmaceutical benefits, with less openness and honesty than desirable.
These problems are no invention. They emerge from the responses of consumer groups and trade unions approached by the Council for Medical Schemes.
The council has also noticed that benefit changes that upset staff have frequently not been properly ratified by the registrar for medical schemes, as required by law.
CEOs often do not consider it their task to understand medical schemes and the regulatory environment. Paradoxically, they probably belong to schemes but have no knowledge of their own rights, let alone those of their employees.
Does the average CEO know, for instance, that it is illegal to charge a higher price because he/she has an expensive health condition? That the scheme cannot charge him/her more than younger employees? That he/she will get more rights next year when certain chronic conditions have to be covered by law? That the broker who sold the scheme had to be accredited?
If CEOs understood their buying power in regard to medical schemes, they could form an effective lobby group that could press for lower prices, more rational benefits and for less to be spent on non-health- care costs. This was the pattern in the United States.
Anybody scrutinising the creation of a new public service medical scheme will have noticed in the tender documents that this particular employer — the state — knows what its muscle can achieve for staff.
The same lack of knowledge is evident with regard to HIV/Aids. Said one delegate at this week’s Durban conference: “South African employers had better catch a wake-up — HIV/Aids is not seen as an immediate threat, and hasn’t been translated into a bottom line cost. It should be a boardroom issue.”
The conference underlined the advantages South Africa has over the rest of the continent. Local companies tend to employ more people, and employee benefits generally cover many more workers. South African unions, too, are better organised and represented in South Africa than elsewhere in Africa. These factors should produce a keener workplace consciousness of HIV/Aids — but it does not.
In Uganda, conference delegates heard, business targets open- produce markets to spread the word about HIV/Aids. And it seems everybody could learn from Botswana — or face that country’s ferocious health minister!
South African unions may not have given an adequate lead in the workplace on Aids issues, but neither have employers, who do not understand many workplace health issues adequately.
The “catch a wake-up” call could serve as the new workplace slogan for both sides of industry.
Pat Sidley is the head of communications and education at the Council for Medical Schemes