The insurance role in workplace health promotion: a comparative analysis of the United States and the Philippines

There is a void in the health promotion literature concerning the role of health insurance. This study offers a comparative analysis of employee health insurance in the United States and the Philippines. As the first study of its kind, it examines insurance as an instrument of health promotion policy for improving population health and reducing healthcare costs. The following questions guide this study: (i) How has insurance coverage of employee healthcare in these two countries evolved and changed over time, and why? (ii) What factors incentivize payers (employers and insurers) to incorporate health promotion into their health plans, even if health promotion does not fall within the traditional ambit of insurance? and (iii) How does health promotion through the insurance vehicle operate cost-efficiently and within the Global Health Promotion framework of the World Health Organization (WHO)? US and Philippine public-use datasets were gathered and disaggregated to address these questions. The Affordable Care Act (ACA) in the US and universal healthcare legislation leading to the Universal Healthcare Act (UHC) in the Philippines initiated major paradigmatic shifts in insurance coverage. Health literacy, behavioral change and social equity are objectives pursued in both countries by mandating and/or nudging payers to offer health screenings, wellness and fitness programs and primary preventive and diagnostic services. By providing a means to finance access to promotive health and encourage individual responsibility for risk prevention ('healthism'), insurance influences social attitudes about health. However, our findings indicate that outcomes and relative success vary depending on a country's insurance environment, its regulation and the economic, political and socio-cultural forces that affect or shape it (e.g. private markets vs. multi-payer system). Contextual realities also drive incentives and rewards to payers and users of promotive health benefits against the backdrop of financial risk or exposure.