Benefits: one size does not fit all - health benefits and minorities

Business & Health, May, 1997 by Janet Gemignani

Meeting the health needs of an increasingly diverse workforce may seem like an impossibility, but budget-minded benefits managers are finding ingenious ways to accomplish it--and save money besides.

Always a melting pot, the United States will be more multicultural than ever in the next millennium. Savvy employers, aware of the rapid shifts in demographics, have already begun to prepare to accommodate the needs of an ethnically, racially and culturally diverse workforce:

* A third of the 39 million workers expected to enter the labor force by 2005 will be minorities, while the majority of the 23 million leaving the workforce by then will be white males, the Bureau of Labor Statistics projects.

* Asians and Hispanics are the fastest-growing ethnic groups, according to the Census Bureau. If current immigration and birth rates continue unabated, Hispanics will surpass African-Americans as the largest minority by 2005.

* By the middle of the 21st century, racial and ethnic minorities--blacks, Asians, Native Americans and Hispanics--collectively will comprise a majority nationwide. That's already the case in New Mexico, Hawaii and many big cities. California is expected to achieve this minority majority status by the year 2000 and Texas 10 years later.

Dramatic changes in family structure add to the mix More than one in four American children lived with a single parent in 1995 That was true of just over on kid in 10 a quarter of a century ear her. Over the past 25 years, the proportion of households made up of married couples with children plummeted from 40 to 26 percent. Meanwhile, women's participation in the workforce went from 43 percent in 1970 to 59 percent in 1994. By 2005, according to the Employee Benefits Research Institute, it's likely to reach 63 percent. Consider, too, the 3 to 10 percent of Americans who are gay or lesbian, and it's clear that employers are in the increasingly difficult position of providing benefits for a population whose needs are all over the place.

HOW CAN COMPANIES COPE?

Strike a balance between budget realities and the financial needs of your organization on one hand and the maintenance of employee morale on the other. That's the advice of Russ Harris, a diversity consultant based in Herndon, Va. A good benefits package will go a long way to stem the turnover of key people who might be lured to firms with better benefits.

The key to providing it, according to Harris, is for firms with diverse workforces to conduct needs assessments every two or three years. Employee meetings, orientation sessions and anonymous surveys are good ways to get feedback.

The purpose of the assessment is threefold: to find out what health or related services staffers need, which ones they're most likely to use and which they perceive as having the highest value. An employer may discover, for instance, that the firm's large immigrant population doesn't use--or care much about--expensive dental or vision benefits but wants legal assistance because of the immigration problems they face. A firm with many young female employees may find generous leave policies and emergency child care programs in greater demand.

Employers concerned with the health care needs of a specific group might take a lesson from HMOs around the country. In seeking to attract various ethnic populations to increase market share, many health plans have discovered that minorities are unlikely to respond to mainstream tactics. Attracting a particular clientele calls for more targeted strategies.

Take Kaiser Permanente, which set up a Chinese clinic at San Francisco Medical Center last year. Of the close to one third of the city's population that's Asian, six out of 10 are Chinese--the area's fastest growing ethnic group and the one in which Kaiser had the least market penetration. "We did focus groups and telephone surveys to better understand the Chinese marketplace," recalls Dennis Lum, Kaiser's sales and marketing director for the Bay area. The HMO quickly realized it had to improve service before entering the market, he says.

Kaiser prepared for the clinic launch by hiring more Chinese-speaking physicians and staff. The HMO also printed all the signage and handouts in Chinese, arranged to serve Chinese food in the clinic cafeteria, and stocked kiosks in the lobby with Chinese-language newspapers. The strategy worked.

By the end of the year, Kaiser's Chinese enrollment base had grown by more than 5 percent, Lum reports. That's more than double the ethnic group's growth rate in the region. Although many of the Chinese-Americans in the plan have individual coverage--Chinese employers rarely provide health coverage--Kaiser has signed up several firms with a large Chinese ethnic workforce, including a sewing factory and an electronics company. The HMO's next step: Use the lessons it learned to better serve Hispanics statewide.

OVERCOMING LANGUAGE BARRIERS

If Kaiser had a hard time adapting its services for just one ethnic group, imagine the hassle open enrollment causes at Marriott International. The Bethesda, Md.-based hotelier employs 182,000 people who speak 65 native languages--everything from Haitian Creole to Kiswahili, Russian and Telugu--at 5,500 locations nationwide. "We want that diversity because we have guests on our property from so many different cultures," says Patty Cassidy, who handles Marriott's open enrollment. While most of the hotel chain's workers are bilingual, a lot of them have a hard time understanding complex insurance information written entirely in English.