March 18, 2013
As a couch enthusiast of some renown, I'm generally opposed to any form of mandated physical exertion.
Our bodies know it's time to exercise when the guilt of not doing so outweighs the pleasure of eating ice cream in a comfy chair, or when said chair breaks under our weight.
Unfortunately, our life decisions do come with "consequences," dreadfully annoying things invented by Communists. And the consequences of poor health choices can include increased health care costs.
Which brings us to "corporate wellness programs" or "wellness incentives," which are becoming common across the country. The general idea is if you take advantage of company-sponsored health initiatives — from smoking cessation to weight loss — and meet certain goals, you save money on health insurance.
This is not, at first glance, a terrible idea. While nobody likes being told what to do, it's tough to argue with the basic premise that being healthy is good.
And though executives may have other priorities than caring about how clogged your arteries are, there seems to be potential savings from reduced absenteeism and fewer employees dying in the break room midcheeseburger.
Not to mention quieting the grumbling of workers who live healthy lives about having to offset the medical costs of a co-worker who sucks down Pringles like a Hoover.
But two new studies published this month in the journal Health Affairs raise questions about the overall efficacy and fairness of workplace wellness initiatives.
Gautam Gowrisankaran, an economics professor at the University of Arizona, examined the wellness program at a St. Louis hospital and found the rate of hospitalization for conditions targeted by the program dropped 41 percent. But this led to no net reduction in health claim costs.
Gowrisankaran explained that people in the wellness program exhibited "more faithful adherence to medication and doctor visits," which partially offset savings from fewer hospitalizations. The program's health screenings also revealed problems that sent some employees to the doctor.
The lack of overall savings, Gowrisankaran said, didn't make the program a failure: "If you can reduce hospitalizations for things like heart attacks by 40 percent, that's a great thing for an employer."
Employees who took part in the program saved about $1,700 a year, so that carrot was certainly in place. But Gowrisankaran said he can understand the conflicting opinions about these programs.
"On the one hand, there's the argument that we need to get employees to take more charge of their own health and behavior, and anything we can do to incentivize that is good," he said. "On the other hand are people who are privacy advocates who don't want their employer to get in their way. If I want to enjoy my doughnut and my cigarette in the morning, that's up to me."
(I'll pause here while everyone takes a break to smoke a doughnut.)
The second study says: "Despite widespread enthusiasm for health-contingent programs, there is sparse evidence that these programs can reduce short- or even medium-term costs through health improvement."
Co-author Jill Horwitz, a law professor at the University of California at Los Angeles, said: "The premise is that if people do all these things, their health is going to improve, and they're going to save money. But many studies show these incentive programs don't lead to health improvement."
The study found mixed evidence that employees with the targeted health conditions or behaviors (obesity, hypertension, smoking) have higher health costs than other employees. And there wasn't much to show that financial incentives are good at changing behavior.
What troubles Horwitz is the possibility that such programs are shifting costs away from workers who are more likely to be healthy anyway and placing them on those who are less healthy — and less able to shoulder the cost.
From the study: "The prevalence of unhealthy conditions typically targeted by wellness programs is highest among people with low socioeconomic status."
One way to avoid this would be to offer the services without tying them to a financial reward.
"When it's not related to compensation, that might be less worrisome," Horwitz said. "When you're adjusting the price of health insurance, you're really adjusting somebody's compensation package."
The bottom line here is your company's wellness program isn't the answer to our health care problems. But that doesn't necessarily make it a bad concept.
I think it's a net positive if a company is looking out for employee health, whether it's being done out of altruism or unabashed corporate greed. But smart companies can't just say, "Head to the gym, fatty, and we'll give you $50."
These programs need to be fair to all employees and actually improve workers' lives — particularly if they can get me back to my couch.
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