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Employee Wellness Programs: The Carrot or the Stick?


Employee wellness programs sound like a good idea. After all, it's in a company's best interest to have a healthy, productive workforce and to try to keep the cost of group insurance down. ' Before any benefits of such programs can be realized, however, companies need buy-in from their employees.

A recent HBNS news story reported that creating teams with potential lottery-style cash rewards motivated more employees to complete health risk assessments, a core feature of many wellness programs. ' ' 'There is often this assumption if we just give people 'x' amount of dollars, the bigger 'x' is, the more effective it will be.'  One can argue that lotteries take advantage of the fact that people don't understand probabilities very well,' said Kevin Volpp, MD, co-author of the study.

Some employers use incentives tied directly to health insurance, as Washington Post's Sarah Kliff writes: 'Some wellness programs use carrots, decreasing a worker's health insurance premiums if they enroll in a smoking cessation program or start hitting the gym. Some use sticks, setting higher deductibles or premiums for those who can't meet a certain body-mass index or do not quit smoking.''  Other employers forgo the carrot and the stick altogether by making wellness programs compulsory.

Kevin Volpp, a professor at the University of Pennsylvania School of Medicine, who has studied the use of incentives in health insurance programs, says, "We're seeing a big move in this direction driven by employers' concern about rising health costs and their sense that employee behavior has a lot to do with high cost."'  A recent USA Today/Kaiser Health News story details one such company, which subjects its employees to an annual health check to determine how much they will pay in insurance premiums.

However, Julie Appleby reports that some approaches raise the disturbing possibility of discrimination based on health status: 'While supporting wellness programs in general, several patient advocacy groups warned the Obama administration last March that additional consumer protections are needed. Tying medical test results to financial incentives or penalties in premiums or deductibles could discriminate against some workers, especially those who already have health problems'"

Whether these programs can really curb health insurance costs is still up for debate, but there is growing evidence to support them. ' According to a recent study in the American Journal of Health Promotion, employees who participated in a health-improvement program had fewer medical costs over three years than those who did not.


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