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Healthier employees, lower health care costs?

Story about companies that charge employees more or penalize them for health risks makes an interesting companion to Grant Gallicho's post about the uninsured.

So far, companies that tie wages to health improvements focus on conditions that can be managed to some extent--smoking, obesity and high cholesterol. At least one company is no longer hiring employees who use tobacco, in states where not hiring them is legal.

What the story doesn't say is whether the programs have been successful at holding or improving health insurance costs for employers. Nor does it say how successful those wellness programs are. Are employees getting healthier in those company gyms?

Anyone have experiences with employee wellness programs? Thoughts on where this all might be headed?



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Let's see -- employers who don't pay their employees decent wages will also be in the business of telling them how to conduct their personal lives? Excuse me, sir, there's a little too much fat on that underarm -- stop eating Twinkies, and get to the gym, or else. Sorry, dear, but employees who stop off at McDonald's for hash browns won't advance very far here. Oh, I forgot: the fundamental concern is the cost to employers, who must now be given the authority to manage, not only their employees' labor, but every morsel, drop, and breath they take. I seem to recall that Pullmann built a town on this principle of "benevolence." Rather than provide universal health care -- not health "insurance," which still retains the intrinsically pernicious insurance industry (why, exactly, do we need an insurance industry to stand as a sentinel between us and physicians?) -- this proposal makes management even more ubiquitous than it already is.

There are laws that protect employees from outright discrimination, but clearly, this is a form of big brother that is uncomfortable and unwelcome for many. "It all depends" on how it is done, whether it is a good or bad thing, but this is one of the negative aspects of employer provided insurance that is rarely discussed: when your employer foots the bill, he, she or it gains a stake in your personal life because of the costs that are incurred on your behalf. Just add it to the list of reasons for why a different way of doing things would be much preferable.

Wellness programs work, both in helping people be more healthy and in keeping insurance costs (and absenteeism) down.And yes, people don't like to be told that they need to make lifestyle changes. But the healthcare problem in the United States sits on three legs. Along with the insurance problem is the provider cost and efficiency problem and the consumer problem. Americans are generally in rotten shape. Of course they would love to have their self inflicted problems paid for by someone else, but I think in fact, even if lifestyle changes are not mandated, something is going to have to give here.When I post stuff like this on other sites, I usually then brace myself for the massive flames of people telling me why in their obesity etc. is not really their fault. Or, they talk about their God given right to smoke cigarettes or drink heavily. And maybe some of this is true. But I don't think the alternative is (or will prove to be) to do nothing.

Flip side of Eugene McCarraher's scenario: A friend worked for a small graphic arts company. The boss brought in a masseuse every Friday afternoon to do chair massages which helped reduce tension and stress from sitting in front of a computer all week. It was voluntary, but no one ever turned one down. (And sneaking out on Friday afternoons was reduced considerably because people wanted to stick around for their massages.)I worked as a contractor for one of the Detroit car companies, which offered a heart-smart line in its cafeteria. Some of the best food I ever ate, and I don't have high cholesterol or blood pressure.Another small company I worked for offered a bonus to employees who quit smoking--and coupons at a nice restaurant to the whole department to celebrate the achievement. Nice little peer pressure incentive.These, of course, were voluntary programs.One area not addressed in the article--and perhaps by employers who offer (or demand) wellness program paticipation--is mental health. I would guess that anybody reading this who has health insurance will find that his policy has higher co-pays for mental health treatment and limits the number of mental health visits a policy holder may have. Yet clinical depression and circumstantial stress result in a fair amount of absenteeism as well. Interesting that employers did not cite that as an area they wanted to work on.

Well, many employers already offer EAPs for employees with mental health or family issues. Plus, asking someone to join a group that has been targeted as needing mental health support is likely to be seen as an unwelcome intrusion into the person's privacy. So the employer is more likely to go for stress reduction, work/family balance and similar issues that don't carry the same kind of stigma. And then there's my general rule about mental illness: people who really, really need help rarely have insight into their conduct, and are frequently unwilling to get help even when it's offered for free. Not always, but frequently enough.

Barbara, I see what you mean, of course, but it strikes me that obesity has something of the same stigma as mental health problems. I'm always amazed when students laugh about how they drank to near unconsciousness on Friday night, but revile fat people for their moral failure to be skinny.

I think Healthcare is a major problem in this country. Certainly, all solutions have to be discussed. When I was with Beth. Steel, Bath Iron works attempted to put a program in which prevented all their employees from smoking,even outside the work place. I guess they had received a deduction from their health insurer if they could achieve this. As far as I know, when employees fought it, and when they saw that it would be declared unconstitutional, it never went anywhere. I use this illustrasion because Bath Iron paid a living wage. Health care costs are a major problem in this country. I think the most important thing is that there has to be a lot of discussion, a lot of ideas have to be presented. Some will be good and some will be bad, some better. some worse. There will always be the possibility of abuses. Nobody wants to turn the american worker from a free worker into a "serf" by having companies govern their personal life, but free, intelligent and honest discussion is the only way to find a solution to this massive problem both for employers and employees. I wish I had a solution.

Remembering from my HR days twenty years ago:(1) Wellness programs do work. The catch is in the design/implementation so that they are not perceived as benefitting one group at the expense of the rest -- typically young middle managers on the go who really like to jog vs. older blue collar types. In my experience this was handled sensitively.(2) The punitive proposals were around then too. They were unworkable due to privacy considerations and discrimination issues. (Are you overweight because of pituitary problems or are you just a fat slob? Do you have high blood pressure because you're African-American or do you have a culpably poor diet? Can we check?(3) I am not much of a believer in slipery slopes, but this whole area of discussion can slant off into who should be allowed to have children or who should be forced to abort a child that looks to have an expensive medical future ahead of it.

NYC management benefits plan offers some coverage for wellness plans. While I try in retirement to exercise with some regularity, if I can, I don't seem elligible under the plan. (It's said NYC management plan offers less than optimal visual support but great psychiatric coverage, if that means anything.)Wellness and preventative plans are important to seniors. The Srong Women program and Men growing Stronger developed at Tufts for example have demonstrable benefits. SimilArly, balance classes for older seniors and low impact aerobics for brittle seniors are vttal tools.At lunch today,I suggested to our visiting Deputy Director on Aging that there was no immediate hope for national hralth care refiom *despite the AARP oitiative) and minimal hope in our State for major change. Thus, a need to emphasize prevention more from youngest to oldest.Especially useful might be programs involving dental and visual issues, which often health plans don't cover and poor lack access to. I urged that the State seek out leaders in these professions (there must be national or statewide professional asociations of them) and partner with them in putting forth handu materials on prevention and what to do if there are problems.Having said that, I still think universal health care is a major job for government - my communitarian nature says public safety and public health are the first two responsibilities of good government.l

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