The association of health risks with workers' compensation costs

Health profile of workers from different industries in Singapore

Introduction

Workplace safety and health are interrelated - a worker who is not healthy may cause safety lapses at the workplace; conversely, safety lapses could affect the health of the workers. This study was part of a larger Total Workplace Safety and Health (WSH) programme run by the Workplace Safety and Health Council, Singapore. The objectives were to obtain a baseline health profile of workers across four major industries and identify important health risks for targeted workplace interventions.

Methods

Five service providers (SPs) were appointed to run the Total WSH programme. As part of the programme, SPs conducted an anonymous basic health survey among workers of participating companies.

Results

The responses of 6,373 respondents from the cleaning, construction, manufacturing, and transport and storage industries were studied. The overall response rate was 62%. Key health issues identified were high rates of obesity (22%) and smoking (24%) and low prevalence of regular exercise and healthy dietary habits. Chronic disease rates were similar to population self-reported rates (hypertension 15%, high lipid 12% and diabetes mellitus 6%). The workers reported high work stress (13%).

Conclusion

Health issues are prevalent in the workforce and may affect work and employee safety. It is increasingly important for employees' health to be considered in risk assessments and prioritised in workplace safety and health management systems and strategies. Health promotion interventions should be targeted, and multilevel and multicomponent initiatives should be integrated with pre-existing occupational safety programmes.

The Effect of Introduction of Motorized Stretchers on Hospital-Based Patient Transporter Injuries and Resultant Workers' Compensation Costs

Manual stretchers cause more injuries than hydraulic stretchers in workers who transport patients.

OBJECTIVE

To evaluate the impact of introducing motorized stretchers on transporter injuries and resultant workers' compensation costs.

METHODS

The number of transporters who sustained injuries related to stretcher manipulation, and associated workers' compensation costs, before and after the introduction of motorized stretchers, was determined. The Wilcoxon Rank Sum test was used to examine costs and lost and restricted workdays.

RESULTS

The number of injuries and restricted work days decreased after motorized stretchers were introduced. Transporters incurred less lost work days (median 24.5 vs 7 days, P = 0.050).

CONCLUSIONS

Motorized stretchers were associated with decreased injuries and lost work days.

Lifestyle Medicine and Worker Productivity

The issue of employee productivity has become a major concern for companies. Inefficiency can occur at every stage of production either as poor design, worker limitation, or other factors. It is generally assumed that a healthy worker is more productive than an unhealthy worker. As early as 1776 Adam Smith observed and published in The Wealth of Nations that poor worker health was a detriment to industrial productivity. The objective of this article is to review the literature documenting the gain or loss of productivity related to the health of workers, as well as any lifestyle management strategies that can be used to improve employee health and productivity. The impact of employee obesity, smoking, physical activity, sleep, and behavioral health on productivity will be explored. By identifying and addressing health risks that impair worker performance, lifestyle medicine professionals can demonstrate a significant return on investment by creating a healthier and more productive work force.

Larger Workplaces, People-Oriented Culture, and Specific Industry Sectors Are Associated with Co-Occurring Health Protection and Wellness Activities

Employers are increasingly interested in offering workplace wellness programs in addition to occupational health and safety (OHS) activities to promote worker health, wellbeing, and productivity. Yet, there is a dearth of research on workplace factors that enable the implementation of OHS and wellness to inform the future integration of these activities in Canadian workplaces. This study explored workplace demographic factors associated with the co-implementation of OHS and wellness activities in a heterogenous sample of Canadian workplaces. Using a cross-sectional survey of 1285 workplaces from 2011 to 2014, latent profiles of co-occurrent OHS and wellness activities were identified, and multinomial logistic regression was used to assess associations between workplace demographic factors and the profiles. Most workplaces (84%) demonstrated little co-occurrence of OHS and wellness activities. Highest co-occurrence was associated with large workplaces (odds ratio (OR) = 3.22, 95% confidence interval (CI) = 1.15⁻5.89), in the electrical and utilities sector (OR = 5.57, 95% CI = 2.24⁻8.35), and a high people-oriented culture (OR = 4.70, 95% CI = 1.59⁻5.26). Promoting integrated OHS and wellness approaches in medium to large workplaces, in select industries, and emphasizing a people-oriented culture were found to be important factors for implementing OHS and wellness in Canadian organizations. Informed by these findings, future studies should understand the mechanisms to facilitate the integration of OHS and wellness in workplaces.

Tobacco-free policies at worksites in Kansas

BACKGROUND

This study sought to examine the relationship between tobacco-free policies at worksites to worksite demographics such as company size and geographic location.

METHODS

Worksites participating in a worksite wellness workshop were asked to complete a worksite wellness instrument, which provided an assessment of their wellness practices already in place in the worksite, including the degree to which tobacco-free policies were in place at the worksite.

RESULTS

At a bivariate level, those more likely to have tobacco-free policies included: urban employers (76.8% versus 50% rural employers, p = 0.0001); large employers (> = 250 employees) (74.3% versus 43.1% small employers (<50 employees), p = 0.0003); and schools (69.4%) and hospitals (61.5%) (versus 35.5%, agricultural/ manufacturing employers, p = 0.0125). At the multivariate level, rural employers (AOR = 0.47, 95% CI 0.23, 0.95) and small employers (AOR = 0.34, 95% CI 0.16, 0.71) had decreased odds, compared to their urban and large employer counterparts, of having tobacco-free policies.

CONCLUSIONS

Rural and smaller employers are less likely to have tobacco-free policies than their urban and large counterparts.

The Portion of Health Care Costs Associated With Lifestyle-Related Modifiable Health Risks Based on a Sample of 223,461 Employees in Seven Industries: The UM-HMRC Study

OBJECTIVE

This study estimates the percent of health care costs associated with employees' modifiable health risks.

METHODS

Cross-sectional multivariate analysis of 223,461 employees from seven industries who completed a health risk assessment during 2007 to 2012.

RESULTS

Modifiable health risks were associated with 26.0% of health care costs ($761/person) among employees with no self-reported medical conditions and 25.4% among employees with a medical condition ($2598/person). The prevalence and relative costs of each of the 10 risks were different for those without and with medical conditions, but high body mass index was the most prevalent risk for both groups (41.0% and 63.9%) and also contributed the largest percentage of excess costs (7.2% and 7.3%).

CONCLUSIONS

This study, coupled with past work, gives an employer a sense of the magnitude that might be saved if modifiable health risks could be eliminated.

Understanding the Relationship between Health Risks and Health-Related Costs

Dr. Anderson reflects on the lack of consistency in studies on the relationship between health risks and medical costs. Part of the inconsistency is caused by differences in risk assessment instruments, but a more important concern is lack of clear conceptualization and statement of research goals. One reason for exploring this relationship is to be able to predict health care costs accurately: a very different reason is to identify causal variables, the modification of which will have an impact on costs.

Impact of a Health Promotion Program on Employee Health Risks and Work Productivity

Purpose.

Evaluate the impact of a multicomponent workplace health promotion program on employee health risks and work productivity.

Design.

Quasi-experimental 12-month before-after intervention-control study.

Setting.

A multinational corporation headquartered in the United Kingdom.

Subjects.

Of 618 employees offered the program, 266 (43%) completed questionnaires before and after the program. A total of 1242 of 2500 (49.7%) of a control population also completed questionnaires 12 months apart.

Intervention.

A multicomponent health promotion program incorporating a health risk appraisal questionnaire, access to a tailored health improvement web portal, wellness literature, and seminars and workshops focused upon identified wellness issues.

Measures.

Outcomes were (1) cumulative count of health risk factors and the World Health Organization health and work performance questionnaire measures of (2) workplace absenteeism and (3) work performance.

Results.

After adjusting for baseline differences, improvements in all three outcomes were significantly greater in the intervention group compared with the control group. Mean excess reductions of 0.45 health risk factors and 0.36 monthly absenteeism days and a mean increase of 0.79 on the work performance scale were observed in the intervention group compared with the control group. The intervention yielded a positive return on investment, even using conservative assumptions about effect size estimation.

Conclusion.

The results suggest that a well-implemented multicomponent workplace health promotion program can produce sizeable changes in health risks and productivity.

Hardiness and Support at Work as Predictors of Work Stress and Job Satisfaction

Purpose.

To test a theoretically and empirically based model linking potential protective resources (hardiness, coworker and supervisor support) to the outcomes of work stress and job satisfaction and replicating the relationship of work stress to job satisfaction while accounting for the potential influence of negative affectivity.

Design.

A cross-sectional research design using survey data collected from two convenience samples.

Setting.

Two worksites: (1) a high-tech company and (2) a government agency.

Subjects.

High-tech employees (N = 310; response rate, 73.8%) and government agency employees (N = 745; response rate, 49.7%).

Measures.

The Dispositional Resilience Scale measured hardiness and the Positive and Negative Affect Schedule measured negative affectivity. Coworker and supervisor support were measured using the Coworker Support Scale and the Supervisor Support Scale, respectively. The Perceived Work Stress Scale measured work stress, and a single item from the Job Satisfaction Scale assessed overall job satisfaction.

Results.

A multiple-group path analysis examined the proposed model. Similar patterns of association were found for both samples and suggested a more parsimonious model without the path from negative affectivity to job satisfaction. The model supports the protective nature of hardiness and support at work with regard to work stress and job satisfaction.

Conclusion.

Explanations of relationships depicted in the model, practical implications for reducing work stress and enhancing job satisfaction, limitations and future directions are discussed.

Health risk factors as predictors of workers' compensation claim occurrence and cost

OBJECTIVE

The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs.

METHODS

Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated.

RESULTS

Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05).

CONCLUSIONS

The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims.

Impact of changes in medical condition burden index and stress on absenteeism among employees of a US utility company

Purpose

– The purpose of this paper is to investigate the impact of changes of medical condition burden index (MCBI) and stress on absenteeism and discuss implications for policy/program design.

Design/methodology/approach

– Sample: US utility employees that participated in Health Risk Appraisals (HRA) during 2009 and 2010 (n=3,711). Methods: the MCBI was created by summing number of medical conditions. Absenteeism was measured from administrative records. Change in MCBI and stress and impact on absenteeism was assessed according to incremental change, by low/high categorizations, and by using multivariate regression.

Findings

– Incrementally, greater changes in MCBI or stress generally resulted in corresponding absenteeism change. For both MCBI and stress, high categories were associated with greater absenteeism compared to those in low categories. Those remaining in the low MCBI category decreased absenteeism (−0.10 days/year; p=0.01). Changes from low to high MCBI resulted in increased absenteeism (+0.12 days/year; p=0.04. Changes in stress from low to high or from high to low categories resulted in concurrent changes in absenteeism (+0.21 days/year; p=0.04 and −0.31 days/year; p=0.01, respectively). Regression analyses indicated the interaction between stress and MCBI as a significant contributor to absenteeism change.

Research limitations/implications

– Conclusions: MCBI, stress and their interaction appear to be direct determinants of absenteeism. Companies should consider both physical and emotional health simultaneously in program interventions in order to reduce absenteeism.

Originality/value

– Unlike most studies illustrating cross-sectional relationships, this study shows how changes in stress and medical conditions relate to changes in absenteeism. The interaction between MCBI and stress in this context is also a novel addition.

Implementation of a worksite wellness program targeting small businesses: the Pinnacol Assurance health risk management study

OBJECTIVE

To assess small business adoption and need for a worksite wellness program in a longitudinal study of health risks, productivity, workers' compensation rates, and claims costs.

METHODS

Health risk assessment data from 6507 employees in 260 companies were examined. Employer and employee data are reported as frequencies, with means and standard deviations reported when applicable.

RESULTS

Of the 260 companies enrolled in the health risk management program, 71% continued more than 1 year, with 97% reporting that worker wellness improves worker safety. Of 6507 participating employees, 34.3% were overweight and 25.6% obese. Approximately one in five participants reported depression. Potentially modifiable conditions affecting 15% or more of enrollees include chronic fatigue, sleeping problems, headaches, arthritis, hypercholesterolemia, and hypertension.

CONCLUSIONS

Small businesses are a suitable target for the introduction of health promotion programs.

Health and performance: science or advocacy?

Purpose

– The purpose of this paper is to examine the literature assessing the return-on-investment (ROI) of healthy workplace programs.

Design/methodology/approach

– Used a narrative review to summarize and evaluate findings.

Findings

– Although substantial ROI data now exist, methodological and logical weaknesses limit the conclusions that can be drawn.

Practical implications

– A strategy for monetizing the benefits of healthy workplaces that draws on both human resource accounting and strategic human resource management is described.

Social implications

– The promotion of healthy workplaces is an important goal in its own right. To the extent that ROI estimates are important in advancing this goal, these estimates should be based on clear logic and strong methodology.

Originality/value

– The paper suggests the need for stronger research designs but also note the difficulties in monetizing outcomes of the healthy workplace.

Examining individual factors according to health risk appraisal data as determinants of absenteeism among US utility employees

OBJECTIVES

To investigate predictors of absenteeism and discuss potential implications for policy/program design.

METHODS

Health Risk Appraisal (HRA) data and self-reported and objective absenteeism (personnel records) were used to develop a structural equation model, controlling for age, sex, and job classification. A Medical Condition Burden Index (MCBI) was created by summing the number of self-reported medical conditions.

RESULTS

Higher MCBI and stress were direct predictors of absenteeism. Physical activity was not associated with absenteeism but mediated both stress and MCBI.

CONCLUSIONS

Because stress impacted both absenteeism and MCBI, organizations may benefit by placing stress management as a priority for wellness program and policy focus. Physical activity was not directly associated with absenteeism but was a mediating variable for stress and MCBI. Measures of stress and physical health may be more meaningful as outcome measures for physical activity programs than absenteeism.

The association of smoking with medical treatment adherence in the workforce of a large employer

PURPOSE

Prior descriptive epidemiology studies have shown that smokers have lower compliance rates with preventive care services and lower chronic medication adherence rates for preventive care services in separate studies. The goal of this study was to perform a more detailed analysis to validate both of these findings for current smokers versus nonsmokers within the benefit-covered population of a large US employer.

PATIENTS AND METHODS

This study involved the analysis of incurred medical and pharmacy claims for employee and spouse health plan enrollees of a single US-based employer during 2010. Multivariate regression models were used to compare data by active or never-smoker status for preventive care services and medication adherence for chronic conditions. Analysis controlled for demographic variables, chronic condition prevalence, and depression.

RESULTS

Controlling for demographic variables and comorbid conditions, smokers had significantly lower cancer screening rates, with absolute reductions of 6%-13%. Adherence to chronic medication use for hypertension was also significantly lower among smokers, with nearly 7% fewer smokers having a medication possession ratio of ≥80%. Smokers were less adherent to depression medications (relative risk =0.79) than nonsmokers (P=0.10). While not statistically significant, smokers were consistently less adherent to all other medications than nonsmokers.

CONCLUSION

Current smokers are less compliant with recommended preventive care and medication use than nonsmokers, likely contributing to smoking-related employer costs. Awareness of these care gaps among smokers and direct management should be considered as part of a comprehensive population health-management strategy.

Integrated worker health protection and promotion programs: overview and perspectives on health and economic outcomes

OBJECTIVE

To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for the integration of occupational safety and health and worksite health promotion programs, and to summarize what is known about the impact of these programs on health and economic outcomes.

METHODS

A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes were undertaken.

RESULTS

Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes were considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures.

CONCLUSIONS

Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types.

Estimating the cost of a smoking employee

OBJECTIVE

We attempted to estimate the excess annual costs that a US private employer may attribute to employing an individual who smokes tobacco as compared to a non-smoking employee.

DESIGN

Reviewing and synthesising previous literature estimating certain discrete costs associated with smoking employees, we developed a cost estimation approach that approximates the total of such costs for U.S. employers. We examined absenteeism, presenteesim, smoking breaks, healthcare costs and pension benefits for smokers.

RESULTS

Our best estimate of the annual excess cost to employ a smoker is $5816. This estimate should be taken as a general indicator of the extent of excess costs, not as a predictive point value.

CONCLUSIONS

Employees who smoke impose significant excess costs on private employers. The results of this study may help inform employer decisions about tobacco-related policies.

Health Care Expenditure Among People With Disabilities

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities. Furthermore, by computing the expenditures attributable to secondary conditions, obesity, and health behaviors, the authors emphasize the importance of disability-inclusive workplace health-promotion programs for employees with disabilities. Overall, the authors observed that the annual average health care expenditure among employed people with disabilities was US$4,524 (95% confidence interval [CI] = US$4,248–US$4,800) compared with US$1,325 (95% CI = US$1,299–US$1,351) for employed people without disabilities. Furthermore, obesity accounted for 27% to 41% of excess expenditures for people with various disability classifications compared with their nonobese peers with disabilities. Secondary conditions accounted for about 20% to 25% of higher health care expenditures among working people with various disability classifications, compared with their peers with disabilities who do not have secondary conditions. In addition, lack of exercise and alcohol consumption accounted for one fourth to over one third of excess health care expenditures among employed people with disabilities. The authors discuss implications of these findings for rehabilitation counselors and public health practitioners.

Telephonic screening and brief intervention for alcohol misuse among workers contacting the employee assistance program: A feasibility study

INTRODUCTION AND AIMS

Substantial empirical support exists for alcohol screening, brief intervention, and referral to treatment (SBIRT) in medical, but not non-medical settings such as the workplace. Workplace settings remain underutilised for delivering evidenced-based health services. This research aims to translate medical research into behavioural health-care practice in a telephonic call centre acting as a point of entry into an Employee Assistance Program (EAP). The goal of the study is to examine the feasibility of implementing routine telephonic alcohol SBIRT in an EAP call centre and assess whether routine SBIRT results in increased identification of workers who misuse alcohol.

DESIGN AND METHODS

The design was pretest-posttest, one-group, pre-experimental. An alcohol SBIRT program developed based on World Health Organization recommendations was implemented in one EAP call centre serving one large employer. Workers were offered screening using the Alcohol Use Disorder Identification Test (AUDIT) during intake, brief counselling using motivational interviewing, referral to counselling, and follow-up.

RESULTS

At 5 months, 93% of workers contacting the EAP completed the AUDIT-C: 40% prescreened positive and 52% went on to screen at moderate or high risk for an alcohol problem. Overall identification rate (18%) approached general US population estimates. Most agreed to follow-up and three-quarters set an appointment for face-to-face counselling.

DISCUSSION AND CONCLUSIONS

Integration of routine alcohol SBIRT into EAP practice is feasible in telephonic delivery systems and increases identification and opportunity for brief motivational counselling. When SBIRT is seamlessly integrated workers are willing to answer questions about alcohol and participate in follow-up.[McPherson TL, Goplerud E, Derr D, Mickenberg J, Courtemanche S. Telephonic screening and brief intervention for alcohol misuse among workers contacting the employee assistance program: A feasibility study.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VII 2004-2008

OBJECTIVE

To conduct the seventh periodic review and analysis of the clinical and cost-effectiveness research conducted in worksite/corporate environments between 2004 and 2008.

METHODS

A literature search of US-based research was conducted using a multistage process including MEDLINE, ADI, EDGAR, CARL, Inform, Lexis-Nexis, as well as direct inquiries to key researchers in this area of expertise.

RESULTS

From 2004 to 2008, there were 16 new studies that met the Inclusion/Exclusion criteria. These studies are critiqued and entered into a data table consisting of 13 variables and citations of the 16 new studies.

CONCLUSIONS

Clinical and cost-effectiveness research in the worksite/corporate environment continues to evolve although there was only one randomized clinical trial conducted during the most recent interval. There are innovations in pilot studies, quasi-experimental methodologies, and econometric modeling as indicative of future trends.

Indirect costs of obesity: a review of the current literature

This study reviews the recent literature on the relationship between obesity and indirect (non-medical) costs. Medline and Web of Science searches were conducted to identify published studies from 1992 to present that report indirect costs by obesity status; 31 studies were included. The indirect costs were grouped into six categories: costs associated with absenteeism, disability, premature mortality, presenteeism, workers' compensation, and total indirect costs. Compared with non-obese workers, obese workers miss more workdays due to illness, injury, or disability. Costs of premature mortality vary substantially across countries. The results for presenteeism and workers' compensation were mixed. More research is needed to determine obesity's causal role in increasing indirect costs, especially for workers' compensation and presenteeism. Cohort and longitudinal study designs should be a priority.

Employee health and presenteeism: a systematic review

INTRODUCTION

Many employers focus on their large and easily measured cost of health care, yet until recently they have ignored the impact of health on productivity. Studies of some chronic conditions and some health risk factors suggest that costs of lost productivity exceed costs of medical care. This review will examine the literature to explore the link between employee health and on-the-job productivity, also known as presenteeism.

METHODS

Searches of Medline, CINAHL and PubMed were conducted in October 2006, with no starting date limitation with "presenteeism" or "work limitations" as keywords. A total of 113 studies were found using this method. Each study was evaluated based on the strength of the study design, statistical analyses, outcome measurement, and controlling of confounding variables.

RESULTS

Literature on presenteeism has investigated its link with a large number of health risks and health conditions ranging from exercise and weight to allergies and irritable bowel syndrome. As expected, the research on some topic areas is stronger than others.

CONCLUSIONS

Based on the research reviewed here, it can be said with confidence that health conditions such as allergies and arthritis are associated with presenteeism. Moreover, health risks traditionally measured by a health risk appraisal (HRA), especially physical activity and body weight, also show an association with presenteeism. The next step for researchers is to tease out the impact of individual health risks or combinations of risks and health conditions on this important outcome measure.

Effect of smoking status on productivity loss

OBJECTIVE

The objective of this study was to describe health-related productivity losses in nonsmokers, former smokers, and current smokers using a large, cross-sectional database of U.S. employees.

METHODS

Volunteers completed the Wellness Inventory, an instrument measuring productivity losses related to 11 health conditions affecting employee health. Results are aggregated, dollarized, and reported by smoking group.

RESULTS

Current smokers missed more days of work and experienced more unproductive time at work compared with former smokers and nonsmokers. The average annual cost for lost productivity for nonsmokers was 2623 dollars/year compared with 3246 dollars/year for former smokers and 4430 dollars/year for current smokers. More than half the costs were due to unproductive time at work.

CONCLUSION

Current smokers incurred the highest productivity losses, which translated into higher costs to employers for current smokers. Costs were lower for former smokers and nonsmokers.

The Savings Gained From Participation in Health Promotion Programs for Medicare Beneficiaries

OBJECTIVE

The objective of this study was to estimate savings to Medicare associated with participation in one or more health promotion programs offered to 59,324 retirees from a large employer and their aged dependents.

METHODS

Propensity score and multiple regression techniques were used to estimate savings adjusted for demographic and health status differences between elderly retirees and dependents who used one or more health promotion services and nonparticipants.

RESULTS

Participants who completed a health risk assessment saved from $101 to $648 per person per year. Savings were generally higher as more programs were used, but differences were not always statistically significant.

CONCLUSION

Using the health risk assessment as a guide for health promotion programs can yield substantial savings for the elderly and the Medicare program. The federal government should test health promotion programs in randomized trials and pay for such programs if the results suggest cost savings and better health for Medicare beneficiaries.

The association of two productivity measures with health risks and medical conditions in an Australian employee population

PURPOSE

To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism.

DESIGN

A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions.

SETTING AND SUBJECTS

Employees (n=224) of a private insurance provider in Australia.

MEASURES

A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records.

RESULTS

Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism.

CONCLUSIONS

This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.

A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: update VI 2000-2004

This critical review focuses on the 12 new studies focused on the clinical and cost outcomes research focused on worksites and published between 2000 and 2004. Although these new studies indicate further evidence of positive clinical and cost outcomes, the quantity and quality of such research continue to decline. When corporations and health plans are demanding more evidence-based outcomes, this decline in rigorous research marks a serious challenge to the field of health promotion and disease management.

BMI, physical activity, and health care utilization/costs among Medicare retirees

OBJECTIVE

To examine the influence of physical activity (PA) and BMI on health care utilization and costs among Medicare retirees.

RESEARCH METHODS AND PROCEDURES

This cross-sectional study was based on 42,520 Medicare retirees in a U.S.-wide manufacturing corporation who participated in indemnity/preferred provider and one health risk appraisal during the years 2001 and 2002. Participants were assigned into one of the three weight groups: normal weight, overweight, and obese. PA behavior was classified into three levels: sedentary (0 time/wk), moderately active (1 to 3 times/wk), and very active (4+ times/wk).

RESULTS

Generalized linear models revealed that the moderately active retirees had US 1456 dollars, US 1731 dollars, and US 1177 dollars lower total health care charges than their sedentary counterparts in the normal-weight, overweight, and obese groups, respectively (p < 0.01). The very active retirees had US 1823 dollars, US 581 dollars, and US 1379 dollars lower costs than the moderately active retirees. Health care utilization and specific costs showed similar trends with PA levels for all BMI groups. The total health care charges were lower with higher PA level for all age groups (p < 0.01).

DISCUSSION

Regular PA has strong dose-response effects on both health care utilization and costs for overweight/obese as well as normal-weight people. Promoting active lifestyle in this Medicare population, especially overweight and obese groups, could potentially improve their well-being and save a substantial amount of health care expenditures. Because those Medicare retirees are hard to reach in general, more creative approaches should be launched to address their needs and interests as well as help reduce the usage of health care system.

The development of a new corporate specific health risk measurement instrument, and its use in investigating the relationship between health and well-being and employee productivity

BACKGROUND

There is a growing body of evidence linking health and well-being to key business issues. Despite this, corporate uptake of workplace health promotion programmes has been slow outside the USA. One possible reason for this is the lack of a generally available health risk measure that is quick and easy to administer and produces data that is rich enough to inform and direct subsequent employee health promotional interventions.

METHODS

We report on the development and validation of the health and well-being (HWB) assessment, a free to use health risk appraisal questionnaire that has been specifically developed for use in the corporate setting. The HWB assessment focuses upon modifiable health issues that directly impact upon business drivers. Development involved interviews with business leaders to ascertain their key areas of focus, scientific and general literature review to find evidence for health status having an impact upon these areas, and end user testing.Three UK-based organisations (insurance, telecommunications and consumer goods sectors) participated in the research. A total of 2224 employees completed the HWB assessment, the short-form 36 (SF-36) and the World Health Organisation Health and Work Performance questionnaire (WHO-HPQ) as part of the validation process.

RESULTS

The HWB assessment is a twenty item questionnaire covering ten areas of health and well-being. Completion of the HWB assessment generates a global health risk score and ten sub-scores corresponding to the ten areas covered. It is easy to use and quick to complete (average completion time was eight minutes) and showed good internal consistency and test-retest reliability. Statistically significant correlations with similar SF-36 variables were observed. A significant negative correlation between HWB score and productivity decrement, as measured by the WHO-HPQ, was observed (r = -0.4). Individuals with HWB scores above the 25th percentile were more likely to achieve workplace productivity standards than those with scores below the 25th percentile (OR 3.62, 95% confidence limits 2.93 - 4.47).

CONCLUSION

The HWB assessment generates reliable business focused health risk data that can be used to direct and target appropriate interventions within corporate populations. It may also be useful in quantifying the financial impact health status issues have upon organisations.

Comparing excess costs across multiple corporate populations

The purpose of this study was to examine the relationship of health risk level to charged medical costs and determine the excess cost of higher risk individuals compared to low risk. Two years of medical claims from six corporations were used to determine costs of health risk assessment (HRA) participants and nonparticipants. A total of 165,770 employees, 21,124 of which took an HRA, were used for the study. Costs increased as risk level increased. There were no significant differences within a risk level between companies for the cost ratio. Percent of medical costs due to excess risk ranged from 15.0-30.8% for HRA participants and 23.8-38.3% for the study population. Cost patterns were consistent across companies. Excess cost as the result of increased risk level accounted for a substantial portion of the cost at each company. These results can be used to justify the need for a health-promotion program and to estimate potential savings as the result of excess risk. Even without the use of an HRA, health practitioners should feel confident stating that excess risk accounts for at least 25% to 30% of medical costs per year across a wide variety of companies, regardless of industry or demographics. The numbers can be used as a realistic estimate for any health promotion program financial proposal.

SMOKE-FREE ORDINANCES INCREASE RESTAURANT PROFIT AND VALUE

This study estimates the economic value added to a restaurant by a smoke-free policy using regression analysis of the purchase price of restaurants, as a function of the presence of a smoke-free law and other control variables. There was a median increase of 16% (interquartile range 11% to 25%) in the sale price of a restaurant in a jurisdiction with a smoke-free law compared to a comparable restaurant in a community without such a law. This result indicates that, contrary to claims made by the tobacco industry and other opponents of smoke-free laws, these laws are associated with an increase in restaurant profitability.

Relationship of body mass index and physical activity to health care costs among employees

This study examined the relationship between physical activity and health care costs by different weight groups. The study sample consisted of 23,490 active employees grouped into normal weight, overweight, and obese categories. After adjustment for covariates, physically moderately active (1 to 2 times/week) and very active (3 + times/week) employees had approximately $250 less paid health care costs annually than sedentary employees (0 time/week) across all weight categories. The difference was approximately $450 in the obese subpopulation. The maximum possible savings was estimated to be 1.5% of the total health care costs if all obese sedentary employees would adapt a physically active lifestyle. As a strategy to control escalating health care costs, wellness programs should facilitate engagement in moderate physical activity of at least 1 to 2 times a week among sedentary obese people and help them to maintain this more active lifestyle.)

Change in Health Risks and Work Productivity Over Time

We sought to examine the relationship between changes in health risks and changes in work productivity. Pre- and postanalysis was conducted on 500 subjects who participated in a wellness program at a large national employer. Change in health risks was analyzed using McNemar chi-square tests, and change in mean productivity was analyzed using paired t tests. A repeated measures regression model examined whether a change in productivity was associated with a change in health risks, controlling for age and gender. Individuals who reduced one health risk improved their presenteeism by 9% and reduced absenteeism by 2%, controlling for baseline risk level, age, gender, and interaction of baseline risk and risk change. In conclusion, reductions in health risks are associated with positive changes in work productivity. Self-reported work productivity may have utility in the evaluation of health promotion programs.

Building program participation: strategies for recruitment and retention in worksite health promotion programs

Building program participation is vital for all health promotion programs. There are a large variety of strategies that have been used to enhance recruitment and retention in worksite health promotion programs. Many of these strategies are examined and their significance in the design and operation of health promotion programs in worksite settings is reviewed.