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Torres G, Mukoma G, Neophytou N, Gradidge PJL. Employee Perceptions of an Established Health and Wellness Coaching Program to Improve Behavior. J Occup Environ Med 2023; 65:e571-e577. [PMID: 37278149 DOI: 10.1097/jom.0000000000002905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is limited evidence, particularly qualitative analysis, of health and wellness interventions within the South African workplace. The purpose of this study is to explore whether health and wellness coaching when offered as part of an employee wellness program has potential for developing lifestyle change in a South African workplace. METHODS There were four, 45-minute focus group discussions, where employees discussed their experiences of the workplace health and wellness intervention program. RESULTS Main categories identified from the coding of the transcripts were purpose of the health and wellness coaching program, as well as employees' program experience and improvement to the program. Common barriers to engagement, positive and negative experiences, and suggested improvements were defined by the employees. CONCLUSIONS The study highlighted the need of understanding employee perceptions in the development and implementation of a workplace health and wellness program.
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Affiliation(s)
- Georgia Torres
- From the Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (G.T., N.N., P.J.-L.G.); and SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand and Johannesburg, Johannesburg, South Africa (G.M.)
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Cardiovascular disease prevention in the worksite: Where are we? Int J Cardiol 2022; 368:104-107. [PMID: 35964848 DOI: 10.1016/j.ijcard.2022.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022]
Abstract
The current guidelines of the European Society of Cardiology on cardiovascular (CV) disease prevention highlighted the importance of implementing coordinated set of action, including worksite, aimed at eliminating or minimizing the impact of CV disease and their related disabilities. Workplace wellness programs tend to focus on modifiable risk factors of non-communicable disease, such as nutrition, physical activity, and smoking cessation. However, nowadays, corporate wellness programs are still rare and incomplete, and usually received limited attention. This represents a big public health issue since company health and wellness interventions may provide an important opportunity to identify and manage CV risk. Given the increasing of employees' average age, a progressive shifting of retirement age and an increased number of chronic diseases, these preventive programs will increasingly represent key factors of both employee's health and economic strategies of companies in the near future.
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Unsal N, Weaver G, Bray J, Bibeau D. A Scoping Review of Economic Evaluations of Workplace Wellness Programs. Public Health Rep 2021; 136:671-684. [PMID: 33541206 PMCID: PMC8579389 DOI: 10.1177/0033354920976557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Debates about the effectiveness of workplace wellness programs (WWPs) call for a review of the evidence for return on investment (ROI) of WWPs. We examined literature on the heterogeneity in methods used in the ROI of WWPs to show how this heterogeneity may affect conclusions and inferences about ROI. METHODS We conducted a scoping review using systematic review methods and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed PubMed, EconLit, Proquest Central, and Scopus databases for published articles. We included articles that (1) were published before December 20, 2019, when our last search was conducted, and (2) met our inclusion criteria that were based on target population, target intervention, evaluation method, and ROI as the main outcome. RESULTS We identified 47 peer-reviewed articles from the selected databases that met our inclusion criteria. We explored the effect of study characteristics on ROI estimates. Thirty-one articles had ROI measures. Studies with costs of presenteeism had the lowest ROI estimates compared with other cost combinations associated with health care and absenteeism. Studies with components of disease management produced higher ROI than programs with components of wellness. We found a positive relationship between ROI and program length and a negative relationship between ROI and conflict of interest. Evaluations in small companies (≤500 employees) were associated with lower ROI estimates than evaluations in large companies (>500 employees). Studies with lower reporting quality scores, including studies that were missing information on statistical inference, had lower ROI estimates. Higher methodologic quality was associated with lower ROI estimates. CONCLUSION This review provides recommendations that can improve the methodologic quality of studies to validate the ROI and public health effects of WWPs.
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Affiliation(s)
- Nilay Unsal
- Department of Economics, Ankara University, Ankara, Turkey
| | - GracieLee Weaver
- Office of Research & Engagement, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jeremy Bray
- Department of Economics, Bryan School of Business and Economics, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Daniel Bibeau
- Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, NC, USA
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Baid D, Hayles E, Finkelstein EA. Return on Investment of Workplace Wellness Programs for Chronic Disease Prevention: A Systematic Review. Am J Prev Med 2021; 61:256-266. [PMID: 33965267 DOI: 10.1016/j.amepre.2021.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Individuals with noncommunicable diseases account for a disproportionate share of medical expenditures, absenteeism, and presenteeism. Therefore, employers are increasingly looking to worksite wellness programs as a cost-containment strategy. Previous reviews examining whether worksite wellness programs deliver a positive return on investment have shown mixed results, possibly because the more optimistic findings come from studies with poorer methodologic quality. The purpose of this systematic review is to critically revisit and update this literature to explore that hypothesis. EVIDENCE ACQUISITION A total of 4 databases were systematically searched for studies published before June 2019. Included studies were economic evaluations of worksite wellness programs that were based in the U.S., that lasted for at least 4 weeks, and that were with at least 1 behavior change component targeting 1 of the 4 primary modifiable behaviors for chronic disease: physical activity, healthy diet, tobacco use, and harmful consumption of alcohol. Methodologic quality was assessed using Consensus for Health Economic Criteria guidelines and the risk for selection bias associated with the study design. Data extraction (September 2019-February 2020) was followed by a narrative synthesis of worksite wellness programs characteristics and return on investment estimates. EVIDENCE SYNTHESIS A total of 25 relevant studies were identified. After conducting a quality and bias assessment, only 2 of the 25 studies were found to have both high methodologic rigor and lower risk for selection bias. These studies found no evidence of a positive return on investment in the short term. CONCLUSIONS The highest-quality studies do not support the hypothesis that worksite wellness programs deliver a positive return on investment within the first few years of initiation.
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Affiliation(s)
- Drishti Baid
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Edward Hayles
- Department of Political Science, Swarthmore College, Swarthmore, Pennsylvania
| | - Eric A Finkelstein
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
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Viterbo LMF, Costa AS, Vidal DG, Dinis MAP. Workers' Healthcare Assistance Model (WHAM): Development, Validation, and Assessment of Sustainable Return on Investment (S-ROI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3143. [PMID: 32365961 PMCID: PMC7246570 DOI: 10.3390/ijerph17093143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/26/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
The present study aimed to present and validate the Worker´s Healthcare Assistance Model (WHAM), which includes an interdisciplinary approach to health risk management in search of integral and integrated health, considering economic sustainability. Through the integration of distinct methodological strategies, WHAM was developed in the period from 2011 to 2018, in a workers' occupational health centre in the oil industry in Bahia, Brazil. The study included a sample of 965 workers, 91.7% of which were men, with a mean age of 44.9 years (age ranged from 23 to 73 years). The Kendall rank correlation coefficient and hierarchical multiple regression analysis were used for the validation of WHAM. The assessment of sustainable return on investment (S-ROI) was made using the WELLCAST ROI™ decision support tool, covering workers with heart disease and diabetes. WHAM can be considered an innovative healthcare model, as there is no available comparative model. WHAM is considered robust, with 86% health risk explanatory capacity and with an 85.5% S-ROI. It can be concluded that WHAM is a model capable of enhancing the level of workers' health in companies, reducing costs for employers and improving the quality of life within the organization.
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Affiliation(s)
- Lilian Monteiro Ferrari Viterbo
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, 4249-004 Porto, Portugal; (A.S.C.); (D.G.V.); (M.A.P.D.)
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Song Z, Baicker K. Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes: A Randomized Clinical Trial. JAMA 2019; 321:1491-1501. [PMID: 30990549 PMCID: PMC6484807 DOI: 10.1001/jama.2019.3307] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/06/2019] [Indexed: 12/14/2022]
Abstract
Importance Employers have increasingly invested in workplace wellness programs to improve employee health and decrease health care costs. However, there is little experimental evidence on the effects of these programs. Objective To evaluate a multicomponent workplace wellness program resembling programs offered by US employers. Design, Setting, and Participants This clustered randomized trial was implemented at 160 worksites from January 2015 through June 2016. Administrative claims and employment data were gathered continuously through June 30, 2016; data from surveys and biometrics were collected from July 1, 2016, through August 31, 2016. Interventions There were 20 randomly selected treatment worksites (4037 employees) and 140 randomly selected control worksites (28 937 employees, including 20 primary control worksites [4106 employees]). Control worksites received no wellness programming. The program comprised 8 modules focused on nutrition, physical activity, stress reduction, and related topics implemented by registered dietitians at the treatment worksites. Main Outcomes and Measures Four outcome domains were assessed. Self-reported health and behaviors via surveys (29 outcomes) and clinical measures of health via screenings (10 outcomes) were compared among 20 intervention and 20 primary control sites; health care spending and utilization (38 outcomes) and employment outcomes (3 outcomes) from administrative data were compared among 20 intervention and 140 control sites. Results Among 32 974 employees (mean [SD] age, 38.6 [15.2] years; 15 272 [45.9%] women), the mean participation rate in surveys and screenings at intervention sites was 36.2% to 44.6% (n = 4037 employees) and at primary control sites was 34.4% to 43.0% (n = 4106 employees) (mean of 1.3 program modules completed). After 18 months, the rates for 2 self-reported outcomes were higher in the intervention group than in the control group: for engaging in regular exercise (69.8% vs 61.9%; adjusted difference, 8.3 percentage points [95% CI, 3.9-12.8]; adjusted P = .03) and for actively managing weight (69.2% vs 54.7%; adjusted difference, 13.6 percentage points [95% CI, 7.1-20.2]; adjusted P = .02). The program had no significant effects on other prespecified outcomes: 27 self-reported health outcomes and behaviors (including self-reported health, sleep quality, and food choices), 10 clinical markers of health (including cholesterol, blood pressure, and body mass index), 38 medical and pharmaceutical spending and utilization measures, and 3 employment outcomes (absenteeism, job tenure, and job performance). Conclusions and Relevance Among employees of a large US warehouse retail company, a workplace wellness program resulted in significantly greater rates of some positive self-reported health behaviors among those exposed compared with employees who were not exposed, but there were no significant differences in clinical measures of health, health care spending and utilization, and employment outcomes after 18 months. Although limited by incomplete data on some outcomes, these findings may temper expectations about the financial return on investment that wellness programs can deliver in the short term. Trial Registration ClinicalTrials.gov Identifier: NCT03167658.
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Affiliation(s)
- Zirui Song
- Harvard Medical School, Massachusetts General Hospital, Boston
| | - Katherine Baicker
- University of Chicago Harris School of Public Policy, Chicago, Illinois
- National Bureau of Economic Research (NBER), Cambridge, Massachusetts
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Stadhouders N, Kruse F, Tanke M, Koolman X, Jeurissen P. Effective healthcare cost-containment policies: A systematic review. Health Policy 2019; 123:71-79. [DOI: 10.1016/j.healthpol.2018.10.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/01/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022]
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Abstract
Increasingly, corporate health promotion programs are implementing wellness programs integrating principles of behavioral economics. Employees of a large firm were provided a customized online incentive program to design their own commitments to meet health goals. This study examines patterns of program participation and engagement in health promotion activities. Subjects were US-based employees of a large, nondurable goods manufacturing firm who were enrolled in corporate health benefits in 2010 and 2011. We assessed measures of engagement with the workplace health promotion program (e.g., incentive points earned, weight loss). To further examine behaviors indicating engagement in health promotion activities, we constructed an aggregate, employee-level engagement index. Regression models were employed to assess the association between employee characteristics and the engagement index, and the engagement index and spending. 4220 employees utilized the online program and made 25,716 commitments. Male employees age 18-34 had the highest level of engagement, and male employees age 55-64 had the lowest level of engagement overall. Prior year health status and prior year spending did not show a significant association with the level of engagement with the program (p > 0.05). Flexible, incentive-based behavioral health and lifestyle programs may reach the broader workforce including those with chronic conditions and higher levels of health spending.
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Guico-Pabia CJ, Cioffi L, Shoner LG. The Lucent-Takes-Heart Cardiovascular Health Management Program. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/216507990205000809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective, pre- and postevaluation of a worksite cardiovascular health management program consisted of employee education, measurement of cardiovascular risk factors, and on-site individual counseling for all employees, along with follow up screening for high risk participants. Of 1,099 employees (16.4% of those eligible) who participated in the initial screening, 596 (54.2%) were classified as high risk. A total of 167 (28.0%) high risk participants completed the 6 month follow up screening. Most high risk participants in the 6 month follow up screening reported they had increased their exercise (64.7%), improved their diet (71.3%), and visited a physician (61.7%). A minority of the participants (16.8%) began new cardiovascular medications, and 2.4% were diagnosed with diabetes. In addition, there were statistically significant decreases in the percentages of participants with elevated systolic blood pressure, diastolic blood pressure, low density lipoprotein cholesterol, and total cholesterol to high density lipoprotein ratio. Almost all (99.7%) of the 909 participants (82.7% of all participants) who completed the satisfaction survey were satisfied or very satisfied with the overall program. Screening in the workplace can identify individuals at high risk for cardiovascular disease. In this study, more than half of the participants were classified as high risk. Most high risk individuals who attended the 6 month follow up screening had improved their cardiovascular health, but attrition remains a challenge for worksite programs.
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Lynch WD, Chikamoto Y, Imai K, Lin TF, Kenkel DS, Ozminkowski RJ, Goetzel RZ. The Association between Health Risks and Medical Expenditures in a Japanese Corporation. Am J Health Promot 2016; 19:238-48. [PMID: 15675538 DOI: 10.4278/0890-1171-19.3s.238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine the relationship between health risks and medical care expenditures in an employer setting in Japan. Design. A cross-sectional, correlational study. Setting. A large Japanese corporation. Subjects. A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six percent were male, and subjects were primarily white-collar workers. Measures. Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals. Results. Average total expenditures were ¥48,017 (US$445). The 90th percentile of the expenditure distribution was approximately ¥111,750 (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35%), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1%), and high blood glucose (9.4%). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76% higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking, poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors. Conclusions. This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected associations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.
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Pelletier KR. International Collaboration in Health Promotion and Disease Management: Implications of U.S. Health Promotion Efforts on Japan's Health Care System. Am J Health Promot 2016; 19:216-29. [PMID: 15675536 DOI: 10.4278/0890-1171-19.3s.216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For more than 25 years, health promotion and disease management interventions have been conducted by large employers in the United States. Today there are more than 100 studies of such multifactorial, comprehensive interventions that all demonstrate positive clinical outcomes. For those interventions that have also been evaluated for return on investment, all but one have demonstrated cost-effectiveness. This article is an evidence-based overview of the clinical and cost outcomes research to elaborate on the insights gained from this research in the areas of implementation and evaluation of such programs; integration of health promotion and disease management programs into conventional, occupational medicine; accessing difficult to reach populations, such as mobile workers, retirees, and/or dependents; areas of potential conflict of interest and privacy/confidentiality issues; health consequences of downsizing and job strain; and, finally, recommendations for improved integration and evaluation of such programs for both clinical and cost outcomes. With medical costs rapidly escalating again on a global scale, these interventions with evidence of both clinical and cost outcomes can provide the foundation to improve the health, performance, and productivity of both individuals and their corporations.
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Affiliation(s)
- Kenneth R Pelletier
- Department of Medicine at the University of Maryland School of Medicine, USA
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Baxter S, Sanderson K, Venn AJ, Blizzard CL, Palmer AJ. The relationship between return on investment and quality of study methodology in workplace health promotion programs. Am J Health Promot 2016; 28:347-63. [PMID: 24977496 DOI: 10.4278/ajhp.130731-lit-395] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the relationship between return on investment (ROI) and quality of study methodology in workplace health promotion programs. DATA SOURCE Data were obtained through a systematic literature search of National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Database (HTA), Cost Effectiveness Analysis (CEA) Registry, EconLit, PubMed, Embase, Wiley, and Scopus. STUDY INCLUSION AND EXCLUSION CRITERIA Included were articles written in English or German reporting cost(s) and benefit(s) and single or multicomponent health promotion programs on working adults. Return-to-work and workplace injury prevention studies were excluded. DATA EXTRACTION Methodological quality was graded using British Medical Journal Economic Evaluation Working Party checklist. Economic outcomes were presented as ROI. DATA SYNTHESIS ROI was calculated as ROI = (benefits - costs of program)/costs of program. Results were weighted by study size and combined using meta-analysis techniques. Sensitivity analysis was performed using two additional methodological quality checklists. The influences of quality score and important study characteristics on ROI were explored. RESULTS Fifty-one studies (61 intervention arms) published between 1984 and 2012 included 261,901 participants and 122,242 controls from nine industry types across 12 countries. Methodological quality scores were highly correlated between checklists (r = .84-.93). Methodological quality improved over time. Overall weighted ROI [mean ± standard deviation (confidence interval)] was 1.38 ± 1.97 (1.38-1.39), which indicated a 138% return on investment. When accounting for methodological quality, an inverse relationship to ROI was found. High-quality studies (n = 18) had a smaller mean ROI, 0.26 ± 1.74 (.23-.30), compared to moderate (n = 16) 0.90 ± 1.25 (.90-.91) and low-quality (n = 27) 2.32 ± 2.14 (2.30-2.33) studies. Randomized control trials (RCTs) (n = 12) exhibited negative ROI, -0.22 ± 2.41(-.27 to -.16). Financial returns become increasingly positive across quasi-experimental, nonexperimental, and modeled studies: 1.12 ± 2.16 (1.11-1.14), 1.61 ± 0.91 (1.56-1.65), and 2.05 ± 0.88 (2.04-2.06), respectively. CONCLUSION Overall, mean weighted ROI in workplace health promotion demonstrated a positive ROI. Higher methodological quality studies provided evidence of smaller financial returns. Methodological quality and study design are important determinants.
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Acosta H, Cruz-Ortiz V, Salanova M, Llorens S. Healthy organization: analysing its meaning based on the HERO Model / Organizaciones saludables: analizando su significado desde el Modelo HERO. INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2015. [DOI: 10.1080/21711976.2015.1016751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Caloyeras JP, Liu H, Exum E, Broderick M, Mattke S. Managing manifest diseases, but not health risks, saved PepsiCo money over seven years. Health Aff (Millwood) 2015; 33:124-31. [PMID: 24395944 DOI: 10.1377/hlthaff.2013.0625] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings.
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What Are Some of the Features of Worksite Wellness Interventions in the United States? J Occup Environ Med 2015; 57:e26-9. [DOI: 10.1097/jom.0000000000000320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preventive and promotive health initiatives: An experience of a wellness clinic in southern India. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Musich S, McCalister T, Wang S, Hawkins K. An Evaluation of the Well at Dell Health Management Program: Health Risk Change and Financial Return on Investment. Am J Health Promot 2015; 29:147-57. [DOI: 10.4278/ajhp.131115-quan-582] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate the effectiveness of the Well at Dell comprehensive health management program in delivering health care and productivity cost savings relative to program investment (i.e., return on investment). Design. A quasi-experimental design was used to quantify the financial impact of the program and nonexperimental pre-post design to evaluate change in health risks. Setting. Ongoing worksite health management program implemented across multiple U.S. locations. Subjects. Subjects were 24,651 employees with continuous medical enrollment in 2010–2011 who were eligible for 2011 health management programming. Intervention. Incentive-driven, outcomes-based multicomponent corporate health management program including health risk appraisal (HRA)/wellness, lifestyle management, and disease management coaching programs. Measures. Medical, pharmacy, and short-term disability pre/post expenditure trends adjusted for demographics, health status, and baseline costs. Self-reported health risks from repeat HRA completers. Analysis. Propensity score–weighted and multivariate regression–adjusted comparison of baseline to post trends in health care expenditures and productivity costs for program participants and nonparticipants (i.e., difference in difference) relative to programmatic investment. Results. The Well at Dell program achieved an overall return on investment of 2.48 in 2011. Most of the savings were realized from the HRA/wellness component of the program. Cost savings were supported with high participation and significant health risk improvement. Conclusion. An incentive-driven, well-managed comprehensive corporate health management program can continue to achieve significant health improvement while promoting health care and productivity cost savings in an employee population.
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Integrated health programs, health outcomes, and return on investment: measuring workplace health promotion and integrated program effectiveness. J Occup Environ Med 2014; 55:S38-45. [PMID: 24284755 DOI: 10.1097/jom.0000000000000044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore return on investment (ROI) in workplace health promotion studies. METHODS Studies with high ROI attribution for workplace health promotion were reanalyzed using standardized measures. Key variables included intervention duration, sector and population size, annualized cost, and health outcomes. RESULTS ROI was often overestimated. Programs with the highest reported ROI were concentrated in large corporations, where cognitive programs incurred low per person costs. Ten of the 12 studies involved individualized health promotion only, and did not engage work organizational modification or integration with occupational health. Some effective health interventions were discounted because they were not easily monetized. CONCLUSIONS ROI, an investment metric, amplifies short-term labor-related effects and discounts longer-term chronic disease prevention.
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Shahly V, Kessler RC, Duncan I. Worksite primary care clinics: a systematic review. Popul Health Manag 2014; 17:306-15. [PMID: 24835541 DOI: 10.1089/pop.2013.0095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite levels of health spending that are higher per capita and as share of gross domestic product than any country worldwide, the US health care system is fragmented, technology and administration heavy, and primary care deficient. Studies of regional variations in US health care show similar "disconnects" between higher spending and better health outcomes. Faced with rising health benefit costs and suboptimal workforce health amid economic downturn, concerned US employers have implemented innovative payment and health care delivery strategies such as consumer-driven health plans and targeted prevention programs. The former may impose undue cost shifting, prohibitive out-of-pocket expenses, and health literacy challenges, while the latter have shown inconsistent near-term economic returns and long-term clinical efficacy. Employers have begun exploring more comprehensive health delivery platforms such as integrated worksite primary care clinics that have potential to cost-effectively address several pressing problems with current US health care: the growing primary care physician shortage, poor access to routine care, lack of coordinated and patient-centered treatment models, low rates of childhood immunizations, and "quality-blind" fee-for-service payment mechanisms. Such on-site medical clinics exploit one of the rare comparative strengths of the US health care system-its plentiful supply of highly skilled registered nurses-to offer workers and their dependents convenient, high-quality, affordable care. A relatively recent health care paradigm, worksite clinics must yet develop consistent reporting strategies and credible demonstration of outcomes. This review explores available evidence regarding worksite primary care clinics, including current rationale, historical trends, prevalence and projected growth, expected health and financial benefits, challenges, and future research directions.
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Affiliation(s)
- Victoria Shahly
- 1 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts
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How healthy is the Singaporean worker? Results from the Singapore national health survey 2010. J Occup Environ Med 2014; 56:498-509. [PMID: 24806563 DOI: 10.1097/jom.0000000000000131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the prevalence of common medical conditions (including mental health and self-rated health) and lifestyle risk factors for disease of the Singapore workforce with the nonworking population, and evaluate the association of these factors with occupation class. METHODS Data were obtained from a population-representative cross-sectional survey in 2010. Adjusted prevalence ratios (PRs) were obtained by modified Breslow-Cox proportional hazards regression model. RESULTS Within the workforce, after adjustment for age, sex, and ethnicity, daily smoking (PR = 1.87; 95% confidence interval [CI], 1.40 to 2.51; P < 0.001), no regular exercise (PR = 1.13; 95% CI, 1.07 to 1.20; P < 0.001), and poor self-rated health (PR = 1.46, 95% CI, 1.22 to 1.76; P < 0.001) were more prevalent in the lower-skilled occupation classes. CONCLUSIONS Lower-skilled occupation classes in Singapore are associated with lifestyle risk factors, and tailored workplace health promotion programs addressing their specific health needs are needed.
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Effect of an Employer-Sponsored Health and Wellness Program on Medical Cost and Utilization. Popul Health Manag 2013. [DOI: 10.1089/pop.2011.0108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Roux L, Donaldson C. Economics and Obesity: Costing the Problem or Evaluating Solutions? ACTA ACUST UNITED AC 2012; 12:173-9. [PMID: 14981208 DOI: 10.1038/oby.2004.23] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There is no doubt that obesity is a major public health problem. However, what is the contribution of economics to solving it? In this report, we make the case that the role of economics is not in measuring the economic burden of obesity, through so-called cost-of-illness studies. Such studies merely confirm that obesity is a serious societal issue; adding a monetary figure to this does not add much. The economic foundations of such estimates can also be questioned, thus lessening their policy relevance. The real value of economics in the arena of obesity care is in evaluating, through formal economic evaluation, the use of our scarce health care resources in different strategies to prevent and treat obesity.
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Affiliation(s)
- Larissa Roux
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Abstract
The frequency of mania has not changed during the last century even with the development of new diagnostic criteria sets. More specifically, from the mid-1970s to 2000, the rate of mania (variably labeled major affective disorder-bipolar disorder and bipolar I disorder) was consistently identified in US and international studies as ranging from 0.4% to 1.6%. By the late 1990s to the 2000s, the prevalence reported by some researchers for bipolar disorders (I and II and others) was in the 5% to 7% and higher ranges. The purpose of this paper was to review explanations for this change and the potentially negative impacts on the field.
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Serxner S, Alberti A, Weinberger S. Medical Cost Savings for Participants and Nonparticipants in Health Risk Assessments, Lifestyle Management, Disease Management, Depression Management, and Nurseline in a Large Financial Services Corporation. Am J Health Promot 2012; 26:245-52. [DOI: 10.4278/ajhp.090805-quan-253] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To compare changes in medical costs between participants and nonparticipants in five different health and productivity management (HPM) programs. Design. Quasi-experimental pre/post intervention study. Setting. A large financial services corporation. Subjects. A cohort population of employees enrolled in medical plans (n = 49,793). Intervention. A comprehensive HPM program, which addressed health risks, acute and chronic conditions, and psychosocial disorders from 2005 to 2007. Incentives were used to encourage health risk assessment participation in years 2 and 3. Measures. Program participation and medical claims data were collected for members at the end of each program year to assess the change in total costs from the baseline period. Analysis. Multivariate analyses for participation categories were conducted comparing baseline versus program year cost differences, controlling for demographics. Results. All participation categories yielded a lower cost increase compared to nonparticipation and a positive return on investment (ROI) for years 2 and 3, resulting in a 2.45:1 ROI for the combined program years. Conclusion. Medical cost savings exceeded program costs in a wide variety of health and productivity management programs by the second year.
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Affiliation(s)
- Seth Serxner
- Seth Serxner, PhD, is with OptumHealth, 6300 Olsen Memorial Highway, CA960-1000, Golden
Valley, Minnesota. Angela Alberti, MEd, is a nursing student at Rutgers University,
Bogota, New Jersey. Sarah Weinberger, BA, is a graduate student at the University of
California, Berkeley, California
| | - Angela Alberti
- Seth Serxner, PhD, is with OptumHealth, 6300 Olsen Memorial Highway, CA960-1000, Golden
Valley, Minnesota. Angela Alberti, MEd, is a nursing student at Rutgers University,
Bogota, New Jersey. Sarah Weinberger, BA, is a graduate student at the University of
California, Berkeley, California
| | - Sarah Weinberger
- Seth Serxner, PhD, is with OptumHealth, 6300 Olsen Memorial Highway, CA960-1000, Golden
Valley, Minnesota. Angela Alberti, MEd, is a nursing student at Rutgers University,
Bogota, New Jersey. Sarah Weinberger, BA, is a graduate student at the University of
California, Berkeley, California
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Abstract
OBJECTIVE To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population. METHODS Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations. RESULTS Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others. CONCLUSIONS Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.
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Grossmeier J, Terry PE, Anderson DR, Wright S. Financial impact of population health management programs: reevaluating the literature. Popul Health Manag 2012; 15:129-34. [PMID: 22313443 DOI: 10.1089/pop.2010.0086] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although many employers offer some components of worksite-based population health management (PHM), most do not yet invest in comprehensive programs. This hesitation to invest in comprehensive programs may be attributed to numerous factors, such as other more pressing business priorities, reluctance to intervene in the personal health choices of employees, or insufficient funds for employee health. Many decision makers also remain skeptical about whether investment in comprehensive programs will produce a financial return on investment (ROI). Most peer-reviewed studies assessing the financial impact of PHM were published before 2000 and include a broad array of program and study designs. Many of these studies have also included indirect productivity savings in their assessment of financial outcomes. In contrast, this review includes only peer-reviewed studies of the direct health care cost impact of comprehensive PHM programs that meet rigorous methodological criteria. A systematic search of health sciences databases identified only 5 studies with program designs and study methods meeting these selection criteria published after 2007. This focused review found that comprehensive PHM programs can yield a positive ROI based on their impact on direct health care costs, but the level of ROI achieved was lower than that reported by literature reviews with less focused and restrictive qualifying criteria. To yield substantial short-term health care cost savings, the longer term financial return that can credibly be associated with a comprehensive, prevention-oriented population health program must be augmented by other financial impact strategies.
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Goetzel RZ, Schoenman JA, Chapman LS, Anderson DR, Ozminkowski RJ, Lindsay GM. Strategies for strengthening the evidence base for employee health promotion programs. Am J Health Promot 2012; 26:TAHP1-6, iii. [PMID: 21879926 DOI: 10.4278/ajhp.26.1.tahp] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Employee health promotion programs have been a visible facet of the American workplace for more than 30 years. During that time, a substantial amount of research on best practices has been conducted, but because of a lack of significant public investment in research funding there is still much to be done. Most researchers and practitioners familiar with the literature recognize the need to strengthen the evidence base for the field. In this edition of The Art of Health Promotion we examine the primary recommendations emerging from a recent federally sponsored effort to identify strategies for strengthening the evidence base for employee health promotion.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University, USA
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Kaufman HW, Williams FR, Odeh MA. Value of laboratory tests in employer-sponsored health risk assessments for newly identifying health conditions: analysis of 52,270 participants. PLoS One 2011; 6:e28201. [PMID: 22163283 PMCID: PMC3233567 DOI: 10.1371/journal.pone.0028201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 11/03/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Employer-sponsored health risk assessments (HRA) may include laboratory tests to provide evidence of disease and disease risks for common medical conditions. We evaluated the ability of HRA-laboratory testing to provide new disease-risk information to participants. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional analysis of HRA-laboratory results for participating adult employees and their eligible spouses or their domestic partners, focusing on three common health conditions: hyperlipidemia, diabetes mellitus, and chronic kidney disease. HRA with laboratory results of 52,270 first-time participants were analyzed. Nearly all participants had access to health insurance coverage. Twenty-four percent (12,392) self-reported one or more of these medical conditions: 21.1% (11,017) self-identified as having hyperlipidemia, 4.7% (2,479) self-identified as having diabetes, and 0.7% (352) self-identified as having chronic kidney disease. Overall, 36% (n = 18,540) of participants had laboratory evidence of at least one medical condition newly identified: 30.7% (16,032) had laboratory evidence of hyperlipidemia identified, 1.9% (984) had laboratory evidence of diabetes identified, and 5.5% (2,866) had laboratory evidence of chronic kidney disease identified. Of all participants with evidence of hyperlipidemia 59% (16,030 of 27,047), were newly identified through the HRA. Among those with evidence of diabetes 28% (984 of 3,463) were newly identified. The highest rate of newly identified disease risk was for chronic kidney disease: 89% (2,866 of 3,218) of participants with evidence of this condition had not self-reported it. Men (39%) were more likely than women (33%) to have at least one newly identified condition (p<0.0001). Among men, lower levels of educational achievement were associated with modestly higher rates of newly identified disease risk (p<0.0001); the association with educational achievement among women was unclear. Even among the youngest age range (20 to 29 year olds), nearly 1 in 4 participants (24%) had a newly identified risk for disease. CONCLUSIONS/SIGNIFICANCE These results support the important role of employer-sponsored laboratory testing as an integral element of HRA for identifying evidence of previously undiagnosed common medical conditions in individuals of all working age ranges, regardless of educational level and gender.
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Affiliation(s)
- Harvey W Kaufman
- Quest Diagnostics, Madison, New Jersey, United States of America.
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van Dongen JM, Proper KI, van Wier MF, van der Beek AJ, Bongers PM, van Mechelen W, van Tulder MW. Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Obes Rev 2011; 12:1031-49. [PMID: 21883870 DOI: 10.1111/j.1467-789x.2011.00925.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made.
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Affiliation(s)
- J M van Dongen
- Body@Work, Research Center for Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands.
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Brott A, Dougherty A, Williams ST, Matope JH, Fadich A, Taddelle M. The Economic Burden Shouldered by Public and Private Entities as a Consequence of Health Disparities Between Men and Women. Am J Mens Health 2011; 5:528-39. [PMID: 22064880 DOI: 10.1177/1557988311421214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
On average, American men live shorter, less healthy lives than women. They are more likely to be the victim of a violent crime, die in a car crash, commit suicide, and be injured at work. In addition, men have higher death rates in 9 of the top 10 causes of death, and are less likely to receive routine preventative care, leaving men with a life span that is significantly shorter than women’s. Recently, policy makers and researchers have been paying more attention to health disparities including race, sex, and ethnicity. However, men are still noticeably absent from these discussions despite being significantly harmed by disparities in preventive care, quality of life, and overall health outcomes. Ignoring these disparities is costly in terms of lost productivity, lives lost, and financial costs incurred by the government and employers each year. Premature death and morbidity in men costs federal, state, and local governments in excess of $142 billion annually. It also costs U.S.employers and society as a whole in excess of $156 billion annually in direct medical payments and lost productivity and an additional $181 billion annually in decreased quality of life. As federal and state governments and the private sector struggle with increasing health entitlement burdens—including escalating health care costs—eliminating male health inequities emerges as an important source of savings. This analysis will examine the economic and intangible costs associated with the health disparities that exist between genders and the benefits reaped if these disparities are reduced or eliminated.
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Affiliation(s)
| | | | | | | | - Ana Fadich
- Men’s Health Network, Washington, DC, USA
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The Relationship Between 11 Health Risks and Medical and Productivity Costs for a Large Employer. J Occup Environ Med 2011; 53:468-77. [DOI: 10.1097/jom.0b013e31821586b8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The influence of worksite health promotion program management and implementation structure variables on medical care costs at PPG Industries. J Occup Environ Med 2011; 52:1160-6. [PMID: 21124248 DOI: 10.1097/jom.0b013e3181ff203f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the relationship between critical factors for successful worksite health promotion programs such as management support and program implementation and health care costs at PPG Industries. METHODS We analyzed survey data from 37 PPG worksites measuring management support and program implementation. We estimated the relationship between management and implementation scores in 2007 and subsequent health care costs in 2008 using ordinary least squares regression. RESULTS High program implementation scores were associated with higher health care costs (P < 0.01) as were high management scores (P < 0.05). However, sites with a combination of high management and implementation scores had lower health care costs, while sites with low scores on these dimensions had higher cost trends. CONCLUSIONS Employers should consider administering worksite health promotion structural assessments to identify gaps in management support and program implementation that may influence program effectiveness.
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Barriers to implementation of workplace health interventions: an economic perspective. J Occup Environ Med 2011; 52:934-42. [PMID: 20798640 DOI: 10.1097/jom.0b013e3181f26e59] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify insurance related, structural, and workplace cultural barriers to the implementation of effective preventive and upstream clinical interventions in the working age adult population. METHODS Analysis of avoided costs from perspective of health economics theory and from empiric observations from large studies; presentation of data from our own cost-plus model on integrating health promotion and ergonomics. RESULTS We identify key avoided costs issues as a misalignment of interests between employers, insurers, service institutions, and government. Conceptual limitations of neoclassical economics are attributable to work culture and supply-driven nature of health care. DISCUSSION Effective valuation of avoided costs is a necessary condition for redirecting allocations and incentives. Key content for valuation models is discussed.
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The Effectiveness of Health Promotion at the University of Minnesota: Expenditures, Absenteeism, and Participation in Specific Programs. J Occup Environ Med 2010; 52:269-80. [DOI: 10.1097/jom.0b013e3181cf3aed] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soler RE, Leeks KD, Razi S, Hopkins DP, Griffith M, Aten A, Chattopadhyay SK, Smith SC, Habarta N, Goetzel RZ, Pronk NP, Richling DE, Bauer DR, Buchanan LR, Florence CS, Koonin L, MacLean D, Rosenthal A, Matson Koffman D, Grizzell JV, Walker AM. A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback. Am J Prev Med 2010; 38:S237-62. [PMID: 20117610 DOI: 10.1016/j.amepre.2009.10.030] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 08/04/2009] [Accepted: 10/27/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many health behaviors and physiologic indicators can be used to estimate one's likelihood of illness or premature death. Methods have been developed to assess this risk, most notably the use of a health-risk assessment or biometric screening tool. This report provides recommendations on the effectiveness of interventions that use an Assessment of Health Risks with Feedback (AHRF) when used alone or as part of a broader worksite health promotion program to improve the health of employees. EVIDENCE ACQUISITION The Guide to Community Preventive Services' methods for systematic reviews were used to evaluate the effectiveness of AHRF when used alone and when used in combination with other intervention components. Effectiveness was assessed on the basis of changes in health behaviors and physiologic estimates, but was also informed by changes in risk estimates, healthcare service use, and worker productivity. EVIDENCE SYNTHESIS The review team identified strong evidence of effectiveness of AHRF when used with health education with or without other intervention components for five outcomes. There is sufficient evidence of effectiveness for four additional outcomes assessed. There is insufficient evidence to determine effectiveness for others such as changes in body composition and fruit and vegetable intake. The team also found insufficient evidence to determine the effectiveness of AHRF when implemented alone. CONCLUSIONS The results of these reviews indicate that AHRF is useful as a gateway intervention to a broader worksite health promotion program that includes health education lasting > or =1 hour or repeating multiple times during 1 year, and that may include an array of health promotion activities. These reviews form the basis of the recommendations by the Task Force on Community Preventive Services presented elsewhere in this supplement.
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Affiliation(s)
- Robin E Soler
- National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.
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Abstract
Amid soaring health spending, there is growing interest in workplace disease prevention and wellness programs to improve health and lower costs. In a critical meta-analysis of the literature on costs and savings associated with such programs, we found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. Although further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.
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Affiliation(s)
- Katherine Baicker
- School of Public Health, Harvard University, in Boston, Massachusetts, USA.
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Using a personal health care cost calculator to estimate future expenditures based on individual health risks. J Occup Environ Med 2009; 51:449-55. [PMID: 19322111 DOI: 10.1097/jom.0b013e3181996ceb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the development and application of an innovative Health Improvement Cost Calculator tool designed to help individuals recognize the link between their current health risks, future medical costs, and productivity. METHODS We describe how the Calculator was developed using data from studies that tie health care costs and productivity to population health risks, and how changes in risks are projected to reduce future spending for individual workers. RESULTS Two simulations of the model illustrate how individuals may realize future economic costs or benefits depending on whether they maintain or change their health-risk profile. CONCLUSIONS The Calculator has the potential to be a powerful motivational tool for individuals, especially those heading toward retirement, who are looking to understand the relationships between their health risks, future medical spending, and impacts on productivity.
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Kuhnen AE, Burch SP, Shenolikar RA, Joy KA. Employee Health and Frequency of Workers' Compensation and Disability Claims. J Occup Environ Med 2009; 51:1041-8. [DOI: 10.1097/jom.0b013e3181b32071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Punnett L, Cherniack M, Henning R, Morse T, Faghri P. A conceptual framework for integrating workplace health promotion and occupational ergonomics programs. Public Health Rep 2009; 124 Suppl 1:16-25. [PMID: 19618803 DOI: 10.1177/00333549091244s103] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Musculoskeletal, cardiovascular, and mental health are all associated with the physical and psychosocial conditions of work, as well as with individual health behaviors. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially in light of recent findings that work organization influences so-called lifestyle or health behaviors. Macroergonomics provides a framework to improve both physical and organizational features of work and, in the process, to empower individual workers. The Center for the Promotion of Health in the New England Workplace (CPH-NEW) is a research-to-practice effort examining the effectiveness of worksite programs that combine occupational safety and health--especially ergonomics--with health promotion, emphasizing the contribution of work organization to both. Two intervention studies are underway in three different sectors: health care, corrections, and manufacturing. Each study features participatory structures to facilitate employee input into health goal-setting, program design and development, and evaluation, with the goal of enhanced effectiveness and longer-term sustainability.
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Affiliation(s)
- Laura Punnett
- Center for the Promotion of Health in the New England Workplace, University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA.
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Rothstein MA, Harrell HL. Health risk reduction programs in employer-sponsored health plans: Part I-efficacy. J Occup Environ Med 2009; 51:943-50. [PMID: 19625972 PMCID: PMC3034441 DOI: 10.1097/jom.0b013e3181b05421] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs. METHODS We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation. RESULTS There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal. CONCLUSION Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions.
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Affiliation(s)
- Mark A Rothstein
- Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, KY 40202, USA.
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Serxner S, Gold D, Meraz A, Gray A. Do Employee Health Management Programs Work? Am J Health Promot 2009; 23:1-8, iii. [DOI: 10.4278/ajhp.23.4.tahp] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Goetzel RZ, Baker KM, Short ME, Pei X, Ozminkowski RJ, Wang S, Bowen JD, Roemer EC, Craun BA, Tully KJ, Baase CM, DeJoy DM, Wilson MG. First-year results of an obesity prevention program at The Dow Chemical Company. J Occup Environ Med 2009; 51:125-38. [PMID: 19209033 PMCID: PMC2877035 DOI: 10.1097/jom.0b013e3181954b03] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine first-year results from a workplace environmental obesity prevention program at The Dow Chemical Company. METHODS A quasi-experimental cohort study was conducted among employees at nine treatment worksites (n = 8013) who received environmental weight management interventions and three control worksites (n = 2269). Changes in employees' weight, body mass index (BMI), and other health risks were examined using chi2 and t-tests. RESULTS After 1 year, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased. CONCLUSIONS Environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in 1 year.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Using a Return-On-Investment Estimation Model to Evaluate Outcomes From an Obesity Management Worksite Health Promotion Program. J Occup Environ Med 2008; 50:981-90. [DOI: 10.1097/jom.0b013e318184a489] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Goetzel RZ, Ozminkowski RJ. The Health and Cost Benefits of Work Site Health-Promotion Programs. Annu Rev Public Health 2008; 29:303-23. [DOI: 10.1146/annurev.publhealth.29.020907.090930] [Citation(s) in RCA: 461] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ron Z. Goetzel
- Department of Health and Productivity Research, Thomson Healthcare, Washington, DC 20008;
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Goetzel RZ, Shechter D, Ozminkowski RJ, Marmet PF, Tabrizi MJ, Roemer EC. Promising Practices in Employer Health and Productivity Management Efforts: Findings From a Benchmarking Study. J Occup Environ Med 2007; 49:111-30. [PMID: 17293753 DOI: 10.1097/jom.0b013e31802ec6a3] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify key success factors related to employer-based health and productivity management (HPM) programs. METHODS Data regarding promising practices in HPM were gathered via literature review, discussions with subject matter experts, online inventory, and site visits. RESULTS Promising practices in HPM include 1) integrating HPM programs into the organization's operations; 2) simultaneously addressing individual, environmental, policy, and cultural factors affecting health and productivity; 3) targeting several health issues; 4) tailoring programs to address specific needs; 5) attaining high participation; 6) rigorously evaluating programs; and 7) communicating successful outcomes to key stakeholders. CONCLUSION Increased efforts should be directed at disseminating the experiences of promising practices. However, more research is needed in this area, so that additional public and private funding is made available for applied research in "real-life" business settings. Finally, employers should be provided effective tools and resources to support their HPM efforts.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Cornell University, Washington DC 20008, USA.
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