Austin Frakt and Aaron Carrol had a nice column in Bloomberg on Wellness programs and the PSU program in particular. They point out that,
Whether wellness programs work as intended or not, let’s recognize what they also do: They increase the cost of coverage for some employees. That saves employers money but by shifting costs to workers. Those who bear the brunt of this increase are the less healthy employees, who also tend to be those of lower socioeconomic status.
Now let’s consider what wellness programs might do: reduce health-care spending and improve health. In general, the evidence is weak that they will. Why? Conceptually, factors within workers’ control make only a small contribution to rising health-care costs, so there’s only so much such a program can do, even if it works perfectly. Empirically, the track record of wellness programs’ efficacy is mixed at best.They do not point to the irony of our self-financing system directly. But they note the fact that the research shows that they are ineffective. And they answer the question of why they are so popular with employers.
More rigorous studies find that wellness programs in general don’t save money. With few exceptions, they often don’t improve health, either. The additional screenings that such programs encourage can lead to overuse of care, pushing spending higher without improving health.
Given all of this, why are wellness programs so pervasive? Our hypothesis is that it’s a form of supplier-induced demand: The wellness industry is doing a good job of pushing its product. Understanding research is challenging, and it’s relatively easy for a marketing representative to cite glorious-sounding results.
Clearly the suppliers of these programs benefit, as PSU employees could see when we took our biometric testing and saw how many people the wellness program hired. I think that PSU is just counting on a lot of dropped spousal coverage. As they conclude,
Penn State’s plan would hardly be the first time Americans bought something that may not work as well as advertised. Companies should reconsider the reasons that they are so eager to have them and whether they’re really worth the investment.
1 comment:
Anecdotally, I intensely dislike the Blue Cross-Blue Shield Federal Employee "wellness" program, which takes the form of an "Online Health Coach." Was adopted by BC-BS under the Obama administration. From what I've seen over the past 6-7 years, the Online Health Coach realistically won't change anyone's behavior any better than following Dr. Mehmet Oz or similar health guru on Facebook. That doesn't even take into account that the extra time spent on the computer to answer the requisite survey questions crowds out alternatives like taking a walk! Whoever was hired to design the software is subpar (maybe some of the same firms who initially designed the Affordable Care Act website?). For initial questionnaire in January each year, the reward is $50 placed on a debit card, whose use is restricted to medical/dental/optical providers, pharmacies, and the like. My husband and I get through that all right, in about 20 minutes answering questions. Some of the answers aren't mutually exclusive, e.g., How many alcoholic drinks do you have per week? (1) none (2) one or (3) 7 or more -- so someone like myself who has about 2 drinks per month (usually at a restaurant) can't answer accurately. (I usually choose (2) since it's the closest proximate.) The questionnaire is peppered with suggestions about how to improve one's health, and then incentivizes the enrollee to set goals in order to earn three additional deposits of $30 each to the debit card. Typical "goals": parking one's car farther from the store, taking the stairs instead of the elevator, choosing fewer refined carbs in favor of more fruits & vegetables, etc.. So to earn that additional $90, one has to log in each week for a substantial portion of the year to be queried about the goals, to re-set them, and/or to add additional goals. There's a lot of focus on smoking cessation and reducing alcohol consumption, so my husband and I have to navigate around a lot of clutter since we are both non-smokers and very occasional social drinkers. It's gotten to the point that my husband feels his time is worth more than the $90 he could net after the initial $50 (he works as a PhD economist). But most years I slog through the weekly accounting, and then use the money to pay for dental cleanings or the like. BC scrutinizes what one spends the money on, so I shudder to think about the overhead this program is costing us insured in the form of higher premiums. For example, they contacted us each time we paid our ordinary dentist in the DC area, because their practice goes by "Center for Cosmetic Dentistry" and cosmetic surgery/procedures aren't allowable charges on the debit card. (We stopped using the card for dental cleanings & exams to avoid more paperwork.)
Another inefficient government-mandated program which I wish would be abolished.
Seems like a market distortion to transfer up to $140 of their own premiums to those who want to devote the time & effort (for those without "internet access," there is an option to speak to a live rep, I believe, and/or to receive a hard-copy via USPS.). Impact on health outcome for our family has been negligible, probably nil. Two persons in the household are "eligible" to participate (to cap the payout at $280, I assume) so our college son has been spared this exercise.
Post a Comment