The worker's health: whose business is it?

Business & Health, Dec, 1997 by Jan Ziegler

The cardinal rule of wellness and health risk screening programs: Be vigilant about confidentiality.

Employers and health care providers can implement a variety of programs to boost compliance with treatment regimens and wellness programs. But how do they maximize participation without crossing into corporate paternalism and creating employee resentment? How far before a company crosses a legal or ethical line? How can a firm ensure employees that their confidentiality is protected?

There are no simple answers to these questions. In some instances, the employers and participants themselves will provide solutions. In other cases, guidelines may be found in federal legislation, such as the Americans with Disabilities Act (ADA) and soon the Health Insurance Portability Act, or through the example of companies that have implemented successful programs.

But even though some basic principles have evolved, it's clear that workplace wellness is still a work in progress. For example, to promote wellness, not to mention encouraging employees to burn off any excess chocolate calories, Hershey Foods has maintained a fitness center on corporate grounds since 1979. Participation is not required of any employee, says Renee Karstetter, health promotion specialist at Hershey, nevertheless, "some people think we're trying to push it clown their throats."

Therein lies one of the greatest snags to hit the corporate wellness trend: All the well-intentioned, beautifully structured programs in the world will make no difference in workers' health or employers' costs if too few workers participate. The challenge of getting people enrolled and active has led employers to test a diverse range of incentive programs, from awarding T-shirts and briefcases for participation to raising employees' health premiums if they don't make a physician-certified effort to get designated chronic conditions under control.

Not all incentives work as well as others. At Hershey, for instance, employees told the company they were not pleased with a financial incentive-disincentive program. The company discontinued it and is now implementing a new wellness effort.

"There's a lot of experimentation going on in corporate health promotion," asserts Kim Monk, manager of public policy at the Washington Business Group on Health. "There's no body of research saying 'This is right, this is wrong.'"

CHANGE IN THE WIND

The wellness trend itself signifies a revolution in the corporate health ethic, says Peter Conrad, head of the department of sociology at Brandeis University, Waltham, Mass. Traditionally, health on the job and off has been strictly divided, with occupational medicine handling on-site incidents and private medicine taking care of everything else. Now that line is becoming less clear.

The extent to which times have changed is indicated in a survey published in September 1996 by William M. Mercer, Inc. Of the 259 companies that responded, 55 percent have health management programs. Of those, 63 percent use some form of incentive to encourage employee participation.

But does health promotion even belong in the workplace? Karstetter says, "Yes. Many people do not visit their physicians unless something goes wrong, and if they're not going to their doctors, where are they going to get the information?"

"Health promotion is a good thing," Conrad says. "To provide a way to do that in the workplace is also a benign thing; there's nothing malevolent about it, as long as it's voluntary."

Still, even if health programs are not a direct attempt to control employee behavior, they can be seen as a way of influencing the employee's private life through persuasion or coercion, a scenario that concerns Conrad. "Institutions could eventually even begin to dictate, if in a soft way, what people's lifestyles ought to be," he said.

As worker comments about Hershey's fitness center show, one individual's mandate can be another's convenience. Similarly, simple promotion and education through the use of brochures and booklets may be seen as a nuisance by one worker and a benefit by another. But a new briefcase or a gift certificate to a local store - the type of incentive used most often - may be seen in a more positive light.

THE ROLE OF INCENTIVES

Incentives in general seem to improve employee participation in health efforts, said Bruce Kelley, national practice leader for health management at William Mercer. Without them, average participation in wellness assessments ranges between 30 and 40 percent, he said, and most participants are low-risk employees. With rewards, average participation rises to 60 to 70 percent, and high-risk employees can be more easily persuaded to take part.

Some employers charge workers in certain risk categories more for their health coverage and then give them the opportunity to reduce their costs by participating in programs or otherwise attempting to get their conditions under control or meet acceptable standards as measured by screening tests.

Employers say these programs are voluntary - it is the employee's decision to work on a particular condition, wear a seat belt while driving, exercise, get prenatal care. If they don't, they just pay more. But this form of incentive-disincentive doesn't always work well. In fact, Hershey found that a few employees were inspired to lie about their exercise and smoking habits to avoid penalties.