I really like the idea of encouraging health in any form.
But it seems that when the health care systems feed you green jello, white bread and skippy peanut butter sandwiches when you are sick isn't a system worth solely relying upon to guide us.
Also, it seems percentage wise, the best results for the investment should be on extreme health risk areas. (like help people quit smoking)
I'm also not sure hospitals serving cheap calories when better options are available ought to disqualify the entire medical system. The people who make the decision to do that are corporate types and nurses, whereas the people who do medical research are doctors and those who do things of the sort mentioned in the article may be data scientists. It's not fair to disqualify the entire system based on one bad choice, and were it the greatest flaw of the medical system, we ought to thank God.
It definitely feels to me that the medical system is not really about "health" but about fixing things. A lot of doctors don't live particularly healthy lifestyles, hospitals feed junk food and so on. I am not saying they can't do their job but generally I think it would be better if part of working in the medical profession were to have a healthy lifestyle. For example a doctor who doesn't exercise himself or doesn't eat healthy food or is sleep deprived can sort of give advice to people but somebody who has first hand experience with a wholesome lifestyle can give much better, realistic advice.
A while ago we had a nutritionist in the company lobby giving nutrition advice but the fact that she was quite overweight herself definitely didn't help her credibility.
Not sure where “and nurses” is coming from in your comment. Nursing research is predominately on long-term patient outcome, whereas MD education is predominately on the disease / underlying cause. The nurses I know are more focused on and better educated on how holistic care serves the long-term outcomes of the patients, while docs are better educated to attend to the acute problems.
I would expect a change to quality of calories provided in a hospital to originate from a DNP before a MD.
It is coming from exactly what you said, I would also expect a change to nutrition to originate from a DNP. My point is they have more control over day-to-day intake.
I thought the whole justification for the U.S.' ridiculous health care costs was that it provided a "better quality of care"? The last couple of times I've encountered hospital food (in Australia, a knee reconstruction which cost $500 and having a baby which cost $2k or so) it was a very well balanced meal.
I've heard some people justify it that way, but I keep seeing report after report about the US ratio of dollars to positive outcomes being very bad and getting worse.
> Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.
From your first link. It gloms all spending together without accounting for the lifestyle of our population- obesity rates, exercise, etc. Treatments are available to everyone- that means expensive care for even the elderly, who would otherwise me deemed "not worth the cost" to government budgets.
There is no justification for US healthcare costs. There is a culture that requires everyone to have private insurance but there doesn't appear to be legislation that caps the cost of treatment.
In countries like Australia, because the government collects taxes for healthcare and does most of the spending, it caps how much its willing to spend (per doctor visit, or per medication) and the market responds appropriately.
The Australian federal government controls the pricing of medication in the community (i.e from a chemist) and Australian states control the pricing of medication within hospitals.
I feel like this is outdated, at least in respectable facilities.
I stayed in a hospital for a week over a very bad accident. The food wasn't great but I had a lot of healthy choices.
This was in NoVA which is a wealthy place and the hospital is very nice. The issue would be more substandard care nationwide than what the worst of hospitals have to offer.
Is that what you were getting? I was in the Kaiser hospitals for 2 weeks and they gave me lots of good options. They had a tablet where you pick one item and it narrows down the remaining items to match your overall nutritional needs (calories, protein, etc.)
Look at the faces of people that have dedicated their life to yoga (or christian monk, or sufism or whatever), and then people who have dedicated their life to the profit motive & been successful (billionares).
I'm sure it's quite nice if you can make a living giving yoga courses to office slaves who work their asses off in open office cubicals in fear of being fired tomorrow for shitty money and so on....Yoga won't help them.
There's a lot of livelihoods that do not involve offices or even working for a company out there in the world today. But I can understand how it seems that if you were raised in the United States and aren't either really poor or wealthy.
Those employee wellness programs are being used as cheap place holder to cover up anti-social working conditions. Unpaid overtime and unhealthy working environment won't go away with Yoga. Even if it helps some to forget the actual issues, it doesn't solve them.
> Those employee wellness programs are being used as cheap place holder to cover up anti-social working conditions. Unpaid overtime and unhealthy working environment won't go away with Yoga. Even if it helps some to forget the actual issues, it doesn't solve them.
Absolutely. We need unions (or if that's a dirty word, some organization/democracy at the point of production) in order to ensure equitable society and also that people's contribution to society through their work & their productivity is adequately valued - that people are working because they see their place in the whole & on a voluntary basis - what's occuring right now is work based on fear and necessity, the false scarcity means people have to chose to put up with injustice at work in order to survive & the hours mean the working poor are mostly silent.
I think a lot of factors come in to play, and this finding does not surprise me for an employer such as BJs wholesale. Compare that workforce vs IBM, where employees remain with the company longer and have much more sedimentary jobs, and wellness programs are probably providing better ROI.
Wellness programs don't need to have positive outcomes to make sense for insurers. Instead, they need to use enough superfluous technology to discourage older people from signing up for them.
Hence, from a linked point in the article:
> AARP, the consumer advocacy group for older Americans, sued the federal government in 2016, arguing that the rules governing the [wellness programs] violated anti-discrimination laws aimed at protecting workers’ medical information.
That lawsuit against Kaiser was over individual coverage. Kaiser realizes all its savings by carefully maintaining very health (i.e., young) pools. The medical information stuff is the legal argument, but it was really a lawsuit about making people do stuff that disproportionately negatively affects old people.
If you try the wellness program for people whose enrollment is through their employer, and your employees are disproportionately not college educated or young, the wellness program of the kind you and I are familiar with will not be effective at either lowering costs or improving health outcomes. That's why this program was sort of doomed to fail.
There exists an as-of-yet unobserved program that gives people money in exchange for behavior modification with positive health and cost savings outcomes. It will probably look more consuming entertainment--stuff that has evidence people will do over long periods of time. We're a long ways off from finding the appropriate design of such a program.
I've seen it done in a much more brutal (if less discriminatory) fashion - everyone who doesn't get a full fluids screening in done 2 months sees their premium jump.
Employees are responsible for booking their lab appointment, receiving the lab sample, and then submitting it manually. So that's 2-3 weeks to schedule and make an appointment, followed by at least 4 weeks for the lab's turnaround, followed by time to submit the paperwork from the lab.
That is pretty harsh. I'm personally scared of the future liability and privacy implications of deep screens, especially if it's employment related. Is that irrational or justified?
On the other hand, my life insurance company asked for an update on my health, and after I had a blood test, they came back and said I was so healthy they were going to have to cut my rates, and they did massively, by like half. They weren't threatening to raise rates or offering to reduce them, so I guess it felt like a very positive thing. Still worried that somehow the data will be used against me to reject claims when I get old.
The good news is that all the solutions are systemic, relying on individual heroic actions to preserve privacy won't work for society at large.
The bad news is that we hate each other and don't like systemic solutions, even if they are easy (and it is comparatively easy to specify what information private insurers can use when setting premiums and then audit the premiums).
I think it's justified. I felt lethargic so I got my testosterone tested. Came back low. But now that's a pre-existing condition so if the ACA is overturned I'm SOL.
It will probably return to the pre-ACA regime where maintaining continuous coverage of SOME sort will preclude an insurer from using "pre-existing conditions" to deny coverage. COBRA is useful for this especially for those who lose their jobs, albeit at immense cost.
I'm not saying everything's fine, but you do have some options.
I've never been without health insurance and I was rejected from several insurance carriers pre-ACA. I was on cobra at the time but trying to switch because it was so expensive. But luckily Cobra got me through until the ACA kicked in.
Tangental question - how did you get your testosterone tested? I'm curious to do the same thing. Do you just book a meeting with your PCP? Ask them for it? Is it more practical to do a number of different blood tests at once?
Yes, but that actually works and makes people generally happier with it than if it were pitched as a penalty.
A good case study of this is world of warcraft's rest system when it was first introduced in beta vanilla back in the day. Initially it was called a penalty for playing too long; you would begin to receive less XP. Players didn't like this, so they rereleased the system and called it a rested XP bonus. Players loved it.
It may be manipulative, but if it makes people happier and results in higher usage rates for the system, then why not?
With no opting out because it would affect lifestyle choices? There actually are some programs to get boni, but I am mostly against this. Public health insurance is a system based on solidarity. I would like the option to opt out of Public health insurance.
Yep. My employer lowers my premium and awards us with Amazon gift cards if we earn a certain amount of points each year. You earn points by completing a full blood test, visiting the dentist, etc. It's a significant enough amount that everyone is motivated to do it.
It would require probably hundreds of thousands of dollars of extra salary before I would consider sharing that info with my employer, possibly millions (not exaggerating). Trading that info even for tens of thousands of dollars (let alone peanuts like gift cards) seems deeply unappealing to me.
If they needed a digital version of a doctor’s sign off, that’s enough for me to say no thanks. I don’t want them knowing when or where or how frequently I check off their particular health checklist items. Giving them any more details, such as the result of tests, would be an astronomical violation of trust, no way.
I even hate it that my insurance company generates paper _or_ digital records stating the exact application of my benefits (resulting in a copay, etc) for individual appointments, even if I already paid the relevant bill onsite at the doctor.
It just creates a data exfil / hacking risk if it’s digital, or a risk someone (China) will pick through trash or recycling and get it, when there’s literally no need to create the record (they’d already have the claims record from the doctor making a claim, this is a separate thing they generate to send to me redundantly describing the applied benefits... note: it’s not a bill (and very clearly says it’s not)).
That's pretty crazy because outside of cholesterol and A1C using blood tests for screening in asymptomatic populations has little proven benefit.
EDIT: And there's no benefit in testing cholesterol or A1C every two months unless you're actively tinkering with medication doses for people with high cholesterol or diabetes respectively.
It doesn't matter if the test does anything, if the main aim is price discrimination.
A company can boost profits by raising prices and offering a discount for anything inconvenient. Increase the price by $250. Then offer $50 off for spending an hour in a phone queue. $50 off for clipping a coupon out of a newspaper. $50 off for faxing us a photo of you with a shoe on your head. $50 off for making a pilgrimage to the hermit who lives on top of the mountain. $50 off for filling in a form only available on Flash on Konqueror on KDE2 on FreeBSD.
Price-sensitive customers will go through the hassle to get 5x$50 off, price-insensitive customers will pay the extra $250. Thus, more profit from the latter without losing the former.
4 weeks??? Aside from a handful of tests which need cultures to be performed, I would be shocked if tests took more than 4 days. When I have my HbA1c, TSH, lipids, CBC, and electrolytes checked, I normally have results within 12 hours.
The last place I worked before moving away from the states had different rates for different folks. It was not a percentage of income, but rather a flat fee.
So if you did your physical, you got a discount. Non-smoker? Charge less. (They'd only pay for smoking cessation program once, though). Not meeting company wide health numbers (blood sugar, cholesterol, etc)? You get charged more unless you have a doctors note saying it was medically impossible for you to meet the numbers.
Not only that, but Americans have a concept of "pre-existing conditions" -- that is, your medical history -- so that a health insurer can refuse to cover you on the basis that it might not be profitable for them.
Americans have the concept of a death panel, which is theoretically some sort of government entity that decides whether you get medical care, but actually exists as a profit motive for health care.
Pre-existing condition exclusions no longer exist. Although Trump wants to overturn the ACA and bring them back though. Death panels exist in the abstract: they are largely republican politicians who want to bring back pre-existing conditions and otherwise strip people of insurance and remove specific coverages as well. Fox News and Murdoch have really done a lot of damage to the country.
> ... so that a health insurer can refuse to cover you on the basis that it might not be profitable for them.
Or rather, on the basis that known expenses are not something which ought to be paid for through insurance. Which is completely correct: Insurance exists to mitigate risk. Once something becomes a pre-existing condition it is no longer a risk.
The problem with the pre-ACA system was not that insurers sometimes wouldn't cover pre-existing conditions, but rather that the insurance you had at the time the risk was realized (when the condition was discovered) didn't cover the full lifetime cost of treatment for that condition—it was dependent on maintaining the same insurance plan. That implies that the insurer, and perhaps even your employer, has every incentive to drive you off your current plan once your condition is discovered and thus make your treatment someone else's problem.
Whether we're talking about a broken bone or discovering that you have leukemia, once it's been established that the condition is covered by your insurance plan the cost of treatment should continue to be paid by that insurance provider—perhaps via a trust—even after you've switched insurance companies or dropped health insurance altogether. Having the payments for your treatment pass to the new insurer when you switch insurance providers is a unearned windfall for the original provider and an unfair (and ultimately unsustainable) penalty for the new insurer forced to take over treatment of your pre-existing condition.
Hang on, so the clock ticks until the lab sends it back, rather than the time submitted to the lab? And the lab is associated with the insurer/health provider? So all they have to do is delay everything for 3 months?
The clock ticks from announcement until the employee submits the results received from the lab. The lab is selected from a list of approved labs, but is otherwise unaffiliated.
Collecting behavior data is important to insurers as they can profile customers based on public data.
For example, if you work out 4 days a week, and have back pain diagnosis, you might be a different risk for recovery complications than a guy who doesn’t work out.
There are folks looking at using consumer behavior and habits to predict health outcomes.
You cannot even pay people to do them because the first remark back among my coworkers is, they //the company// aren't giving us enough to participate. There were even prizes for some categories for wellness categories, like the steps counting programs for which they gave up counters to weight loss.
of course there are other self defeating attitudes available too, from those who won't contribute more than the match for 401k, again the company's fault, to those who take more smoke breaks because of the extra cost on their premiums.
I am not sure if its a product of the education system or television. I think schools should focus a bit more on instructing students to better themselves for no other purpose than to improve themselves. that waiting for someone to make you improve yourself is the first step in failing
Maybe paying more is something that should be explored...
I think for $500-$1,000 a month per person you would have widespread behavior change in most companies, and it wouldn't really even be that expensive in the context of total healthcare+wellness program spending.
My current company is paying 100%. The rates jump going from 1 to 2 people, and then again when you throw in kids. This has been my experience at most places, aside from the company fully covering the cost. The $820 number is entirely their contribution.
If we did have kids and needed them to be covered, we'd run out of what the company offers to cover up to ($10k / year) and have to start contributing as well.
I'm confused, wouldn't this be expected? More people, especially people who tend to make expensive additional people, would make the rate go up. Is your point that it went up more than double, instead of exactly double?
You can, though. Our company did up to ten bucks a day for a walking program and participation was quite high. It promptly fell off a cliff when the value went down to up to $4 a day.
You couldn't pay me to participate because I categorise it as BS. It's way overstepping the jurisdiction of the employer. FWIW I don't have a problem with weight, diet or exercise.
> from those who won't contribute more than the match for 401k,
This can be an entirely rational choice. Contributing less than the match is irrational because it's giving up on additional compensation, but often 401K choices are terrible and the tax deduction isn't worth it in many circumstances.
Plus 401(k) fees are usually higher than if you just opened your own IRA with Vanguard and bought some no-load index funds. Rational order to do it is: fund 401(k) to the match, fund your own IRA to the max, then fund the 401(k) to the max.
I've seen the same thing. The perception is that the reward doesn't match the amount of effort required, and/or that the programs offered aren't going to do much for serious preexisting health issues (may or may not be true). And people who already like to exercise and like fitness aren't going to be motivated by what they might view as "newbie" programs.
And then you get into the tangled mess of workplace interpersonal interactions and privacy issues. Does anyone want to spend even more time with their coworkers, if the program is hosted on premises? Does HR need to know that Employee #4752 wants to lose 10 pounds? Or that a different employee wants a stress reduction class?
I like the idea mentioned elsewhere in the comments re: giving people a discount or other reward for proven gym attendance. That's easy enough. In my case, I'd be going to the gym, anyway, link my gym barcode to the plan and it's a done deal.
> There were even prizes for some categories for wellness categories, like the steps counting programs for which they gave up counters to weight loss.
What were the rewards like? I’ve seen those usually in the range of a fraction of a percent of salary, which isn’t going to motivate anyone. Things which would help involve spending money because most people need time and lifestyle support more than some drone nagging them about something they already knew: provide solid bike-to-work support (showers, storage, etc.), high-quality nearby childcare so parents have time to workout, ending a culture of overtime, flexible scheduling & showers so people can workout in the middle of the day, make sure that healthy and tasty food is readily available so it’s not “5 minutes to the vending machines or 30 to get non-junk”, etc.
>> What were the rewards like? I’ve seen those usually in the range of a
>> fraction of a percent of salary, which isn’t going to motivate anyone.
I worked in this space for a while (the company used Rails to do their apps!), so I'll give some input.
It varied from company to company, but most of our customers gave out tiered rewards. Everyone who participated got a step counter of some sort. Everyone who logged X amount of days recieved a t-shirt or water bottle. And the 'winning' teams would get wellness-related gift cards ($50-$250, again depending on the company). The cards were usually for sporting goods stores or 'healthy' items but sometimes they were for chain restaurants.
Now, when I say winning, there were often many teams that tied for first place. The reason was, for whatever activity you had to log (healthy foods, exercise minutes, steps), there was a daily cap. And we'd find obvious cheaters who would log all their activity on the last day of the program (or even for their whole team). People would call/email with support issues asking why they don't have the amount of points they should have, it's always a big ordeal. Teams accusing others of cheating...
I don't think any of that is wrong but it just doesn't seem reasonable to expect prizes worth 0.5% of the U.S. median income to cause significant lifestyle changes. American culture has a huge focus on fitness so I don't think there are any simple steps which will produce substantial results.
My wife's school did one of these: they were relying on peer competition to drive participation but that generally is only effective over short times unless there's a big prize (a free Fitbit is multiple orders of magnitude too small), so what ended up happening is that after the first week or so it was just measuring who had already been walking more (i.e. people who lived nearby or took public transit) and would have done so in any case.
Some interesting bits to counter the title's face value:
> Researchers followed thousands of BJ’s Wholesale Club employees for a year
> Nearly all the studies to date had been observational and have largely concluded that the programs save some money for employers. But this study randomly assigned employees to a wellness program and compared their results with those of employees who were not enrolled in such efforts.
> Employers looking for a quick reduction in their health care spending will be disappointed
It makes sense to me that benefits come on a longer time scale and when employees join the specific programs that interest/apply to them (rather than random assignment).
Yes. Following people for just a year is ~meaningless. If someone quits smoking, for example, the benefit of reduced lung cancer incidence will show up on decade scale.
I’m sure the biggest intervention they are hoping for is weight loss. The reduction in insulin/metformin prescriptions would be evident if the program was effective.
If they need to lose 30-40 pounds (or more) that might not happen in the 1 year time frame.
And don't bother replying and telling me you lost that much weight in less time, I am aware that can be done, but not by small tweaks which these incentives normally give.
> when employees join the specific programs that interest/apply to them (rather than random assignment)
The problem with this from a study standpoint is that it introduces self-selection bias. A complication for exercise programs in particular is that avoidance of exercise can be caused by cardiovascular and metabolic dysfunction.
the only people i know who take advantage of wellness programs are people who are already doing things well beyond the wellness program requirements. They participate in a variety of sports in all seasons, run 5ks or marathons, ski, bike hike or play organized sports. For them it's just a way to subsidize things they are already doing, maybe get a free fitness tracker or gym membership.
I don't think wellness program alone won't be able to make people change their lifestyle. To me, thing that made big difference was access and motivation; particularly for me, easy access to on-site gym (especially with a group class)
I transitioned from hating-to-workout to doing 5 days a week in gym, engaging in activities ranging from Yoga to HIIT.
Not to mention that these programs are notoriously difficult to actually use as an employee. Some require getting monthly receipts from your gym, then faxing to your healthcare provider, waiting for a check to come in the mail, etc. Look for companies like https://myleon.co/ to disrupt this space and make these programs more effective.
The most interesting thing about this is not that wellness programs don't work (this is the null hypothesis for all interventions, behavioral interventions particularly, and diet/exercise interventions especially) but that it offers a direct examination of 'correlation!=causation': they did the cluster randomized trial, but they also did the naive correlational analysis ignoring the randomization to see how misleading the estimates would be.
They compare the estimates side by side in the supplement https://www.gwern.net/docs/statistics/causality/2019-song-su... You can see that the estimates are... different. Frequently, the point estimates aren't even the same sign. Self-selection and 'healthy user bias' are very much things.
(I collate a bunch more of these kinds of correlation!=causation results in https://www.gwern.net/Correlation as a way of making the point that, empirically and especially when it comes to humans, correlation frequently is not causation, and this is not merely some carping pedantic statistician's complaint, but normal.)
It's not particularly convincing to track people for only one year on behavior changes that are known from many other studies to yield long term health benefits. And the researchers in this study would know that.
I really don't want another game in my life to micromanage my behavior. Diet and exercise are their own rewards.
I got a rewards program for everywhere I eat. A miles program got every airline I fly. A tax code with a million subsidies and loopholes. Auto insurance companies who want to stick telematics in my car. Now I have health insurance companies gamifying literally what I eat and how I spend my free time.
Totally agree, it's gotten out of hand. We have too many people with too little to do. And too much money to pay them to do useless things. So they come up with more programs.
On the other hand I look after my health reasonably well. I take very few sick days as a result. It would be nice if my employer showed some sort of recognition of that.
You don't need a participation medal in taking care of yourself. Right now you aren't earning more money or being directly rewarded by being healthy but this is a personal investment in your own future, why should anyone else show any form of recognition to a very personal life choice?
I do the same, I'm healthy, I go to the gym, I bike to work, my reward is getting older fit while I see people on my age group having more and more issues.
Yup, you might be more productive than someone that is unhealthy and taking sick days, etc., at the same time you don't use your paid time off (or have days discounted from your salary, such as here in Sweden) for when you got sick.
I'm on the same boat, my taxes pay for healthcare which I hope I won't ever need.
I just don't believe in strictly direct incentives to motivate people to change behaviour, even less for a whole society. People aren't motivated just by a dangling carrot, making people healthier is much more systemic than awarding who takes care of themselves.
Unfortunately, we don't have a good way to measure the difference between "few sick days due to good health" and "few sick days because came into office sick".
Or, for that matter, "many sick days due to unsolvable chronic illness but doing their best" and "many sick days due to eating an entire bag of Doritos during lunch and feeling ill".
Yeah they'll give you recognition alright - for saving them money by allowing them to pry into your personal life.
Maybe it's just working for an international megacorp, but I can tell you with absolute certainty they don't give a shit about my health - except to the extent it affects the bottom line. I'll get my positive recognition from my doctor because it means something from them.
The amount of creative work that can be accomplished in a day is finite, regardless of the length of the workday. The only way you could shift a work schedule that much is if you substantially change the type of work being done, and accept that you would get less creative work per week while gaining more resources in other areas such as rote tasks or physical labor.
The vast majority of my work is not particularly creative.
Documentation, meetings, replying to emails answering someones question.
When get to do some coding its not usually especially complex. Occasionally it is, but I imagine having longer days would be easier to get 4 hours "in the zone", something which happens rarely at present.
The people who conducted this study should be embarrassed. First off they chose BJ's wholesale, which I would venture to say doesnt have the healthiest of employees on the planet and doesnt represent a good sample. Second, they didnt actually track what the individuals were actually doing, were they eating a diet high in greens and low in processed foods? Were they getting cardio in daily? Were they smoking, drinking excessively? How anyone serious about health, nutrition, or even cost spending could take this study seriously, beyond me.
Why would the study want to target "the healthiest employees on the planet"? That would bias the study. Seems to me they chose a random company (that would agree to participate) with average workers. The whole point would be to see if these programs improve healthcare. Honestly, the majority of BJ's workers work in a giant warehouse store and get a lot of walking in daily as part of their job. (*Source: I'm a former BJ's Wholesale 'team member' although I worked in the office in IT)
I've never worked for an employer that had a program which required you to share data. I have always been able to expense things like gym, mattresses, copays, whatever as part of TC but never data collection.
If employers want to reduce US health care spending, why don't they band together and lobby Congress to introduce legislation to reduce health care costs?
I have a gut feeling it is the insurance companies that set ever increasing rates which drive up costs overall. And then they cover less forcing patients to pay out of pocket for anything more than a flu shot.
There are other countries with the same quality services for much cheaper costs. Maybe even better quality.
Employers would save more money getting the insurance companies to lower rates (via legislation likely) than trying wellness programs.
The only employee wellness program that works is one that actually has a time slot (not lunch) during work hours for an employee to exercise. Where the employee is literally being paid to exercise. Be it cycling, weights, walking, etc.
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[ 2.7 ms ] story [ 259 ms ] threadBut it seems that when the health care systems feed you green jello, white bread and skippy peanut butter sandwiches when you are sick isn't a system worth solely relying upon to guide us.
Also, it seems percentage wise, the best results for the investment should be on extreme health risk areas. (like help people quit smoking)
A while ago we had a nutritionist in the company lobby giving nutrition advice but the fact that she was quite overweight herself definitely didn't help her credibility.
I would expect a change to quality of calories provided in a hospital to originate from a DNP before a MD.
https://www.commonwealthfund.org/publications/issue-briefs/2...
https://interactives.commonwealthfund.org/2017/july/mirror-m...
https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
etc
From your first link. It gloms all spending together without accounting for the lifestyle of our population- obesity rates, exercise, etc. Treatments are available to everyone- that means expensive care for even the elderly, who would otherwise me deemed "not worth the cost" to government budgets.
https://www.bma.org.uk/connecting-doctors/b/the-bma-blog/pos...
https://www.google.com/amp/s/amp.smh.com.au/business/workpla...
No, not everything over here is perfect. The takeaway is that there is much more to care than spending / "outcome".
In countries like Australia, because the government collects taxes for healthcare and does most of the spending, it caps how much its willing to spend (per doctor visit, or per medication) and the market responds appropriately.
The Australian federal government controls the pricing of medication in the community (i.e from a chemist) and Australian states control the pricing of medication within hospitals.
I stayed in a hospital for a week over a very bad accident. The food wasn't great but I had a lot of healthy choices.
This was in NoVA which is a wealthy place and the hospital is very nice. The issue would be more substandard care nationwide than what the worst of hospitals have to offer.
Paint me surprised!
Who's happier?
Those employee wellness programs are being used as cheap place holder to cover up anti-social working conditions. Unpaid overtime and unhealthy working environment won't go away with Yoga. Even if it helps some to forget the actual issues, it doesn't solve them.
Absolutely. We need unions (or if that's a dirty word, some organization/democracy at the point of production) in order to ensure equitable society and also that people's contribution to society through their work & their productivity is adequately valued - that people are working because they see their place in the whole & on a voluntary basis - what's occuring right now is work based on fear and necessity, the false scarcity means people have to chose to put up with injustice at work in order to survive & the hours mean the working poor are mostly silent.
Look at Finland, look at Norway.
Hence, from a linked point in the article:
> AARP, the consumer advocacy group for older Americans, sued the federal government in 2016, arguing that the rules governing the [wellness programs] violated anti-discrimination laws aimed at protecting workers’ medical information.
That lawsuit against Kaiser was over individual coverage. Kaiser realizes all its savings by carefully maintaining very health (i.e., young) pools. The medical information stuff is the legal argument, but it was really a lawsuit about making people do stuff that disproportionately negatively affects old people.
If you try the wellness program for people whose enrollment is through their employer, and your employees are disproportionately not college educated or young, the wellness program of the kind you and I are familiar with will not be effective at either lowering costs or improving health outcomes. That's why this program was sort of doomed to fail.
There exists an as-of-yet unobserved program that gives people money in exchange for behavior modification with positive health and cost savings outcomes. It will probably look more consuming entertainment--stuff that has evidence people will do over long periods of time. We're a long ways off from finding the appropriate design of such a program.
Employees are responsible for booking their lab appointment, receiving the lab sample, and then submitting it manually. So that's 2-3 weeks to schedule and make an appointment, followed by at least 4 weeks for the lab's turnaround, followed by time to submit the paperwork from the lab.
Great way to raise some rates.
On the other hand, my life insurance company asked for an update on my health, and after I had a blood test, they came back and said I was so healthy they were going to have to cut my rates, and they did massively, by like half. They weren't threatening to raise rates or offering to reduce them, so I guess it felt like a very positive thing. Still worried that somehow the data will be used against me to reject claims when I get old.
The bad news is that we hate each other and don't like systemic solutions, even if they are easy (and it is comparatively easy to specify what information private insurers can use when setting premiums and then audit the premiums).
I'm not saying everything's fine, but you do have some options.
Sorry if this is an obvious question
A good case study of this is world of warcraft's rest system when it was first introduced in beta vanilla back in the day. Initially it was called a penalty for playing too long; you would begin to receive less XP. Players didn't like this, so they rereleased the system and called it a rested XP bonus. Players loved it.
It may be manipulative, but if it makes people happier and results in higher usage rates for the system, then why not?
I even hate it that my insurance company generates paper _or_ digital records stating the exact application of my benefits (resulting in a copay, etc) for individual appointments, even if I already paid the relevant bill onsite at the doctor.
It just creates a data exfil / hacking risk if it’s digital, or a risk someone (China) will pick through trash or recycling and get it, when there’s literally no need to create the record (they’d already have the claims record from the doctor making a claim, this is a separate thing they generate to send to me redundantly describing the applied benefits... note: it’s not a bill (and very clearly says it’s not)).
EDIT: And there's no benefit in testing cholesterol or A1C every two months unless you're actively tinkering with medication doses for people with high cholesterol or diabetes respectively.
A company can boost profits by raising prices and offering a discount for anything inconvenient. Increase the price by $250. Then offer $50 off for spending an hour in a phone queue. $50 off for clipping a coupon out of a newspaper. $50 off for faxing us a photo of you with a shoe on your head. $50 off for making a pilgrimage to the hermit who lives on top of the mountain. $50 off for filling in a form only available on Flash on Konqueror on KDE2 on FreeBSD.
Price-sensitive customers will go through the hassle to get 5x$50 off, price-insensitive customers will pay the extra $250. Thus, more profit from the latter without losing the former.
4 weeks??? Aside from a handful of tests which need cultures to be performed, I would be shocked if tests took more than 4 days. When I have my HbA1c, TSH, lipids, CBC, and electrolytes checked, I normally have results within 12 hours.
So if you did your physical, you got a discount. Non-smoker? Charge less. (They'd only pay for smoking cessation program once, though). Not meeting company wide health numbers (blood sugar, cholesterol, etc)? You get charged more unless you have a doctors note saying it was medically impossible for you to meet the numbers.
Americans have the concept of a death panel, which is theoretically some sort of government entity that decides whether you get medical care, but actually exists as a profit motive for health care.
Or rather, on the basis that known expenses are not something which ought to be paid for through insurance. Which is completely correct: Insurance exists to mitigate risk. Once something becomes a pre-existing condition it is no longer a risk.
The problem with the pre-ACA system was not that insurers sometimes wouldn't cover pre-existing conditions, but rather that the insurance you had at the time the risk was realized (when the condition was discovered) didn't cover the full lifetime cost of treatment for that condition—it was dependent on maintaining the same insurance plan. That implies that the insurer, and perhaps even your employer, has every incentive to drive you off your current plan once your condition is discovered and thus make your treatment someone else's problem.
Whether we're talking about a broken bone or discovering that you have leukemia, once it's been established that the condition is covered by your insurance plan the cost of treatment should continue to be paid by that insurance provider—perhaps via a trust—even after you've switched insurance companies or dropped health insurance altogether. Having the payments for your treatment pass to the new insurer when you switch insurance providers is a unearned windfall for the original provider and an unfair (and ultimately unsustainable) penalty for the new insurer forced to take over treatment of your pre-existing condition.
For example, if you work out 4 days a week, and have back pain diagnosis, you might be a different risk for recovery complications than a guy who doesn’t work out.
There are folks looking at using consumer behavior and habits to predict health outcomes.
of course there are other self defeating attitudes available too, from those who won't contribute more than the match for 401k, again the company's fault, to those who take more smoke breaks because of the extra cost on their premiums.
I am not sure if its a product of the education system or television. I think schools should focus a bit more on instructing students to better themselves for no other purpose than to improve themselves. that waiting for someone to make you improve yourself is the first step in failing
I think for $500-$1,000 a month per person you would have widespread behavior change in most companies, and it wouldn't really even be that expensive in the context of total healthcare+wellness program spending.
I'll stop eating sugar for the other 40%.
Wife and I are around $820 / month, and that's with a $5k deductible.
If we did have kids and needed them to be covered, we'd run out of what the company offers to cover up to ($10k / year) and have to start contributing as well.
You can, though. Our company did up to ten bucks a day for a walking program and participation was quite high. It promptly fell off a cliff when the value went down to up to $4 a day.
Jumping up instead of down might be better psychologically, but starting at $2 means practically no participation at all.
This can be an entirely rational choice. Contributing less than the match is irrational because it's giving up on additional compensation, but often 401K choices are terrible and the tax deduction isn't worth it in many circumstances.
And then you get into the tangled mess of workplace interpersonal interactions and privacy issues. Does anyone want to spend even more time with their coworkers, if the program is hosted on premises? Does HR need to know that Employee #4752 wants to lose 10 pounds? Or that a different employee wants a stress reduction class?
I like the idea mentioned elsewhere in the comments re: giving people a discount or other reward for proven gym attendance. That's easy enough. In my case, I'd be going to the gym, anyway, link my gym barcode to the plan and it's a done deal.
And cut out the people who exercise elsewhere. Let the corner case chase begin!
I want the "Bruce Industries LTD Competitive Meditation Champion Quarter 2 2016-17" t-shirt.
What were the rewards like? I’ve seen those usually in the range of a fraction of a percent of salary, which isn’t going to motivate anyone. Things which would help involve spending money because most people need time and lifestyle support more than some drone nagging them about something they already knew: provide solid bike-to-work support (showers, storage, etc.), high-quality nearby childcare so parents have time to workout, ending a culture of overtime, flexible scheduling & showers so people can workout in the middle of the day, make sure that healthy and tasty food is readily available so it’s not “5 minutes to the vending machines or 30 to get non-junk”, etc.
I worked in this space for a while (the company used Rails to do their apps!), so I'll give some input.
It varied from company to company, but most of our customers gave out tiered rewards. Everyone who participated got a step counter of some sort. Everyone who logged X amount of days recieved a t-shirt or water bottle. And the 'winning' teams would get wellness-related gift cards ($50-$250, again depending on the company). The cards were usually for sporting goods stores or 'healthy' items but sometimes they were for chain restaurants.
Now, when I say winning, there were often many teams that tied for first place. The reason was, for whatever activity you had to log (healthy foods, exercise minutes, steps), there was a daily cap. And we'd find obvious cheaters who would log all their activity on the last day of the program (or even for their whole team). People would call/email with support issues asking why they don't have the amount of points they should have, it's always a big ordeal. Teams accusing others of cheating...
My wife's school did one of these: they were relying on peer competition to drive participation but that generally is only effective over short times unless there's a big prize (a free Fitbit is multiple orders of magnitude too small), so what ended up happening is that after the first week or so it was just measuring who had already been walking more (i.e. people who lived nearby or took public transit) and would have done so in any case.
> Researchers followed thousands of BJ’s Wholesale Club employees for a year
> Nearly all the studies to date had been observational and have largely concluded that the programs save some money for employers. But this study randomly assigned employees to a wellness program and compared their results with those of employees who were not enrolled in such efforts.
> Employers looking for a quick reduction in their health care spending will be disappointed
It makes sense to me that benefits come on a longer time scale and when employees join the specific programs that interest/apply to them (rather than random assignment).
And don't bother replying and telling me you lost that much weight in less time, I am aware that can be done, but not by small tweaks which these incentives normally give.
The problem with this from a study standpoint is that it introduces self-selection bias. A complication for exercise programs in particular is that avoidance of exercise can be caused by cardiovascular and metabolic dysfunction.
I transitioned from hating-to-workout to doing 5 days a week in gym, engaging in activities ranging from Yoga to HIIT.
I don't know how typical I am, though...
They compare the estimates side by side in the supplement https://www.gwern.net/docs/statistics/causality/2019-song-su... You can see that the estimates are... different. Frequently, the point estimates aren't even the same sign. Self-selection and 'healthy user bias' are very much things.
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This parallels an earlier workplace wellness randomized experiment: https://www.gwern.net/docs/statistics/causality/2018-jones.p... which comes with nice graphs/tables comparing & contrasting the correlational vs actual causal effects:
https://www.gwern.net/images/causality/2018-jones-table5-nyt...
https://www.gwern.net/images/causality/2018-jones-figure8-ra...
https://www.gwern.net/images/causality/2018-jones-supplement...
https://www.gwern.net/images/causality/2018-jones-supplement...
https://www.gwern.net/images/causality/2018-jones-supplement...
https://www.gwern.net/images/causality/2018-jones-table5-cor...
(I collate a bunch more of these kinds of correlation!=causation results in https://www.gwern.net/Correlation as a way of making the point that, empirically and especially when it comes to humans, correlation frequently is not causation, and this is not merely some carping pedantic statistician's complaint, but normal.)
So decent stress levels, the right kinds of breaks, proper vacays, good managers, not worrying about stuff all the time.
I got a rewards program for everywhere I eat. A miles program got every airline I fly. A tax code with a million subsidies and loopholes. Auto insurance companies who want to stick telematics in my car. Now I have health insurance companies gamifying literally what I eat and how I spend my free time.
Just fuck off already.
I do the same, I'm healthy, I go to the gym, I bike to work, my reward is getting older fit while I see people on my age group having more and more issues.
Yup, you might be more productive than someone that is unhealthy and taking sick days, etc., at the same time you don't use your paid time off (or have days discounted from your salary, such as here in Sweden) for when you got sick.
I just don't believe in strictly direct incentives to motivate people to change behaviour, even less for a whole society. People aren't motivated just by a dangling carrot, making people healthier is much more systemic than awarding who takes care of themselves.
Or, for that matter, "many sick days due to unsolvable chronic illness but doing their best" and "many sick days due to eating an entire bag of Doritos during lunch and feeling ill".
Maybe it's just working for an international megacorp, but I can tell you with absolute certainty they don't give a shit about my health - except to the extent it affects the bottom line. I'll get my positive recognition from my doctor because it means something from them.
Documentation, meetings, replying to emails answering someones question.
When get to do some coding its not usually especially complex. Occasionally it is, but I imagine having longer days would be easier to get 4 hours "in the zone", something which happens rarely at present.
I am a fan of 5 x 6 hours and 4 x 8 hours.
I have a gut feeling it is the insurance companies that set ever increasing rates which drive up costs overall. And then they cover less forcing patients to pay out of pocket for anything more than a flu shot.
There are other countries with the same quality services for much cheaper costs. Maybe even better quality.
Employers would save more money getting the insurance companies to lower rates (via legislation likely) than trying wellness programs.