A study from the National Bureau of Economic Research reports on the results of a large randomized controlled trial of a large employer with over 12,000 employees. Program eligibility and financial incentives were randomized at the individual level. Over 56 percent of eligible treatment group employees participated. The study found that in the first year, the employees who signed up were healthier and had lower medical costs, but, and this is very important, they concluded we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status. Furthermore, they add: Our selection results suggest that these programs may act as a screening mechanism even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers.
Let me make sure these points are clear. What they’re saying is that the people who sign up for workplace wellness programs are naturally more health-conscious and fit and healthy than those who don’t. Other than giving these employee subgroups a mechanism to be discovered, the program does nothing to actually improve health or lower costs. They go on to suggest that one way an employer could save healthcare costs is to offer a wellness program, then get rid of the employees who don’t sign up. I suppose this would only work for a few early adopter employers. I assume the word would get around amongst the labor force pretty quickly.
This phenomenon explains why some of the early sloppy non-randomized programs thought they found success. They enrolled a few employees in their programs; those employees had lower health care costs, so the program managers just assumed their programs made the difference. Not only is this a classic fallacy in experimental science — observational studies cannot reliably explain cause-effect relationships — workplace wellness programs violate one of the POEM assumptions the Government Industrial Medical Complex clings to: prevention saves money.
Aaron Carroll wrote a piece in the New York Times explaining the concept. His piece spends more space talking about some of the recent CMS and related experiments and their lack of success — no reduction in ER visits when people go from being uninsured to getting Medicaid, for example — and he includes another older workplace wellness study to support his claim. We both end up at the same place, but here’s how I say it: An ounce of prevention costs a ton of money. Now there is even more evidence that this is true in and out of the workplace.
Richard Young is a family physician who blogs at American Health Scare.
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