Charging employees for unhealthy health habits

The concept of penalizing vs. rewarding employees is not new. In fact, most personnel guidelines suggest providing positive rewards for desired behaviors and penalties for undesired behaviors. However, the extension of penalties to health related behaviors or conditions is new. By Dr. Robert V. Miller, Cooper Research

Recently Clarian Health, an Indianapolis health care system, announced it is going to begin charging employees for unhealthy habits such as smoking, being overweight, and lack of exercise. Beginning in 2009, any Clarian Health employees who choose to participate in the company’s health insurance plan must complete a health screening, which will include a body mass index, LDL cholesterol measurement, glucose level measurement, blood pressure reading and a Health Risk Appraisal (HRA). The concept is to encourage healthy habits among all employees and to reduce utilization of the health care system. As part of Clarian’s plan, ‘Health Risk Charges’ (AKA penalties) will occur as weekly payroll deductions.

The idea of health insurance originated out of the manufacturing industry where competition for employees was keen. Companies, in their competition for outstanding workers, as well as the ongoing efforts of organized labor for better benefits, led to health insurance being carried on the backs of employers. Within the past 20 years, the cost of health insurance has shifted significantly to employees, with this trend continuing into the future. However, in most instances, employers still bear the majority of health insurance premiums and it is unlikely that US corporations will escape the responsibility of funding employee health insurance in the foreseeable future.

Healthy living training

As a result, employers have ‘an interest’ in controlling costs and in doing all they can to assure that their workers stay healthy and productive. In the past, work safety was the major concern, but now there is also a shift to healthy habits including a recommended healthy diet, exercise, and avoidance of smoking. Many employers have put in exercise facilities, wellness centers, and some have even focused on ‘healthy living’ training and education.

But just how far can an employer go in managing the personal health habits and health conditions of employees? Do employees have the right to continue bad health habits when companies must pay higher premiums for insuring them? What about employees who have pre-existing conditions prior to employment, who are prone to hypertension, heart disease, and other ailments because of genetic predisposition, or those who suffer from depression?

Does the employer have the right to reward good health behaviors and conversely, punish unhealthy ones? What about the rights of employees for privacy and workplace independence? Employers are now finding themselves on a ‘balance-beam’. They have a strong interest in encouraging good health among employees, but they cannot invade employee rights and liberties. But do employees have the right to do whatever they wish health wise, even to the detriment of their work related abilities and their contributions to employers?

Economic payoffs

Where is the balance? At what point are employers overstepping their boundaries and at what point should employees accept that they have some accountability for their own healthy behaviors and overall health status? There is no simple and easy answer. However, we do know that wellness programs and healthy behaviors are now being emphasized by health insurance companies and many employers. Why? Because it just makes good sense and the economic payoffs are great.

But how do we get employees to change? Do we provide gentle leadership and financial incentives or do we hold employees more accountable with stricter employer governance and penalties for non-compliance? Unfortunately, change is difficult and many studies show that adaptation to change does not easily occur, even in the most successful organizations. Clarian Health is taking a bold step in order to bring about change in its organization. There will be those who criticize the health care system for being too heavy handed and arbitrary. On the other hand, Clarian is showing the rest of us that it is serious about improving the health habits of its employees and is providing a road map for other corporations to follow. Perhaps it can motivate employees to take better care of themselves and improve the quality of their lives. Let’s study the Clarian model and learn from it.

Dr. Robert V. Miller is President/CEO of Cooper Research, Inc., a national leader in healthcare market research and consulting. His company has conducted over 3000 research studies for the leading pharmaceutical companies, health plans, hospital systems, medical device manufacturers, and non-profit healthcare organizations. Miller has been involved in various leadership positions within market research and healthcare for over 30 years.

Many employers have put in exercise facilities, wellness centers, and some have even focused on ‘healthy living’ training and education