title: Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.
abstract: The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.
authors: University of California, Los Angeles, School of Law, USA. Horwitz@law.ucla.edu
authors: Jill R
authors: JR
authors: Horwitz
authors: Brenna D
authors: BD
authors: Kelly
authors: John E
authors: JE
authors: DiNardo
mesh_terms: D003361:Cost Allocation / Q000191:economics / Q000331:legislation & jurisprudence; D017046:Cost Savings / Q000191:economics / Q000331:legislation & jurisprudence; D004649:Employee Incentive Plans / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D015438:Health Behavior; D006293:Health Promotion / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D009042:Motivation; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic; D064890:Social Determinants of Health / Q000191:economics / Q000331:legislation & jurisprudence; D063508:Social Discrimination / Q000331:legislation & jurisprudence; D014481:United States; D017132:Workplace / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration*