The association of health risks with workers' compensation costs.

The purpose of this study was to investigate the association between health risks and workers' compensation (WC) costs. The 4-year study used Health Risk Appraisal data and focused on 1996-to-1999 WC costs among Xerox Corporation's long-term employees. High WC costs were related to individual health risks, especially Health Age Index (a measure of controllable risks), smoking, poor physical health, physical inactivity, and life dissatisfaction. WC costs increased with increasing health risk status (low-risk to medium-risk to high-risk). Low-risk employees had the lowest costs. In this population, 85% of WC costs could be attributed to excess risks (medium- or high-risk) or non-participation. Among those with claims, a savings of $1238 per person per year was associated with Health Risk Appraisal participation. Addressing WC costs by focusing on employee health status provides an important additional strategy for health promotion programs.     

Financial costs due to excess health risks among active employees of a utility company

OBJECTIVE: The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. METHODS: A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. RESULTS: There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. CONCLUSIONS: Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.     

Association of health risks with the cost of time away from work

The purpose of this study was to combine absences, short-term disability, and workers' compensation into a sum of the cost of time away from work (TAW) and compare it with health risk status and individual health risks of 6220 hourly workers at Steelcase Inc. The study used 3 years (1998 to 2000) of TAW and health risk appraisal data. Higher TAW costs were associated with illness days, drug/medication use, the individual's lower perception of physical health, job dissatisfaction, high stress, life dissatisfaction, and physical inactivity. More high-risk individuals (80.6%) had a TAW occurrence than medium- (72.8%) and low-risk (61.1%) individuals. High-risk individuals had higher TAW costs than medium- and low-risk individuals. Of the total TAW costs, 36.2% was attributed to the excess risks of the medium- and high-risk individuals or nonparticipants compared with low-risk participants. If TAW costs follow risk reduction, a potential annual savings of $1.7 million could be achieved.     

The association of two productivity measures with health risks and medical conditions in an Australian employee population

PURPOSE: To investigate the impact of health on job performance using two measures of productivity loss: (1) a self-reported measure of health-related presenteeism and (2) an objective measure of absenteeism. DESIGN: A cross-sectional survey using a Health Risk Appraisal (HRA) to evaluate self-reported presenteeism and the prevalence of 12 health risks and eight medical conditions. SETTING AND SUBJECTS: Employees (n=224) of a private insurance provider in Australia. MEASURES: A Health Risk Appraisal (HRA) questionnaire was used to evaluate self-reported presenteeism on different aspects of job demands and to assess the prevalence of 12 health risks and eight medical conditions. Illness absent hours were obtained from company administrative records. RESULTS: Increased presenteeism was significantly associated with high stress, life dissatisfaction, and back pain, while increased illness absenteeism was significantly associated with overweight, poor perception of health, and diabetes. Excess presenteeism associated with excess health risks (productivity loss among those with medium- or high-risk status compared to those with low-risk status) was independently calculated at 19.0% for presenteeism and 12.8% for illness absenteeism. CONCLUSIONS: This study demonstrates an association between health metrics and self-reported work impairment (presenteeism) and measured absenteeism. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss.     

Examination of risk status transitions among active employees in a comprehensive worksite health promotion program.

Most worksite health promotion programs are designed to effect risk reduction. Net changes in the prevalence of health behaviors are a combination of individuals who reduce to low-risk and those who become high-risk. It is the purpose of this study to examine overall risk status transitions, between low-risk (0-2 risks); medium-risk (3-4 risks); and high-risk (5 or more risks), within a comprehensive worksite health promotion program over the first year of the program (short-term) and after 5 years (long-term). Significant increases were demonstrated in the numbers of individuals who transitioned to lower risk status. Nearly half (0 percentage points) of the net reduction to low-risk status (+10.4 percentage points) occurred during the first year of the program. The design of health promotion programs may need to be adjusted from risk reduction in the short-term to programs that maximize retention of individuals within low-risk categories over the long-term. This program design would maximize the opportunity to obtain initial risk reduction during the first years of the program and then maximize the opportunity to maintain low-risk status in the long-term.     

Excess Healthcare Costs Associated with Excess Health Risks in Diseased and Non-Diseased Health Risk Appraisal Participants

Background: Concerns regarding the effectiveness and impact of disease management are largely based on disease compliance measures. Although disease management programs have measured improvements in compliance and quality of life and cost savings from reductions in hospitalizations and emergency room visits, few programs have focused on changing behavioral health risks not directly related to the specific disease. The basic relationship between behavioral health risks and healthcare costs shows that those individuals with more high-risk behaviors are associated with higher healthcare costs compared with those with low-risk behaviors. The concept of excess costs associated with excess risks is a calculation of theoretical maximum percent savings for an entire group assuming everyone reduces to low risk, and changes in healthcare costs follow the changes in risks. Objective: To establish the magnitude of excess healthcare costs associated with excess health risks, given a diagnosed chronic disease. Methods: 135 251 current and retired employees of General Motors Corporation who had completed a Health Risk Appraisal (HRA) were evaluated. Participants were continuously enrolled in traditional or Preferred Provider Organization (PPO) medical plans from 1996 to 1999 and had completed at least one HRA between 1996 and 1998. Results: Those with and without self-reported disease averaged 19.2 and 9.1% excess healthcare costs associated with excess health risks, respectively. However, the magnitude of the impact differed across age groups and diseases. Individuals less than 45 years of age with self-reported disease were most affected by the presence of additional health risks (44% excess costs) while those aged ≥65 years without disease were least affected (8.2% excess costs). Among those with diseases, those with diabetes mellitus and bronchitis/emphysema were most affected (19.2 and 21.0%, respectively). Conclusions: Disease management programs should ideally provide a systematic approach to assist patients with interventions that improve overall health, as well as focusing on disease compliance measures. The implications for disease management programs are that, even given the presence of disease, promoting and/or maintaining low-risk status can result in potential cost savings.     

The association of health risks with on-the-job productivity

OBJECTIVE: Decreased on-the-job productivity represents a large yet poorly characterized indirect cost to employers. We studied the impact of employee health risk factors on self-reported worker productivity (presenteeism). METHODS: Using a brief version of the Work Limitation Questionnaire incorporated into a Health Risk Appraisal, 28,375 employees of a national company responded to the survey. The association between health risks and work limitation and each of the four domains was examined. Percentage of lost productivity also was estimated. RESULTS: Ten of 12 health risk factors studied were significantly associated with self-reported work limitations. The strength of the associations varied between risks and the four domains of work limitation. Perception-related risk factors such as life dissatisfaction, job dissatisfaction, poor health, and stress showed the greatest association with presenteeism. As the number of self-reported health risk factors increased, so did the percentage of employees reporting work limitations. Each additional risk factor was associated with 2.4% excess productivity reduction. Medium and high-risk individuals were 6.2% and 12.2% less productive than low-risk individuals, respectively. The annual cost of lost productivity in this corporation was estimated at between 99Mdollars and 185Mdollars or between 1392dollars and 2592dollars per employee. CONCLUSIONS: Health risk factors represent additional causes of lost productivity.     

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee

PURPOSE: To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. DESIGN: Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. SETTING: The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. SUBJECTS: Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. MEASURES: Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. RESULTS: Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. CONCLUSIONS: Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.     

Effectiveness of health promotion programs in moderating medical costs in the USA

Although evidence from scientific evaluations of health promotionprograms has demonstrated improvements in selected health outcomes,the relationship between participation in health programs anddefinitive economic returns in medical cost savings has beenmore difficult to establish. The purpose of this study is toevaluate the effect of employee participation in health promotionprograms with selected medical cost outcomes. Program participationwas operationalized as a summed participation score based onemployee program participation data. Increasing levels of programparticipation were associated with increasingly higher medicalcosts but not with higher numbers of health risks. A Cost ChangeModel was developed to investigate the relationship betweenprogram participation and changes in cost status (high cost/lowcost) over a 6-year time period. Program participation was highestamong the high-cost employees. Participation patterns may havereflected the appeal of most health promotion programming tohigh-risk/high-cost employees. Over time those employees whoparticipated in a comprehensive health promotion program, includingintervention programs, experienced moderation in medical costs.In contrast, for those employees with participation primarilyconcentrated in health risk awareness and identification programs,medical costs continued to increase. These findings provideevidence for the effectiveness of a comprehensive health promotionprogram in moderating medical care costs.     

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.     

The health of immigrant women: Queensland women from the former Yugoslavia

A study of the social and health status of women from the former Yugoslavia was conducted in Queensland, Australia. Study participants were predominantly refugee women who had migrated to Australia between 1991 and 1996. A significant number of the women rated their health status as poor or fair. Most women did not perceive any change in health following migration, but more felt that their health had deteriorated than improved. Applying a social model of health, we explored the social contexts of countries of origin and destination that impact on women's health. We analyze how preimmigration trauma, settlement problems, health risk behaviors, and participation in screening programs affect women's health status and health needs. Data analysis indicated that government and nongovernment services can reduce the impact of preimmigration experience on health risk behaviors and poor health outcomes only to a limited degree. Since the low socioeconomic status of immigrants following immigration was identified by women as a main contributing factor to their poor health status, government support in tackling structural barriers in accessing the Australian labor market is essential to achieve positive health outcomes.     

Frequency of visits to a health care provider,health promoting behaviors,and perceived health status among African American women

The primary purpose of this study was to examine whether the self-reported number of health care visits over a 1-year period was associated with engagement in health promoting behaviors (i.e., healthy eating and physical activity) and perceived health status among a cross-sectional sample of African American women who were pre-hypertensive/hypertensive and/or overweight or obese (N = 180). The study participants were recruited in predominantly African American churches and had their data collected in April and May of 2009. Age, income, and education were also examined as moderators in the aforementioned relationships. Results revealed that the self-reported number of health care visits was significantly positively associated with healthy eating and perceived health status. Income moderated the relationship between self-reported number of health care visits and engagement in healthy eating. These results provide support for health promotion programs for African American women with program components that explain the relationships among routine care from a health care provider, engagement in health promoting behaviors, and prevention of chronic health conditions.     

An economic evaluation of universal infant vaccination against hepatitis B virus using a combination vaccine (Hib-HepB): a decision analytic approach to cost effectiveness

OBJECTIVE: To evaluate the health impact and cost effectiveness of two infant vaccination strategies for protection against hepatitis B virus (HBV) infection in the Australian population. Vaccinating only high-risk infants, assuming 65% compliance, was compared with universal vaccination of infants using a combination Hib-HepB vaccine, with 87.4% compliance. METHOD: A Markov model simulated the natural history of HBV infection and disease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high-risk families) and low-risk infants. Clinical and epidemiological data used were obtained from published reports and a survey of clinical experts. The model included the health costs associated with acute and chronic HBV infection, and the sequelae of chronic HBV infection. RESULTS: The model predicted that universal hepatitis B vaccination of an Australian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,862, which is low compared with many other health care interventions. With no discounting of costs or consequences, universal vaccination with the combination vaccine was predicted to save lives and reduce costs. CONCLUSION: There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interventions. Nevertheless, based on these results, universal hepatitis B vaccination of Australian infants using a combination Hib-HepB vaccine would almost certainly be regarded as a worthwhile investment of public funds.     

Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study

Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p less than .001), 2) reduction of subject reported medical utilization from baseline (p less than .05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.     

The association between health risk change and presenteeism change

OBJECTIVE: This prospective study investigates whether changes in health risks are associated with changes in presenteeism (on-the-job productivity loss). METHOD: A total of 7026 employees of a national financial services company responded to a health risk appraisal (HRA), which included a modified version of the Work Limitation Questionnaire (WLQ) in both 2002 and 2004. The association between changes in health risks and changes in self-reported presenteeism was examined. RESULTS: Changes in perceptual/psychologic health risks had a strong association with changes in presenteeism. Individuals who reduced their risks generally saw an improvement in productivity, whereas those who gained risks or remained high-risk status saw deterioration in productivity. Each risk factor increased or reduced was associated with a commensurate change in 1.9% productivity loss over time and estimated to be 950 dollars per year per risk changed. CONCLUSIONS: Positive and negative changes in health risks are associated with same-direction changes in presenteeism.     

System-wide adoption of health promotion practices by schools: evaluation of a telephone and mail-based dissemination strategy in Australia

Schools can potentially benefit from system-wide approaches to the dissemination of health promotion practices. This intervention study undertaken in the Hunter Region of NSW, Australia, used a pre-post design to assess whether a phone and mail intervention dissemination strategy was associated with an increase in the proportion of 218 primary schools undertaking eight health promotion practices. Health promotion practices addressed the prevention of harm associated with five agreed health issues-smoking, nutrition, playground safety, asthma and infectious diseases. The study also assessed acceptability of the dissemination strategy to schools, cost and whether intervention schools' characteristics were associated with uptake of health promotion practices. Compared to baseline a significant improvement in prevalence was observed at both 1 and 2 year follow-up for seven of the eight health promotion practices addressed. The greatest improvement occurred in the first year of the project. There was a greater uptake of the practice of providing information regarding passive smoking in urban schools. The dissemination strategy was found to have a cost per adopted practice of 121 Australian dollars and to be acceptable to the large majority (>90%) of schools. The results suggest that the dissemination strategy may represent a relatively low cost method of enhancing health promotion practices in schools and of monitoring such practices. Further research addressing the methodological issues of this study is needed to confirm these findings.     

Where needs and demands diverge: health promotion in primary care

This study reviews Forth Valley Health Board's ‘Be Better Hearted’ coronary heart disease health promotionprogramme by analysis of data routinely collected between 1988 and 1993. Associations between socioeconomic deprivation, prevalence of risk factors, and attendance at health promotion clinics are of particular interest in relation to future health promotion strategy.

Method

A study was made of computerised records of 20,053 baseline risk factor assessments in the primarycare setting and 1,058 follow-up attendances. A method of classification by socioeconomic status was applied.

Results

Baseline data provided a profile of new attenders over time with regard to age, gender, risk factors and socioeconomic status but lack of follow-up information prevented evaluation of the outcome of the programme. There was a statistically significant association between prevalence of risk factors (such as smoking, obesity and lack of exercise) and deprivation. In the most affluent areas 19.0% of the target population participated in the programme; in deprived areas this fell to 10.7%. There was thus a failure to involve those most in need of health promotion.

Conclusion

If equity in provision of health promotion is to be achieved, measures must be taken locally andnationally to reach deprived sections of the population. In this type of health promotion programme, baseline and follow-up information should be entered on computer at the clinical locus to enable monitoring of outcome. These conclusions are particularly relevant to the national arrangements for health promotion in primary care which were introduced in July 1993.     

Impact of the prevention plan on employee health risk reduction

This study evaluated the impact of The Prevention Plan? on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).     

Perceived health risk of excess body weight among overweight and obese men and women: differences by sex

OBJECTIVES: To describe perceptions of health risk from excess body weight among adults, and assess if lack of perceived risk was associated with trying to lose weight. METHODS: Sex-specific logistic regression models were used to determine odds of disagreement that one's weight is a health risk and odds of trying to lose weight among overweight (BMI=25.0-29.9 kg/m(2), n=1296) and obese (BMI> or =30 kg/m(2), n=1335) adult participants in the 2004 Styles' surveys. RESULTS: Men were more likely than women to disagree their body weight was a health risk (among the overweight, 62% vs. 43%; the obese 20% vs. 14% obese). Disagreement with risk was associated with good health status and race/ethnicity among both sexes and lower education and income among women. Odds of currently trying to lose weight were significantly lower among obese men who disagreed, and overweight men and women who were neutral or disagreed that their body weight was a health risk. CONCLUSIONS: Many overweight and obese adults do not perceive their weight to be a health risk; this perception was associated with lower prevalence of trying to lose weight, particularly among men. Discussion by clinicians about the health risks of excess weight may alter perceived risk and help promote weight loss efforts.     

The Vermont health risk survey and the design of community wide preventive health programs

A Vermont health risk survey was performed to gain information on health knowledge and behaviors of the population. Telephone interviews with 1,594 individuals ascertained respondents' demographic characteristics, preventive health behaviors, and health knowledge. Risk prevalence was obtained on five health risks: alcohol (12%), smoking (33%), lack of exercise (70%), overweight (39%), and non-use of seatbelts (86%). Low income, less education, and blue collar occupation status were associated with increased risks of smoking, lack of exercise, and non-use of seatbelts. Increased prevalence of certain risks are associated with the 18–24 year old age group; 32% of those males reported an alcohol risk and 94% reported non-use of seatbelts. Combined risk scores were increased in groups with low income, less education, and blue collar occupations. These variations in health behaviors by social group were not explained by differences in health knowledge. Design of primary prevention activities needs to (1) be community wide, (2) utilize information on the epidemiology of health behaviors, (3) influence diverse community groups and (4) intervene before risk behaviors are established.Lloyd F. Novick, M.D., M.P.H., is Director of the Arizona Department of Health Services, 1740 W. Adams, Phoenix, Arizona 85007.David Jillson, PH.D. is Senior Research and Statistics Analyst at the Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.Roberta Coffin, M.D. is Commissioner of the Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.Mary Freedman, M.A. is Director, Public Health Statistics, Vermont Department of Health, 60 Main Street, Burlington, Vermont 05401.This article was presented at the Association of State and Territorial Health Officials Annual Meeting April 24, 1984, in Little Rock, Arkansas.