Posts Tagged ‘workplace wellness programs’

New Study on Wellness Carrots and Sticks

February 14th, 2013

A new survey finds that the American public finds the acceptable size of penalties for workplace wellness programs is much smaller than advocates for higher penalties have supported. A population-level on-line survey was fielded to 1,000 US residents. Positive incentive programs were favored by a factor of 4. The magnitude of acceptable penalty was around $50… 14 times lower than that advocated by then Safeway President Steve Burd and far above the 36 times greater than the penalty proposed by the Obama Administration. Harald Schmidt of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, author of the study, notes, “ ‘Carrots’ were clearly preferred over ‘sticks.’ In contrast to the preferences of advocates of increasing the legal limits of incentives, there was little support of large penalties in any of the strata. Opposition was strongest among low-income groups, the overweight and the obese. The findings can suggest that where larger penalties are used, frustration and perhaps even pushback is possible. Care is required to ensure that employees do not perceive any form of incentive program merely as unfair cost-shifting, and reject the approach as a whole.”

 

Republican Party Platform Guts Obesity Policies

August 30th, 2012

Among the provisions in the Republican Party Platform adopted this week in Tampa, Florida are these affecting obesity:

Food stamps and other nutrition programs be sent in block grants to the states.

On Medicare and Medicaid, the platform states,  “The problem (with these programs) goes beyond finances. Poor quality healthcare is the most expensive type of care because it prolongs afflictions and leads to ever more complications. Even expensive prevention is preferable to more costly treatment later on. When approximately 80 percent of healthcare costs are related to lifestyle – smoking, obesity, substance abuse – far greater emphasis has to be put upon personal responsibility for health maintenance. Our goal for both Medicare and Medicaid must be to assure that every participant receives the amount of care they need at the time they need it, whether for the expectant mother and her baby or for someone in the last moments of life.”

Editor’s note: This paragraph is rather hard to discern. On the one hand, it seems to be an blank check for prevention programs which are, overwhelmingly, governmental programs. Yet, then it shifts to personal responsibility. Then, a neck-whipsawing shift to Medicare and Medicaid participants getting every service they need when they need it. So, what exactly does this mean? Do you get bariatric surgery, for example, when you need it? Or is it denied because you did not take “personal responsibility?”

Regarding Medicare, the platform calls for making the program into a “premium support” program for those age 55 and younger. For these individuals, Medicare would provide a voucher to go out and purchase private health insurance coverage. Currently, Medicare covers bariatric surgery and intensive behavioral counseling for both those over age 65 and those disabled and receiving Social Security disability. Frankly, I am skeptical that private insurance companies (which did not insure elderly persons before Medicare was enacted) would cover such persons and such services without prohibitively high premiums.

For Medicaid, the platform proposes “alternatives to hospitalization for chronic health problems. Patients should be rewarded for participating in disease prevention activities. Excessive mandates on coverage should be eliminated. Patients with long-term care needs might fare better in a separately designed program.”

Editor’s note: The platform does not describe what an “alternative to hospitalization” would be. The reference to “patients with long-term care needs” refers to millions of elderly Americans whose nursing home costs are paid for by Medicaid, after their own assets are exhausted. It has been a politically charged issue to make the spouse’s assets at risk for the patient’s nursing home costs. This was proposed in the Ryan Budget. What a “separately-designed” program would be was not specified.

Of course, the platform calls for  the repeal Obamacare or the Affordable Care Act “in its entirety.” This would include free intensive behavioral  counseling for adults with obesity under plans which were not grandfathered, grants for healthier communities, access to breastfeeding sites at work, access to health insurance by persons whose obesity has prevented them from getting insurance due to a “pre-existing condition, and greater rights for individuals to fight denials of claims.

Of course, also repealed would be the regressive provisions for “workplace wellness” programs which penalize overweight workers for not meeting weight targets set by their employers.

In 2008, The Republican Party Platform, adopted in St. Paul, Minnesota, provided:

“Prevent Disease and End the “Sick Care” System. Chronic diseases – in many cases, preventable conditions – are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital.  To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children”.

 

Failure of anti-obesity legislation

August 21st, 2012

Christopher Still and I have a new article out, “Survey of antiobesity legislation: are these laws working?” Unfortunately, the answer is no. This finding is consistent with a paper earlier this year by Dr. Jeffrey Mechanick and last year’s Cochrane Review but contrary to the somewhat rose-tainted view of the Institute of Medicine’s recent report. Here is the abstract:

Obesity is well recognized as a major public health crisis throughout the USA. In recent years,governmental bodies at the federal, state and local levels have enacted policies intended to preventthe transition to obesity. Researchers have had the opportunity to study these policies and evaluate theirimpact on prevention of obesity.

Recent findings Most public policies have been directed principally, but not exclusively, to the prevention of obesity inschool-age children. Interventions have been directed to encouraging breast-feeding, to changing school lunches, limiting access to sugar-sweetened beverages, encouraging physical activity, changing thecomposition of competitive foods and affecting food advertising directed at children as well as collectingBMI information. Efforts more directed at adults include encouraging workplace wellness programs andimproving the nutrition label on packaged foods with front-of-package labels and caloric information on restaurant menus.

Summary  For the most part, evaluations of the interventions reveal weak or modest benefits. The actual picture mightbe less positive due to the poor quality of research and publication bias. Push back by industry and otherswill require higher quality experimental and real world studies. All interventions fail to accommodate themultifactorial aspects of obesity.

See PubMed: http://www.ncbi.nlm.nih.gov/pubmed/22895357