Employers have staked a lot on lowering their health care costs by encouraging employees and dependents to take more responsibility for their health care and by making programs available to help them identify and manage health risks and conditions. Towers Watson surveyed about 3100 employees in 2010 to ascertain attitudes about these efforts and engagement in health. (Towers Survey) One headline finding is that 59% of employees say that managing their health is a top priority in 2010, down from 69% who said so in 2008.
Similarly, the number of employees who reported taking action to improve health declined from 65% in 2008 to 59% in 2010, which is surprising given the continuing rise in health costs and chronic disease. Taking actions such as having preventive exams and screening was more likely with increasing age, increasing income and better health status. Only 44% of employees who are in fair or worse health say managing that health is a top priority and only 45% report taking action to improve their health. People with high deductible plans were also more likely to be involved in their health and employees who had a primary care doctor were more than two times as likely to take action on their health as those who didn’t.
Other findings include that 27% would not participate in wellness efforts without incentives, a third say their employer’s programs have encouraged them to be healthier and 26% report that concerns over health spending are raising their stress levels. In regard to incentives, employees strongly prefer cash, whether directly or in the form of premium credits and 67% were okay with reducing premiums for healthy workers and those who are trying to improve their health and 47% accepted the idea of increasing premiums for employees not trying to address health issues. Note the framing issue in regard to premium reductions versus increases which have exactly the same financial consequences but may be more or less acceptable depending on how positioned.
What is most striking about the survey is that those in poor health are almost recalcitrantly proud of it and are raising costs for everyone else. Contrary to what is in the new federal law and most state laws, people’s insurance premiums should be most directly related to their health behaviors and those who refuse to make efforts to address their health over several years should bear the full cost of their health spending. Otherwise the incentive diminishes for them to make changes and those who do try to maintain their health are punished and lose incentive for continuing to maintain good health.