Do wellness programs help workers?

Responsible researcher: Adriano Valladão Pires Ribeiro

Article title: WHAT DO WORKPLACE WELLNESS PROGRAMS DO? EVIDENCE FROM THE ILLINOIS WORKPLACE WELLNESS STUDY

Article authors: Damon Jones, David Molitor and Julian Reif

Intervention location: Illinois, USA

Sample size : 4,834 employees

Sector: Healthcare

Type of intervention: Offering a well-being program for workers

Variable of main interest: Health and productivity metrics

Evaluation method: Experimental Evaluation (RCT)

Assessment Context

In the United States, the federal government adopted an affordable care measure in 2010 that encouraged companies to offer a share of up to 30% of the total cost of health plans, and some states have also included wellness incentive programs. As a result, more than 50 million workers have some type of coverage for wellness programs and the responsible industry has tripled its revenues since 2010. Among the factors that may explain the popularity of the programs is employers' belief in decreasing medical expenses and increasing worker productivity. Additionally, workers who place a higher value on health could be attracted to or remain with a company that supports wellness care.

In this context, the effects of well-being programs will depend on the type of worker participating, that is, whether or not they already adopted healthy routines before the program. For those who already had a healthy habit, the cost of entering the program is small, but the potential returns are lower when compared to those who had precarious habits. Furthermore, the effects can be broad, impacting health care spending, worker productivity, number of absences from work, health habits and well-being, both in the short and long term.

Intervention Details

To study the issue, a wellness program, iThrive, was implemented for workers at the University of Illinois in the cities of Urbana and Champaign and lasted two years. Three types of interventions were addressed: (i) an annual, in-person biometric health examination; (ii) a health risk assessment carried out online; and (iii) weekly wellness activities. Clinical data on health and information on healthy habits were then collected and a healthier lifestyle was promoted, respectively.

In the first year, 12,459 eligible beneficiaries were invited to participate in the program, of which 4,834 agreed. Of these, 3,300 formed the treatment group and were invited to attend wellness activities and receive compensation for doing so, in addition to completing the two other interventions above. The remuneration for those who completed the two years of the program was between 50 and 650 dollars, a value decided randomly and announced at the beginning of each year. The remaining 1,534 people formed the control group and were not allowed to engage in the activities, they only underwent the biometric exam and answered a questionnaire at the end of each year.

Along with biometric exams and health risk assessment, administrative data about participants was also collected, such as age, gender, race, salary, occupation and sick leave. Participants had to complete questionnaires about their health condition, use of health insurance, satisfaction with work and their productivity. Data from health plans were also collected to know when and why they were used (clinic, hospital, pharmacy, etc.), as well as participation in marathons or 10 and 5 km races in the city of Champaign and a technical index of the worker productivity. All this data combined makes it possible to study, following the methodology described in the subsequent section, the impact of the well-being program on worker productivity, formation of health habits, health expenditure, among others.

Methodology Details

First, it was possible to identify the characteristics of workers most likely to participate in well-being programs based on information from the treatment group. Second, as the participants in each group were selected randomly, the difference in the average results of the variables of interest can be explained by the employee's participation or not in the well-being program. In other words, the results of the treatment group are compared with those of the control group. Variables of interest included medical health expenditures, measures of work productivity, health habits and health status.

Results

It was found that employees who participated in the well-being program spent, on average, $115.3 less per month on health care in the 13 months prior to the program when compared to the control group. On the other hand, they were more likely to have positive spending. In other words, the people in the treatment group who participated in the activities already had a moderate expenditure on health and those in the control group were at the extremes, spending either nothing or a considerable amount. Furthermore, participants in the activities occupy an intermediate position in the income distribution, have slightly lower productivity and were already more likely to practice physical activity before the program.

First Year : After the first year of the program, there was no change in healthcare spending for the treatment group. The impact on productivity was also null in all metrics, whether for administrative data (annual salary, probability of promotion and dismissal and sick leave), for questionnaires (such as happiness at work or feeling more productive at work), or for the productivity index. Measures of health habits, such as going to the gym, participating in marathons and 5 and 10 km races, were also not impacted by the treatment.

Second Year : The program design was similar for the treatment group in the second year and results reported after 30 months of the program. The long-term effects were similar to those obtained after the first year, that is, there was no impact on the variables that measure health expenditure, productivity and physical activity. The main difference is due to workers' perception of managers, after 12 months, they are seen as someone who prioritizes health and safety, but this effect disappears after 30 months.

Public Policy Lessons

The main lesson of the study is the lack of impact of the wellness program on medical expenditure, productivity and the promotion of a healthy routine for workers. The program's biggest beneficiaries were not at the bottom of the income distribution, they already had some medical expenses and practiced physical activities. This suggests a transfer of costs from program participants to lower-paid employees, with high health expenditure and poor health habits. The difficulty of encouraging a healthy routine on a large scale is also highlighted, as financial stimulus is not always sufficient.

Reference

JONES, Damon; MOLITOR, David; REIF, Julian. What do workplace wellness programs do? Evidence from the Illinois workplace wellness study. The Quarterly Journal of Economics, vol. 134, no. 4, p. 1747-1791, 2019.