The association of health promotion participation with health risks and medical costs.

Abstract

Health promotion programming was initiated in the mid 1970s as a rational effort to prevent high-cost diseases that consume the majority of corporate health benefit dollars. The growth of corporate investments expanded the scientific efforts to evaluate the health and cost benefits of these programs. Evidence from these evaluations demonstrated improvements in selected health outcomes. However, the relationship between participation in health programs and definitive economic returns in medical cost savings has been more difficult to establish. The purpose of this project was to evaluate the effect of employee participation in health promotion programs at The Progressive Insurance Corporation by assessing the association of increasing program participation with health risk change and selected medical cost outcomes. Medical cost trends and health risk changes were monitored over a 6-year study period. Program participation was operationalized as a summed program participation score based on company attendance records. Programs were also categorized and summed by program-type: knowledge classes, biometric screening programs, health risk appraisals, or intervention/interactive classes. Increasing levels of program participation were associated with increasingly higher cost employees but not with higher numbers of health risks. This was an unexpected finding since higher cost employees participating in health promotion programs would also be expected to be associated with higher numbers of individual high risks. In this company, with a comparatively younger employee population, increasing program participation was frequently associated with increased medical costs not related to physical disease, e.g., injuries, musculo-skeletal complications, and mental disorders. Although knowledge, screening, and HRA programs attracted participation by higher cost employees, positive health risk change/maintenance and medical cost moderation were associated primarily with participation in intervention programs. High risk for stress was reduced and low risk for exercise was maintained with more participation in intervention programs. Medical cost moderation occurred among those employees with more access to intervention programs while medical costs continued to increase among those employees participating primarily in health risk awareness and identification programs. These findings provide evidence for the effectiveness of intervention programs in reducing or maintaining health risk status and in moderating medical care costs.Ph.D.Health and Environmental SciencesHealth care managementPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131059/2/9825311.pd