If you asked a business owner what their biggest concern is for the upcoming year, the answer will likely be related to health care costs.  In 2004 the increase in health care costs peaked at nearly 15%.  This past year the increase has been about 6.7% - still at a rate much higher than inflation.  Annual health care costs average $7,089 per employee.  According to Mercer’s 2005 National Survey of Employer-Sponsored Health Plans, the type of business most affected by this increases is small business.  Due to high cost, many will need to cut health coverage altogether.

Possible ways to offset these skyrocketing costs include higher deductibles for the employee, higher monthly premiums paid by the employee, a yearly cap for coverage, or enrollment in to an HMO that doesn’t provide local services.  Too often workers will opt out of getting insurance at all, or will not get coverage for family members.  These employees often avoid going to the doctor until a catastrophic even occurs, and are less able to focus when at work because they don’t feel well. 

How do we solve the problem of increasing health care costs?  Worksite wellness programs have been proven to reduce absenteeism, improve productivity, increase employee morale, and decrease conflict with management.  Many large companies are moving towards health promotion at the worksite in 2007 - most report that poor employee health has had a negative effect on the bottom line.

Why is this important?  We know that chronic illness in the United States is at an all time high.  We spend more on health care than any other nation and yet our citizens are not healthy. This trend is reflected at the workplace by increased health care claims, worker’s compensation costs, and short and long-term disability.  There is a loss of productivity and a worsening economic picture for the company and the employee. 

What are the biggest health issues?  Obesity is a monumental problem - more than 30% of Americans are considered obese, and more than 50% overweight.  This results in increased injuries such as back pain, and other associated illnesses like diabetes, hypertension, heart disease and some cancers.  Obesity also affects work performance, as the overweight employee is often tired and uncomfortable much of the day.  Businesses lose about $3,000.00/year per employee who is overweight, and 100 million workdays are lost each year to lower back pain.  The family members of these workers also have a higher number of diseases – the lifestyle of the spouse and children tend to be the same as the employee.

Smoking results in an average of $1,300/year per employee.  Smokers use more sick time and may have associated conditions that require long absences. Work time lost from smoke breaks throughout the workday is also an issue.    Stress is an epidemic in the workplace.  Balanced lifestyles and healthy ways of dealing with stress are not being addressed.  Stress by itself may not be preventable, but the manner in which the employee reacts to stress is.  Programs at the workplace to prevent problems such as drug and alcohol abuse are much more effective than the cost of rehabilitation programs.

How does the company pay for this?  Which program is right for you?  Health promotion programs can be implemented that improve health, save money, and result in a significant return on investment with minimal costs.  It is estimated that for every dollar initially invested in wellness programs at the worksite, there is a four-dollar return on that investment.  Not only are the employees and their families happier and healthier, but the company has a more stable, focused, and productive workforce. 

The first step is to give employees a health risk assessment.  This assessment gets information about individuals, and can improve awareness of unhealthy behaviors. This information needs to be coupled with a clear understanding of the culture of the company.  For example, a company with people that drive all day will need different interventions than a company where employees are at a cubicle, a manufacturing site, or a construction site.  

The development of appropriate incentives should be the next step.  One example would be that those who participate in the health risk assessment would be provided access to an on-site weight management program.  Other examples are a reduction in the percentage paid by the employee for health insurance after quitting smoking, and opening up the wellness program to family members. 

Following implementation of a program, reevaluation using a health risk assessment and claim information should document the improvement in the health of the employees and be directly relatable to a decrease in health care costs.  A few companies that have benefited from these programs are Union Pacific Railroad (with a reported 25% reduction in health care costs), Daimler Chrysler (in their 34 North American sites), and the City of Austin. 

There is no doubt that health care costs will continue to increase without intervention.  The workplace is the ideal place to impact the health of the individual, as we spend most of our time at work.  A healthy workforce improves the company’s bottom line.  Shifting costs and managed care plans don’t solve the problem.  Worksite health promotion is the only answer that works and is cost effective in the long run.

By Patricia B Rosen, MD, MPH is the President of Austin Toxicology/Wellness for Workers and is an accomplished triathlete - she can be reached at 512.371.8822 or www.toxicologyevaluation_austin.yourmd.com
Jeannie L. Samson, M.Ed, writer, mother of four, and accomplished triathlete  - www.jeanniesamson.com