Sacks Naomi, Cabral Howard, Kazis Lewis E, Jarrett Kelli M, Vetter Delia, Richmond Russell, Moore Thomas J
Department of Health Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA.
J Med Internet Res. 2009 Oct 23;11(4):e43. doi: 10.2196/jmir.1263.
Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation.
The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs.
There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups.
Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P= .05; t(729) = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t(1022) = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t(74) = 2.71).
An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization.
不断上涨的医疗保险费用给医疗保险的雇主赞助商及其员工带来了迅速增加的负担。一些雇主通过提供工具来鼓励员工直接管理自己的健康并预防疾病，从而积极主动地管理医疗保健成本。这种工具的一个例子是“健康饮食与生活方式调整计划（DASH for Health）”，这是一个基于互联网的营养和运动行为改变计划。该计划作为一项免费的、可选择加入的福利提供给EMC公司在美国的员工。
目的是确定雇主赞助的基于互联网的饮食和运动计划是否对医疗保健成本有影响。
共有15237名员工及其配偶纳入我们的分析，其中1967人参加了“健康饮食与生活方式调整计划（DASH for Health）”（DASH参与者）。采用回顾性准实验设计，比较DASH参与者和非参与者的研究年度医疗保健成本，同时控制基线年度成本、风险和人口统计学变量。还研究了受试者访问DASH网站的频率与医疗保健成本之间的关系。在所有研究对象以及735名患有心血管疾病（糖尿病、高血压、高脂血症）的亚组中研究了这些关系。多元线性回归分析研究了计划使用与医疗保健成本之间的关系，比较了DASH参与者和非参与者的研究年度成本，然后研究了增加网站使用对医疗保健成本的影响。在心血管疾病亚组中重复进行分析。
总体而言，计划使用与医疗保健成本的变化无关。然而，在心血管疾病风险研究对象中，研究年度的医疗保健成本平均降低了827美元（P = 0.05；t(729) = 1.95）。在1028名计划使用者中，在研究年度访问网站至少9次的人，增加网站使用与较低的医疗保健成本显著相关（每次访问减少14美元；P = 0.04；t(1022) = 2.05），在80名患有特定疾病的计划使用者中年度节省最多（每次访问减少55美元；P < 0.001；t(74) = 2.71）。
雇主赞助的基于互联网的饮食和运动计划有望成为一种低成本福利，有助于降低医疗保健成本高于平均水平且使用率较高的高危人群的医疗保健成本。
