Patel Mitesh S, Asch David A, Troxel Andrea B, Fletcher Michele, Osman-Koss Rosemary, Brady Jennifer, Wesby Lisa, Hilbert Victoria, Zhu Jingsan, Wang Wenli, Volpp Kevin G
Mitesh S. Patel (
David A. Asch is a professor of medicine, medical ethics and health policy, and anesthesiology and critical care medicine at the Perelman School of Medicine and of health care management and operations, information, and decision at the Wharton School, and a member of the faculty at CHIBE, all at the University of Pennsylvania; executive director of the Penn Medicine Center for Health Care Innovation; and a staff physician at the Crescenz VA Medical Center, all in Philadelphia.
Health Aff (Millwood). 2016 Jan;35(1):71-9. doi: 10.1377/hlthaff.2015.0945.
Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums. At twelve months there were no statistically significant differences in mean weight change either between the control group (whose members had a mean gain of 0.1 pound) and any of the incentive groups (delayed premium adjustment, -1.2 pound; immediate premium adjustment, -1.4 pound; daily lottery incentive, -1.0 pound) or among the intervention groups. The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.
雇主通常会通过调整医疗保险费来激励员工养成健康的行为习惯，但这些调整措施的有效性存在争议。我们让197名参加职场健康计划的肥胖参与者设定一个相当于其基线体重5%的减肥目标。他们被随机分配到一个对照组（达到目标没有经济激励）或三个干预组之一，干预组提供价值550美元的激励。两个干预组采用医疗保险费调整的方式，一种是从次年开始（延迟），另一种是在达到目标后的第一个发薪期开始（即时）。第三个干预组采用与保险费无关的每日抽奖激励。在十二个月时，对照组（成员平均体重增加0.1磅）与任何一个激励组（延迟保险费调整组，体重减轻1.2磅；即时保险费调整组，体重减轻1.4磅；每日抽奖激励组，体重减轻1.0磅）之间或干预组之间，平均体重变化在统计学上均无显著差异。激励措施未能促进体重减轻，这表明通过职场健康计划鼓励减肥的雇主应通过采用替代激励设计、更大的激励措施或两者兼用来测试传统保险费调整方法的替代方案。
