Department of Health Administration and Policy, George Mason University, 4400 University Dr, MS 1J3, Fairfax, VA 22030. E-mail:
Am J Manag Care. 2017 Oct;23(10):604-610.
Using a large natural experiment among 39 employers, we examined the effect of adding financial incentives to workplace wellness programs.
The 39 study employers used the same national insurer to administer their wellness programs, allowing us to observe preventive and health-promoting behaviors before and after financial incentives were implemented. Fifteen treatment employers introduced financial incentives into their wellness programs over 3 years, providing variation in the start dates, whereas 24 employers did not introduce financial incentives. These incentives were attached to specific health actions, including annual preventive visits, biometric screening, and selected screening services for diabetes, heart disease, and cancer.
Using multivariate regression, we examined employees and their adult dependents who had insurance coverage for at least 12 months and were offered a wellness program. Outcomes include utilization of annual preventive visits, low-density lipoprotein cholesterol testing, fasting blood sugar (FBS) testing, and breast, cervical, and colon cancer screens.
Financial incentives increased annual preventive visits by 7.7 percentage points, cholesterol testing by 7.9 percentage points, and FBS testing by 7.1 percentage points (P <.05 for each). Compared with baseline rates, these changes represent significant improvements of 21% to 29%. Increases for cancer screening were smaller: 2.7 percentage points for mammograms and 2.2 percentage points for colorectal cancer screening, which correspond to increases over baseline rates of 5.5% and 7.3%, respectively. We did not detect an impact on cervical cancer screening.
The addition of financial incentives to wellness programs increases their impact on selected preventive care services.
通过对 39 家雇主进行大型自然实验，我们研究了在工作场所健康计划中增加财务激励措施的效果。
这 39 家研究雇主使用同一家全国性保险公司来管理他们的健康计划，使我们能够观察到财务激励措施实施前后的预防和促进健康行为。15 家治疗性雇主在三年内将财务激励措施纳入他们的健康计划，在开始日期上有所不同，而 24 家雇主没有引入财务激励措施。这些激励措施与特定的健康行为相关联，包括年度预防访问、生物特征筛查以及糖尿病、心脏病和癌症的特定筛查服务。
我们使用多元回归分析，研究了至少有 12 个月保险覆盖并提供健康计划的员工及其成年家属。结果包括年度预防访问、低密度脂蛋白胆固醇测试、空腹血糖（FBS）测试以及乳腺癌、宫颈癌和结肠癌筛查的利用率。
财务激励措施使年度预防访问增加了 7.7 个百分点，胆固醇测试增加了 7.9 个百分点，FBS 测试增加了 7.1 个百分点（每个都<.05）。与基线率相比，这些变化代表了 21%至 29%的显著改善。癌症筛查的增加较小：乳房 X 光检查增加了 2.7 个百分点，结直肠癌筛查增加了 2.2 个百分点，分别对应于基线率的 5.5%和 7.3%的增加。我们没有发现对宫颈癌筛查的影响。
在健康计划中增加财务激励措施可以提高其对某些预防保健服务的影响。
