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职场健康计划与医疗保健支出的短期变化

Workplace wellness program and short-term changes in health care expenditures.

作者信息

Levy Douglas E, Thorndike Anne N

机构信息

Mongan Institute Health Policy Center, Massachusetts General Hospital, 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA.

Harvard Medical School, Boston, MA, USA.

出版信息

Prev Med Rep. 2018 Dec 30;13:175-178. doi: 10.1016/j.pmedr.2018.12.019. eCollection 2019 Mar.

Abstract

Workplace wellness programs are commonly offered by employers with the expectation that they will reduce health care costs. We previously reported that Be Fit, a 10-week wellness program offered to employees of a large teaching hospital and geared towards improving nutrition and physical activity, led to improvements in weight, serum cholesterol, and blood pressure at program completion and 1-year follow-up. In the present study we assessed whether Be Fit participation was associated with reduced health expenditures by employing a difference-in-differences analysis of claims data for 289 employees who participated in Be Fit between 2010 and 2014 and 194 controls from the same parent company matched on sex, age, health risk score, and baseline health expenditures. We compared changes in expenditures from the year prior to Be Fit participation to the year after initiating participation. We did not observe any inflection in health care expenditures at the time of Be Fit participation for participants or matched controls. After adjusting for matching characteristics, changes in quarterly health expenditures were $236 lower for participants compared to controls (95% CI -$640 to $168). We similarly found no evidence of reduced health expenditures when expenditures were capped at the 99th percentile (excluding the impact of outliers) or limited to expenditures for cardiovascular disease or diabetes. Despite improvements in clinical risk factors, we find no evidence that Be Fit was associated with reduced health expenditures over 1-year follow-up. Reducing health expenditures may require a longer time horizon and programs targeting a broader set of risk factors.

摘要

雇主通常会提供职场健康计划,期望借此降低医疗成本。我们之前报道过,“保持健康”(Be Fit)是一项为一家大型教学医院员工提供的为期10周的健康计划,旨在改善营养和身体活动状况,该计划在结束时以及1年随访期内使体重、血清胆固醇和血压都得到了改善。在本研究中,我们通过对2010年至2014年间参加“保持健康”计划的289名员工以及来自同一家母公司、在性别、年龄、健康风险评分和基线医疗支出方面相匹配的194名对照组人员的理赔数据进行双重差分分析,评估参加“保持健康”计划是否与医疗支出的降低相关。我们比较了参加“保持健康”计划前一年到开始参加计划后一年的支出变化。对于参与者或匹配的对照组,我们在参加“保持健康”计划时未观察到医疗支出有任何变化。在对匹配特征进行调整后,与对照组相比,参与者的季度医疗支出变化低236美元(95%置信区间为-640美元至168美元)。同样,当支出上限设定为第99百分位数(不包括异常值的影响)或仅限于心血管疾病或糖尿病的支出时,我们也没有发现医疗支出降低的证据。尽管临床风险因素有所改善,但我们没有发现证据表明在1年的随访期内“保持健康”计划与医疗支出的降低相关。降低医疗支出可能需要更长的时间跨度以及针对更广泛风险因素的计划。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2ca4/6319308/6fd37a34fb36/gr1.jpg

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