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Many fail to offer cost-effective programs
A new report from a national disease prevention organization provides a disturbing picture of the depth of commitment (or lack thereof) to prevention among U.S. employers.
The report comes from the Washington, DC-based Partnership for Prevention, a national nonprofit organization whose mission is to increase the priority, resources, knowledge, and incentives for disease prevention and health promotion policies and practices. It found that "overall, the coverage for preventive services available to American workers and their families through job-based health insurance does not deliver the best health value for the money spent."
What’s worse, this lack of commitment to preventive services can put employers at cross-purposes with their own employee wellness programs — and with their corporate financial goals.
"The general point is that prevention is not only good for the health of workers, but for the business and bottom line of the company that invests in preventive services," says William J. Roper, MD, MPH, chairman of the Partnership for Prevention. Roper, who currently serves as dean of the School of Public Health at the University of North Carolina at Chapel Hill, is a former director of the Centers for Disease Control and Prevention (CDC) in Atlanta.
"What is clearly borne out in the survey is that people who participate in preventive services through employers are there on the job to do what it is the employer has hired them to do," says Roper. "They are more productive, they do their jobs better, and they have a greater commitment to the organization. This is something employers are particularly concerned with these days. Given such low unemployment, employees are harder to attract. Anything that further cements the relationship between employer and employee is a very important aspect of any job."
Not getting the message
Despite the obvious plusses of preventive services, the report shows employers are not getting the message. The report, which was part of Mercer’s 1997 National Survey of Employer-Sponsored Health Plans, included responses from over 3,000 employers that both sponsor health insurance and employ at least 10 people. Among the findings:
• Of all the preventive services included in the survey, counseling to address serious health risks — tobacco use, physical inactivity, risk drinking, poor nutrition — is least likely to be covered by an employer-sponsored health plan.
• Childhood and adolescent immunizations are among an elite group of preventive services known to save money. They decrease medical costs due to vaccine-preventable illnesses and reduce the time parents spend off the job tending to sick children. Yet one of five employer-sponsored plans does not cover childhood immunizations, and one of four does not cover adolescent immunizations.
• Chlamydia screening for sexually active young women has also been demonstrated to save money, yet it is covered by only one third of employers’ highest enrolled health plans.
"I think the major point the survey showed is that despite general knowledge out there among the public at large — and I hope among those who make decisions about the health of workers — there’s just not enough investment in preventive health; it’s still an area that’s relatively underinvested in," says Roper.
Not top of the mind’
Why are employers "underinvesting" in prevention? "From my activities with the CDC, I’d say it’s because most people don’t think about prevention — it’s not a top-of-the-mind concept," says Roper. "I believe employee health benefit managers are concerned about getting the right health plan and the right docs in the network, but there’s not enough attention and concentration placed on what the notion [of prevention] is all about. We’re trying to raise attention and visibility in this area in a big way."
Roper says science is on his side. "The general point is there is a body of literature that shows the cost-effectiveness of various preventive interventions; there are very good scientific studies that have led to guidelines for prevention," he observes. "The preventive services that do show real benefit are the ones employers generally ought to invest in. For example, immunizations for children, mammography screening, and smoking cessation programs are three that are well-documented as preventive services."
Wellness professionals, take note
Though they are not directly involved in employee benefits, the issue of preventive services certainly impacts wellness professionals, says Roper. Employers that don’t provide such services "are not defeating the purpose [of the wellness program], but they’re not maximizing the opportunity that is out there. The wellness professional has designed a program to promote good health among the work force, but if the benefit program doesn’t include the generally accepted and proven preventive interventions you’re selling yourself short, and you’re not doing all you could do to accomplish as much as possible in this area. And, your health care costs may still continue to rise."
What can wellness professionals do to help change things at their workplace? "This [report] gives those of us in preventive health a real opportunity to go out and make some converts," says Roper. "Wellness professionals can make the case for prevention directly to the decision maker — usually the health benefit administrator. In general, they should highlight the idea of health promotion combined with disease prevention. In the workplace, they can make a case for preventive services to the workers at large, and perhaps they will go back to their boss and ask for a change in the health benefit package. If you have an excited, stirred-up work force then that will happen."
[For more information, contact: Susan Polan, Partnership for Prevention, 1233 20th St. N.W., Suite 200, Washington, DC 20036. Telephone: (202) 833-0009, ext. 106. Fax: (202) 833-0113. Web site: www.prevent.org.]