We thank Health Affairs for the opportunity to respond to Professor Ron Goetzel’s comments on our recent Health Affairs article, “Wellness Incentives in the Workplace: Cost Savings through Cost Shifting to Unhealthy Workers.” In many respects our article was quite limited in scope. We started by noting that companies are increasingly adopting wellness programs based on the idea that, with the help of financial incentives, employees will improve their health and employers will save money. We set out to explore the assumptions underlying this idea and found scarce high-quality evidence on the subject of workplace wellness incentives. What evidence we found offers, at best, limited support to justify these assumptions.
We hope that others will conduct the much-needed research about whether financial incentives can change behavior, improve health, and control spending. We also hope that the body of causal research will be expanded to a wider variety of populations, such as the elderly, and other related issues, such as the effects on incentives of absenteeism, productivity, and long-term health, or to programs that do not involve financial incentives or do not claim to control costs. These other effects and other types of programs are worthy of consideration, but we have not considered them in our article.
The Ethics Of Incentive Programs
Unfortunately, Professor Goetzel misunderstood the scope of our research. Contrary to Professor Goetzel’s assertions, we did not suggest that people should avoid making choices consistent with their health (and other goals), or that employers should not act in the best of interest of employees, employees’ health, or society at large. Still, we are skeptical that wellness programs of the sort encouraged by the Affordable Care Act (ACA) create, as Professor Goetzel suggests, a “win—win—win” situation: good for all workers, good for society, and consistent with the financial interests of employers, firms, and their owners. Rather remarkably, despite the potential for workplace wellness to become a large “social experiment”, we found scant reliable evidence that implementing wellness programs can easily save costs through health improvements without being discriminatory.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.