Workplace wellness programs fail to improve health

Workplace wellness programs have been touted as a powerful tool that can make employees healthier and more productive while reducing health care spending, but the results of a new study suggest such interventions yield less-than-impressive results.

The findings by University of Chicago and Harvard University scholars, published April 16 in the Journal of the American Medical Association , raise questions about the effectiveness of such programs offered by 80 percent of large U.S. employers in the $8 billion workplace wellness industry.

The analysis, the first peer-reviewed, large-scale, multi-site randomized controlled trial of a workplace wellness program, shows that people who worked at sites offering the program exhibited notably higher rates of some healthy behaviors, but no significant differences in other behaviors compared to the control group. Employees working at sites offering the program did not have better clinical measures of health such as body mass index, blood pressure or cholesterol after 18 months, nor did they exhibit lower absenteeism, better job performance or lower health care use or spending.

Workplace wellness programs are intended to encourage employees to engage in behaviors that promote health, with the goals of reducing health care costs, increasing productivity and improving the workplace environment.

"Our ultimate goal is to inform policy and ensure that decisions and investments are based on clear-eyed analysis rather than intuition," said study co-author Katherine Baicker , dean of the Harris School of Public Policy. "These results suggest that workplace wellness plans can affect health behaviors, but had no overall effect on health outcomes."

"Our findings show that health behaviors can respond to a workplace wellness program, but they also temper expectations of realizing large returns on investment in the short term," said study co-author Zirui Song, an assistant professor of health care policy and medicine at Harvard Medical School’s Blavatnik Institute and an internal medicine physician at Massachusetts General Hospital.

Baicker and Song said their goal was to explore the causal effects of workplace wellness programs using the rigorous methods of an experimental design, in order to help policymakers and employers make informed decisions about investing in wellness.

Worksites that offered the wellness program had an 8.3 percentage point higher rate of employees who reported engaging in regular exercise and a 13.6 percentage point higher rate of employees who reported actively managing their weight, compared to those working at sites where the program wasn’t offered.

The program had no significant effects on other outcomes, including 27 self-reported health and behavioral measures such as employees’ self-reported overall health, sleep quality and food choices; 10 clinical markers of health; 38 measures tracking spending and utilization for doctor’s visits, medical tests and procedures and prescription drugs; and three employment outcomes-absenteeism, job tenure and job performance.

The rationale behind workplace wellness

The motivation for employment-based wellness programs is straightforward. If employers can help workers cut back on alcohol consumption, quit smoking, or increase exercise, the idea goes, workers’ health will improve, generating savings on health care costs, lowering the number of sick days people take, and improving the overall wellbeing and productivity of the workforce.

In addition to private investment in workplace wellness program, the Affordable Care Act also allocated public funding for wellness programs. In the broader context of health system reform, wellness programs are part of a suite of ideas that encourage preventive medicine, coordinated care, and wellness education as ways to keep people healthy and reduce medical costs.

Past research has suggested workplace wellness programs might be a good investment. In 2010, Song, Baicker, and David Cutler, the Otto Eckstein Professor of Applied Economics at Harvard University, published a meta-analysis of prior research on wellness programs that found a roughly three-to-one return on investment for such interventions. However, as the authors noted in that meta-analysis, much of the prior literature was limited by the lack of a robust control group, leaving open the possibility that estimates could be biased by confounding factors, along with limited sites, samples, and outcome measures.

The new study findings complement the results of a recent randomized control trial conducted at the University of Illinois by Damon Jones, associate professor at Harris, and co-authors. This study, where individuals (rather than entire worksites) were randomized into a wellness program or a control group, found the impact of such programs is negligible, and incentive-based programs may act as screening mechanisms to attract healthy employees. A full description of Jones’s research can be found at NBER’s website at  www.nber.org/workplacewellness.

The experiment

To help improve the evidence on wellness programs, Baicker and Song decided to implement a large-scale controlled experiment.  To eliminate the unwanted effects of self-selection and other biases inherent in non-randomized studies, Baicker and Song randomized wellness program offerings across different work sites and tracked outcomes among all workers.

"In assessing the potential benefits of a workplace wellness program, it’s essential to separate out confounding factors. The firms that choose to have a program may have employees who are already more health-conscious than those at firm without a program.  And the employees who choose to participate may have different health profiles than those that don’t," Baicker said.  "Our study lets us isolate the effect of the program itself from those confounding factors."

To do so, the researchers partnered with BJ’s Wholesale Clubs to offer new wellness programs in randomly selected sites, which they then compared to the control sites operating as usual.  This allowed the researchers to capture the effects that the program might have in changing workplace culture as well as individual behavior.

What next?

Song said that experimental evaluations in the field of wellness promotion are still relatively uncommon. While this study provides important insights about some kinds of programs currently in use, many questions remain about the best ways to improve population health, he said. One line of questioning directly related to the JAMA study is whether 18 months is enough time to see an impact from a program like this, or do the kinds of changes in healthy behaviors the program produced take longer to yield measurable health benefits?

"As we grow to understand how best to encourage healthy behavior, it may be that workplace wellness programs will play an important role in improving health and lowering the cost of health care," Song said. "For now, however, we should remain cautious about our expectations from such interventions. Rigorous research to measure the effects of such programs can help make sure we’re spending society’s health and wellness dollars in the most effective way."

Citation: "Effect of a Workplace Wellness Program on Employee Health and Economic Outcomes,"  Zirui Song and Katherine Baicker,  JAMA , April 16, 2019. doi: 10.1001/jama.2019.3307

--Article originally appeared on the Harris Public Policy website.

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