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  Barbara Saunders wrote @ February 15th, 2008 at 3:59 pm

I believe true pay-for-performance would debunk some of the myths still present in your article. I don’t believe that time away from the workstation, for smoking or any other purpose, “automatically” reduces productivity. (How about time for a gym break?!)

  PeterC wrote @ February 17th, 2008 at 12:30 pm

I think most people are missing the point on these programs, at least the ones I work with on a regular basis. These programs offer incentives to people who choose to chaange certain unhealthy behaviors which are KNOWN to create, generally speaking, adverse health outcomes. They focus on the behavior and at least the “attempt” to change it- not necessarily the outcome. For example- take smokers. If someone smokes and goes through a program to quit and they actually quit- great, they get the credit and the point associated. However, they also get the same points just for completing the quit smoking program. Focused on behavior and choices- not the result. For the sake of equity, non-smokers automatically get the credit toward the incentives by just ticking the box saying they don’t smoke. These are not perfect systems and are open to abuse (such as people lying) but they are designed to create awareness and enlightenment to get those people who could make a few changes and improve their long term health to get moving. These are NOT programs that penalize the ill, at least not if an employer works with a high quality consultant with depth of experience in the space

  Mike Critelli wrote @ February 20th, 2008 at 11:29 pm

The federal government regulations that put limits on wellness incentives were well-intentioned, but poorly-crafted. I believe that punishing people because of health conditions over which they have no or very limited control is morally wrong, but I also believe that health plans and employers need tools to drive unquestionably good behaviors, and that the right percentage incentives should never be decided by government regulation. Each population is different, and each person requires different types of carrots and sticks to get the right behaviors. Rigid government regulations prevent our society from ever finding out what works through a trial-and-error process.

Incidentally, this is one of the reasons I am strongly opposed to single-payer plans. While they solve the problems of universal and affordable health care coverage, and eliminate the risk of a person being financially wiped out by large health care costs, they embed into our health care system politically driven and bad medical decisions that become exceptionally difficult to change. This is just one example of an ill-advised set of regulations that takes us backwards.

  Scott MacStravic wrote @ February 21st, 2008 at 8:05 pm

I agree that incentive programs normally do not intend to punish those who fail to modify their behavior, improve their health status, etc. but that when employers initiate a new arrangement whereby everybody will pay an extra $1000 for their health insurance, with special discounts for those who are healthy behavers, this is likely to look a lot like a punishment, and may have effects that look like a lot of employees thought it was.

  Scott MacStravic wrote @ February 21st, 2008 at 8:16 pm

I hate to think that I am promoting “myths” about smokers losing time at work and output due to their taking smoke breaks. Clearly the number they take, how long they are, and whether they make up for lost time while they are at their workstations all make a difference in individual cases, but the research data makes it pretty clear that smokers are, on average, less productive than their non-smoking peers, and not because of health issues alone. This would all be taken care of, of course, if workers were paid for their actual performance and output, a move that tends to increase both by itself, rather than through incentives for healthier behavior or status alone. No one that I know of, and certainly not I, believes that improving health behaviors or status ALONE will improve productivity and performance. There are other things such as individual talent and motivation that can improve or depress both far more than health factors. I try not to simply “believe” that what I write is true, but whenever possible base it on published research, though that is not, of course, always possible. It is, however, relative to smokers.

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