This Issue Brief describes employers' efforts to contain health
expenditures through demand management programs. These programs
are designed to reduce utilization by focusing on disease prevention
and health promotion. Demand management includes work site health
promotion, wellness programs, and access management. Work site
health promotion is a comprehensive approach to improving health
and includes awareness, health education, behavioral change, and
organizational health initiatives. Wellness programs usually include
stress management, smoking cessation, weight management, back
care, health screenings, nutrition education, work place safety,
prenatal and well baby care, CPR and first aid classes, and employee
assistance programs (EAPs). These programs are often viewed positively
by workers and can have long-term benefits for employers above
and beyond health care cost containment. Demand management can
benefit employers by increasing productivity, employee retention,
and employee morale and by reducing turnover, absenteeism, future
medical claims, and ultimately expenditures on health care.
Even though a growing number of employers are offering wellness
programs, only 37 percent of full-time workers employed in medium
and large private establishments were eligible for wellness programs
by 1993. However, a recent survey found that 88 percent of major
employers have introduced some form of health promotion, disease
prevention, or early intervention initiative to encourage healthy
lifestyles among their salaried employees.
Distinctions must be drawn between short- and long-term strategies.
Demand management can be thought of as a short-term strategy when
the focus of the program is on creating more appropriate and efficient
health care utilization. Disease prevention is characterized by
longer-term health improvement objectives. Whether the purpose
is to reduce utilization in the short term or in the long term,
the ultimate goal remains the same: to reduce health care expenditures
while improving overall health. This goal can be achieved through
the use of health risk appraisals, organizational health risk
appraisals, high risk programs, awareness programs, medical call
centers, return to work programs, EAPs, and smoking cessation
programs.
Studies of a health promotion program's cost effectiveness must
disentangle the effects of many competing factors on cost effectiveness.
For example, a health risk appraisal program may identify health
problems of which the patient and the health care provider were
unaware, resulting in the treatment of these health problems.
At the same time, the employer may have switched from a nonmanaged
pharmaceutical program to a managed program with incentives for
participants to utilize generic and/or mail order drugs. As a
result, when evaluating a health promotion program, the long-run
impact on the program's cost effectiveness is most important.
