Filling Out Health Questionnaires for Employers

I must confess to a sense of ambivalence about the use of health questionnaires by employers. On the one hand, such an assessment is a necessary precursor to any health improvement plan for employees that would be initiated by the employer. I also understand that, by law, the results of such questionnaires cannot be used for any purpose related to one's employment status. Nevertheless, these instruments can easily be labeled as an intrusion into one's private affairs.

I have frequently blogged about the very high cost of chronic diseases in the U.S. In a recent article in the New York Times, the cost of treating such diseases is estimated to be three-quarters of the cost of all healthcare (see: Getting Healthy, With a Little Help From the Boss). This same article discusses employer-sponsored wellness programs designed to lower the cost of chronic care and reduce the health insurance premiums for the employer. Below is an excerpt from it with boldface emphasis mine:

More and more companies are using health questionnaires as a way of to create personalized health improvement plans for their workers. These surveys ask about your body mass index, how much you exercise and whether you smoke, and are typically administered by a third party. According to privacy laws, the information you provide to the plan administrators cannot be used by your employer for any purpose related to your employment status. In addition, an employer cannot deny health insurance to an employee for failure to complete a health risk questionnaire....While many employers offer incentives for filling out health surveys, there is some debate over whether it is legal for them to do so. Under the federal health privacy law known by its acronym, [HIPAA] ..., your employer can provide an incentive for filling out a risk survey, as long as the reward does not exceed 20 percent of the cost of coverage under the plan, and certain other requirements are satisfied....

After some mental tugging on my part, I have concluded that I am in favor of allowing an employer to provide financial incentives for employees to complete a health survey as an incentive to participate in wellness programs. Presumably, the results of these surveys are then used to tailor various health "interventions" designed to ameliorate or prevent chronic diseases such as diabetes, obesity, and smoking/drinking behaviors. Such interventions, so long as they are not cast in a punitive light, work to the advantage of both the employer and governmental/private health plans. Focusing on the chronic problem of obesity, about which I have posted a number of previous notes, I believe that the most successful weight-loss plans are those that entail a form of competition (see: Statewide Weight-Loss Competitions Achieve Record of Success). Such competitions can be organized within companies.

Some of my libertarian instincts balk at the idea of financially "rewarding" employees with programs and services designed to help them to improve their health while perhaps ignoring those employees who are already fit. I guess that the best response to my dilemma is that the fit employees have already been rewarded and that they benefit from a lowering of the overall healthcare costs attributable to the chronically ill. In addition, I would encourage companies to offer other programs such as healthier food in company dining facilities, perhaps on a subsidized basis. In so doing, they will provide a tangible benefit to the fit as well as those trying to change their life styles and improve their health.