Cost savings in work wellness programs: Is that the right question?

Cost savings in work wellness programs-Twice last week I heard mention of how workplace wellness programs don’t actually reduce costs. The first was someone talking about what a compelling outcome for health coaching would be, and the second was a NY Times editorial that asserted that programs don’t save money in the short term.

I think research on the efficacy of workplace wellness programs is certainly mixed, and there are arguments to be made on both sides. But one feature that keeps coming up is that wellness programs often raise costs in the first year. One reason is that new participants may go get preventive exams that they’ve neglected to date. Vaccinations, mammograms, pap smears, and assorted other tests boost first-year costs. In some cases, these exams catch issues that require further treatment (or perhaps DON’T require further treatment but get it anyway, part of a trend toward over-treatment). There is also the issue of false positives, which can lead to unneeded followups or treatments, not to mention fear and anxiety.

Is this always a bad thing? I tend to think it’s good to get people into the habit of regular medical checkups and preventative care. Although I hear the rationale behind policy changes such as the reduction in frequency of recommended pap smears, you only have to know one person whose life was saved by early detection (or lost because of lack of it) to lean toward over-testing for your loved ones. This quote from the linked article captures the issue:

“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”

Essentially the same effectiveness.” That’s a population-level statistic. That’s saying that among thousands of women, there will be roughly the same number of cancers caught and treated. But there may be one or five or ten that are not, which is not statistically significant but is very meaningful if those women are your mother, sister, friend, or yourself. Yes, false positives are scary and costly. But missed positives can be deadly.

It may not make financial sense for a company to implement a program that is going to increase their short-term employee health costs. I get it. And that is probably more the case today than ever before, as few people stay with the same company for their entire careers. A company that invests in your long-term health may not be your employer long enough to reap the benefits.

That said, I think there’s a moral argument to be made to help each person get the best possible health care from early on, which includes wellness exams. Can’t the focus instead be on meting out follow-up treatment thoughtfully?

I really don’t know the answer to this dilemma. But it’s one I care deeply about, and that I don’t think can be boiled down to dollars.