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ABSTRACT Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums. At twelve months there were no statistically significant differences in mean weight change either between the control group (whose members had a mean gain of 0.1 pound) and any of the incentive groups (delayed premium adjustment, -1.2 pound; immediate premium adjustment, -1.4 pound; daily lottery incentive, -1.0 pound) or among the intervention groups. The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.
Nearly 70 percent of adults in the United States are overweight or obese.1 Obesity may contribute to employer costs through direct medical spending, absenteeism, and decreased worker productivity.2-4 Beginning in 2014 the Affordable Care Act (ACA) increased the proportion of overall health insurance premiumsthatcould beusedasoutcome-basedwellness incentives from 20 percent to30 percent, or to 50 percent if tobacco use is targeted.5 More than 80 percent of large employers now use some form of financial incentive for health promotion.6-9
Employers commonly deploy these incentives through health insurance premium adjustments, lowering the employee contribution to health insurance premiums for those who meet targets or raising premiums for those who do not.9,10 This practice mirrors approaches commonly used throughout the insurance industry and is easy to administer using existing communication channels. However, there has been no prospective evaluation of the effectiveness of premium adjustments in promoting weight loss. Additionally, studies of other kinds of workplace financial incentives for weight loss have been limited by their observational design11,12 and relatively short-term outcomes.13,14
Previous work in behavioral economics indicates...