The Impact of Wellness Programs and Incentives on Preventive Services

描述(由申请人提供)：雇主和健康计划中越来越多的人相信，健康计划是增加获得预防服务和促进健康行为的重要工具。特别令人感兴趣的是如何将财政激励措施纳入这些计划，以进一步鼓励健康促进和预防。我们建议通过研究大公司最近提供的通过同一家大型健康保险公司提供保险的计划来研究财政激励措施对促进预防保健和健康的影响。这一准实验提供了在实际企业提供的背景下研究健康计划的机会，而不是在外部有效性有限的受控实验室环境中。这家健康保险公司提供的早期健康计划包括健康风险评估与健康指导计划和疾病管理计划(“标准健康”)相结合。随后，这家健康保险公司推出了健康计划，将标准的健康服务与现场生物特征筛查和财务激励相结合，这些激励措施明确与参保人为改善健康而采取的行动挂钩(“健康+财务激励”)。在不同的公司，这些财务激励的规模和类型自然会有所不同。我们的研究将利用保险公司引入健康+财务激励计划提供的自然实验。我们将实证估计这些健康+财务激励计划的倾向及其财务激励的结构，以影响健康风险评估、预防服务利用和健康促进行为的比率。我们建议进行一项为期多年的研究，观察参与者在接受新的健康+经济激励计划之前和之后的情况，以及提供标准健康计划的参与者。通过这种独特的准实验设计，我们的研究可以指导财政激励设计，以加强健康计划，改善健康促进和预防活动。最近的医疗改革法(患者保护和平价医疗法案)明确促进健康计划的健康方案。这项研究可以告诉我们，在促进预防保健方面，提供有健康行动金钱奖励的健康计划是否比没有提供的健康计划更成功。此外，它还可以告诉人们如何构建健康计划的激励机制，以鼓励更多的人参与。

DESCRIPTION (provided by applicant): There is growing belief among employers and health plans that wellness programs represent an important tool to increase access to preventive services and promote healthy behavior. Of particular interest is how financial incentives can be incorporated into these programs to further encourage health promotion and prevention. We propose to study the effects of financial incentives to promote preventive care and wellness by examining recent programs offered by large firms that provide insurance coverage through the same large health insurer. This quasi-experiment affords the opportunity to study wellness programs in the context of actual firm offerings rather than in controlled laboratory environments with limited external validity. Early wellness programs offered by the health insurer included health risk assessments in combination with wellness coaching programs and disease management programs ("standard wellness"). Subsequently, the health insurer introduced wellness programs that combine the standard wellness offerings with on-site biometric screening and financial incentives that are explicitly tied to actions taken on the part of enrolles to improve health ("wellness+financial incentive"). Across firms there is natural variation in the size and type of these financial incentives. Our study will take advantage of the natural experiment provided by the insurer's introduction of the wellness+financial incentive program. We will empirically estimate the propensity of these wellness+financial incentive programs, as well as the structure of their financial incentives, to affect rates of health risk assessment, preventive services utilization, and health-promoting behaviors. We propose a multi-year study where we observe enrollees before and after they are offered the new wellness+financial incentive programs, as well as enrollees who are offered standard wellness programs. Through this unique quasi-experimental design our research can guide financial incentives design to enhance wellness programs and improve health promotion and prevention activities. The recent health care reform law (the Patient Protection and Affordable Care Act) explicitly promotes health plan wellness programs. This study can inform whether wellness programs offered with monetary rewards for health actions yield greater success in promoting preventive care than those offered without. Further, it can inform how to structure incentives for wellness programs to encourage greater participation.