Case studies

To give you an overview of some of the issues addressed by our health at work services, we have compiled a number of case studies.

We will periodically be adding to this case study file. If you are interested in these case studies, please contact us.

BUPA Wellness case studies

Hewlett-Packard sign up to BUPA Absence Management service
Managing long term sickness payments
Managing the cost of ill health retirement
Managing sickness absence
Reducing the cost of lost time away from work to see the doctor, dentist or physiotherapist
The impact of early retirement on your pension fund
Identifying employee health risks and improving wellbeing
Stress audit makes a difference
Taylor Woodrow awards BUPA Wellness for cutting absence
BUPA Positive Health
Some leave it too late… a BUPA health assessment case study

BUPA Wellness employee assistance programmes case studies

Harassment and bullying in the workplace
Anger management
Bereavement
Financial pressures
Personal and work life: an integrated approach

Case studies from around the world

Occupational influenza vaccination programmes are worthwhile in UK
Health promotion and fitness programmes reduce healthcare costs
Worksite health promotion programmes reduce disability-related absence
Employees' risk profiles improved by large-scale health and wellness programme
Health and wellness programme delivers substantial health and economic benefits
Worksite healthy lifestyle incentive programme modifies health risks
Comprehensive worksite health promotion programme reduces health risks

Health & Safety Executive case studies

http://www.hse.gov.uk/businessbenefits/casestudy.htm

Hewlett-Packard sign up to BUPA Absence Management service

Background
BUPA enjoys a partnership with Hewlett-Packard (HP) which began almost 10 years ago with Compaq. BUPA provides an integrated health care package to HP comprising onsite occupational health services, medical cover, health screening (through the flexible benefits scheme), an employee assistance programme and supportive training. BUPA Wellness staff are seconded to HP Occupational Health to work full-time on the project.

While Compaq had an absence management system in place when the companies merged, it was restricted to its Scottish base. When Compaq merged with HP in 2002, the company decided to extend the system across all its sites. The challenge for BUPA Wellness was to extend and adapt the system to fit with the new organisation.

The motivation for the extended scheme was to create a uniform absence management system for all staff. BUPA Wellness identified that a system allowing accurate measurement and comparison of absence data could be used to improve employee health and well-being together with business productivity.

The challenge
The aim was to have an HP UK-wide sickness and long-term absence policy, taking into account best practice and relevant benchmarking. A working group was set up comprising HR advisers and Occupational Health. Managers were involved in the later stages of this to ensure buy-in across the organisation and a smooth rollout; in essence, to check the system would work. Behind the policy there was substantial manager's training, presentations and question and answer feedback. The aim was to have a policy that could be easily managed and through which all employees could be fully supported during periods of ill health. The new policy, which applies to all permanent and temporary employees of HP, also sets out procedures for reporting and recording absence.

HP had no standardised absence recording system and no real means of tracking any underlying absence trends. BUPA Wellness has a bespoke absence recording and management system which allows Occupational Health to record then track all absence and report back detailed management information on activity, patterns and trends, and assists Occupational Health advisers to case manage where appropriate.

How it works
When someone contacts their manager to advise they are sick, the manager advises Occupational Health who record the absence. Occupational Health will contact the employee on day eight of the absence, at which point a doctor's note is required and when case management kicks in. Alternatively, an employee can be contacted earlier if their manager requests it, or if the reason given is musculoskeletal or psychological. In the latter two cases Occupational Health are able to fast-track employees to appropriate care. When the employee returns to work, managers are further able to support them via return to work interviews. The policy is well timelined so everyone knows what is expected of them and when it has to be done.

Looking forward
It's early days, the new policy has just been in place for just three months, but already HP is beginning to see that managers and employees are buying in and want to work together to help reduce absence and improve health.

Recognising that improvements are always there for the making, the next stage of the programme is already underway. Managers are reporting employee absence in order to provide, at the end of the year, a full metric picture of absence. HP will be able to track levels of absence by condition, location and by manager to identify trends. From this information BUPA can further develop and tailor practices to support HP in improving employee wellbeing.

Managing long term sickness payments

We were recently asked by a major financial services company to assess the health status of the employees currently claiming benefit from their group income replacement scheme. The results came as a great surprise to the company and have led to valuable savings.

A BUPA occupational health physician reviewed each case to identify if:

• they were still suffering from the same illness or disability
• their rehabilitation was progressing
• their condition had worsened
• they could return to work and, if so, in what capacity
• they had started working elsewhere
• they should still be on the income replacement scheme
• they could be considered for ill health retirement
• they did want to return to work

Of the 16 cases we reviewed, we found that three had reached retirement age, one had died, one had already returned to work, two could return to work in a different capacity. (The Disability and Discrimination Act 1995 dictates that a firm has a statutory duty to consider reasonable adaptations to allow return to work.) One other warranted further investigation. For the rest, we recommended that there was no opportunity for rehabilitation and return to work, because of the severity of their condition.

The costs to the company or your insurer can be substantial when you consider that a beneficiary receiving £30,000 per annum with 20 years to normal retirement age will incur future costs of £600,000.

If you have an income replacement scheme or self-fund long term sickness payments, we'd be pleased to discuss an independent review with you. It could generate some welcome savings in your insurance premiums or salary costs.

Managing the cost of ill health retirement

BUPA Wellness has been providing an independent review of ill health retirement cases for major pension funds since 1996. Our services are tailored to the needs of the each scheme and we can provide initial assessment, advice to a Trustee Board and appeals assessment.

In one particular scheme, where we have been involved since 1998, cases are referred to our qualified occupational health physicians for consideration of eligibility for extra payments.

We gain an in-depth view of the condition and the person's capability. We then report against the scheme rules. Under the previous scheme, before we were involved, the vast majority of cases were deemed eligible for extra payment. In the first four years of our involvement, we reviewed 273 cases and with our intervention only 27.5% were eligible.

We have estimated that in total this resulted in a net saving to the pension scheme of £1.63m. We'd be pleased to discuss a referral arrangement with you for independent review of your ill health retirement applicants or regular advice to your scheme. It could take some of the pressure off your pension fund.

Managing sickness absence

BUPA Wellness was invited by a train operating company in 2002 to help them manage their backlog of long term sickness cases.

Our occupational health nurse co-ordinator attended their sites one or two days a week and initially reviewed 53 cases. All these people were seen, some at their homes.

Within the first three months, 21 people returned to work and three were redeployed. In the next eight months, 16 returned to work, three were put on restricted duties and 10 became severance cases.

With cost in mind, occupational physician involvement was kept to a minimum and focused predominantly on the ill health severance and retirement claims.

Following on from this success, weekly meetings are now held with HR to discuss all absence cases and managers have been made more aware of the help we can provide. All sickness absence cases are automatically referred to us after three weeks for review and support.

Preventive measures have also been put in place, like workstation assessments using a self-completion questionnaire.

As a result, the overall rate of sickness absence for the company has fallen from 9.7 percent to 5 percent, delighting the client and benefiting the employees who have been able to return to work sooner.

Reducing the cost of lost time away from work to see the doctor, dentist or physiotherapist

BUPA Wellness provides on-site medical services for a number of organisations in many different industries to help them reduce the amount of time their employees spend off work to see a doctor, dentist or physiotherapist.

We collected lost time savings data relating to the services provided by our primary care team, our physiotherapy and osteopathy team, and our dental team for a leading financial services company for the period June 2002 to end July 2003.

During the 14 month period there were 4,384 GP consultations, 3,787 physiotherapy and osteopathy consultations, and 2,376 dental consultations. These were private consultations paid for by the employee, meaning no cost to the company apart from providing the space.

We estimate that employees would normally have taken an average of three hours away from the office to see these practitioners. With our on-site services, they were only away from work for an average of 30 minutes, one hour and one hour respectively.

The lost time would have been 31,641 hours for employees to visit these practitioners if the services were not available on-site.

The total lost time saved as a result of the on-site services was 23,286 hours. At a conservative average salary of £25 per hour, we can therefore estimate a saving to the company of £582,150.

This does, of course, assume that all the employees would have taken time off had the service not been available on-site. There is, however, no doubt that early intervention reduces the chances of a condition becoming more complex and more expensive to treat, leading to savings in long-term absence.

As the firm did not record sickness absence data for this period, we have regrettably not been able to add this valuable information to the mix. This evidence has, however, persuaded a number of companies including the one above to implement a sickness absence data recording system. This will enable us to identify and target the causes of absence and have a further impact on decreasing the cost to the firm.

The impact of early retirement on your pension fund

Organisations need to ensure that ill health retirement pensions are given to deserving cases, whilst protecting a vulnerable scheme from inappropriate claims.

Our occupational health team recently advised the pension scheme trustees of a UK business-to-business service provider who were concerned about the number of staff applying for early pensions because of their health. We helped by:

• establishing clinical and medical early eligibility criteria
• defining circumstances when individuals could return to work
• reviewing individual claims for early ill health retirement

A BUPA Wellness occupational health physician reviewed a paper-based assessment for each claimant and where necessary contacted their GP or specialist consultant for further information and/or interviewed the individual.

The occupational health physician then reported back to the pensions trust with medical information to enable the organisation to determine an individual's eligibility for ill health benefits.

Since the introduction of the occupational health intervention, the client has said they are now experiencing a 50 percent reduction in applications for ill-health retirement.

Identifying employee health risks and improving wellbeing

A large government regulatory body employing over 500 people in one location asked BUPA Wellness to conduct a health audit of their staff. Each employee completed our Health Profile Questionnaire. We then reviewed each one, identified their personal health risks and provided advice to each individual on how they could better manage their health.

A cumulative report was produced from all the questionnaire results, profiling the health of the entire workforce. Presented to their occupational health team, this helped the organisation identify health issues that were reducing the effectiveness of the workforce, so that a programme of targeted activities could be put in place.

Since the first report, we have run a series of quarterly health promotion and education programmes with recent topics being smoking cessation, food for health, and alcohol and health.

To deal with health issues identified in the staff's health profiles, we provided a series of health tests including blood pressure, body mass index and testicular and breast examination.

The organisation informed us that this is having a major impact on their overall wellbeing and asked us to carry out health audits on a regular basis.

Stress audit makes a difference

We devised a questionnaire for the employees of a large media sector company in 2002 to assess their levels of stress, so that appropriate recommendations could be made and a stress management policy put in place.

Following this audit, BUPA Psychological Services pin-pointed several areas which were causing significant amounts of pressure for certain employees. This pressure resulted in increased symptoms of stress and in some cases increased sickness absence.

We made recommendations to the company on how the pressures could be alleviated. Although the recommendations required changes for managers and staff in their methods of communication, and in prioritising their time more effectively, none of the recommendations involved costly expenditure. The recommendations included encouraging managers to find more time to communicate with their staff, providing staff with more flexible working conditions where it was possible, and training in how to give positive feedback.

Changes were implemented and a repeat survey was carried out in 2004. Findings from the follow-up survey revealed:

• a 50 percent reduction in the number of employees reporting that they worked long hours
• a 23 percent reduction in the number of employees feeling strained or fatigued
• a 36 percent reduction in the number of employees experiencing pressure caused by managers

The company also experienced a considerable reduction in short-term sickness absence.

Taylor Woodrow awards BUPA Wellness with the "Supplier of the Year" award for cutting absence

Leading home builder Taylor Woodrow has cut employee absence to less than half the construction industry average. The strength of the partnership was demonstrated at the recent Taylor Woodrow Supplier Awards where BUPA was awarded Best Performer in the Corporate Business Services Outsourced Service Provider category.

As part of a contract to look after the health of Taylor Woodrow's 4,500 building site and office staff in the UK, BUPA Wellness provides a comprehensive service for employees and managers. Staff have access to advice on work-related and personal issues and counselling, while managers can call on the occupational health team to assist employees in returning to work after an illness or injury. BUPA Wellness also carries out a pre-employment assessment to check that they are fit for the type of work they will be carrying out.

Since BUPA began working with Taylor Woodrow in 2003, the average number of days employees take off due to sickness has dropped from 3.2 days to 2.8 days a year. This compares to an average of 6.6 days lost through absence per person per year in the construction industry.

Occupational health services are co-ordinated by a team of four from BUPA Wellness, based at Taylor Woodrow's offices in Solihull. The team works with the company's safety department to ensure precautions are taken to safeguard employees.

Although the company has an industry-leading precautionary health and safety process, annual health surveillance is carried out to look for early signs of any potential problems caused by workplace hazards. These could include lung and skin conditions caused by exposure to dust and chemicals, hearing difficulties among those who work in a noisy environment and pain in the hands and arms resulting from use of vibrating tools such as pneumatic drills.

Taylor Woodrow director of human resources, Alec Luhaste, said: "As new employees join the company, BUPA Wellness has performed an important role in ensuring the suitability of our workforce.

"After joining us, employees receive a range of personal support from BUPA which makes a significant contribution to the smooth running of the company and is seen by our people as a valued benefit. In the two years since we began working with BUPA, we have seen a real improvement, particularly in the area of sickness leave."

This service is provided for staff nationwide by Wellness' national network of advisers.

BUPA occupational health manager, Amanda Brown, said: "Our aim is to prevent sickness and injury rather than reacting to problems after they occur."

"For example, we can assess an individual's capabilities to perform the duties that a job entails and advise whether any reasonable adjustments are required to help them carry out their full range of responsibilities."

BUPA Positive Health

Employers are increasingly recognising that health and wellbeing are intrinsically linked with corporate performance.

In fact a survey by the Institute of Health and Productivity Management and Vielife found that people with "good" health status are 20 percent more productive than those with "poor" health status. And 30 percent of a workforce could be suffering from lifestyle issues, eg overweight, poor diet, unfit, sleep problems, stress.

Our new online or paper-based employee health and wellbeing survey, BUPA Positive Health, delivers two benefits at low cost. It provides a benchmark for the business on the health and wellbeing of the workforce with recommendations on the issues that need to be addressed. And it provides a personal report for each individual, with lifestyle advice on how to minimise their health risks for the future. Employees have 12 months' access to the programme with regular advice on how to deal with their particular lifestyle issues.

The survey found that the programme delivered the following benefits:

For the business

• productivity up 8%
• absence reduced by 9%
• staff turnover reduced by 15%
• medical claims costs down 30%

For the employees

• overall health status improved by 12%
• nutrition improved 29%
• body mass index improved by 5%
• eating five or more fruit and veg a day improved by 125%
• stress reduced by 14%
• smoking reduced 9%
• excess alcohol consumption reduced 52%
• sleep problems reduced by 72%

Some leave it too late…a BUPA health assessment case study

A civil engineering firm concerned about improving the health of the workforce, set up an account with BUPA Wellness in 2004 to provide regular health assessments for their staff. 116 employees had BUPA Classic Health Assessments for the first time that year. They were each provided with individual health reports and action plans.

BUPA Wellness provided the company with an anonymous report on the overall health of the workforce, so that appropriate action could be taken to address the issues and reduce the health risks for the future.

The company was amazed at the findings:

• 2 early cancers
• 3 new diabetics
• 44 high blood pressure
• 9 abnormal ECG
• 61 high cholesterol
• 36 overweight
• 16 musculo-skeletal issues
• 15 to reduce alcohol consumption
• 44 diet/exercise issues
• 58 referred to GP
• 44 referred to occupational health professionals

The company confirmed the value of the programme and the significant advantages of early detection to help reduce sickness absence, and reduce the impact of ill health on business performance.

Harassment and bullying in the workplace

BUPA Employee Assistance deals with both personal and work-related issues. There are times when individuals experience problems at work, but they do not feel that they can seek help. This often means that the problem escalates and spills over into their personal life. One such call came from an employee who was being bullied by her manager. The situation resulted in problems sleeping, a lack of concentration, tearfulness and a tendency to shy away from her responsibilities at work. Because the employee had not felt able to seek support and guidance early for fear of being bullied more, the symptoms continued to the point where she was signed off work because of her health.

Whilst away from the work environment (where the bullying was taking place) the caller had time to gain a sense of perspective about the situation and build up enough confidence to telephone the BUPA Employee Assistance helpline. The helpline is confidential, independent and impartial.

The caller first spoke to one of our telephone counsellors who conducted a primary assessment. The need for face-to-face counselling was recognised and offered to the client. During these face-to-face sessions, the counsellor provided a debrief of the bullying incidents the individual had experienced. The counsellor encouraged and installed enough confidence in the individual to contact the HR department within her company.

Whilst still attending counselling sessions, the HR department arranged a meeting between the manager, another colleague and the individual. Prior to the meeting the counsellor and the client performed "role plays" simulating what was likely to happen in the meeting. When the client felt able to cope with the meeting she met with the manager and a mutual colleague. Support from the counsellor was provided after this meeting through debriefing. After addressing the issues with the HR representative, the manager and the counsellor, the individual felt able to return to work one month after the call was originally made to the BUPA Employee Assistance helpline. The counsellor supported the individual through this transition back to work.

A follow up with the counsellor once the course of sessions had been completed highlighted the benefits the BUPA Employee Assistance programme had for this individual. The involvement of the HR department meant the situation could be monitored and if further interventions were required these could be implemented.

Anger management

It is often the case callers telephone the BUPA Employee Assistance helpline believing they have a problem with one thing but as they tell their story to one of our qualified counsellors it becomes apparent that there are other issues involved. Often by addressing one of these issues the other problems can be alleviated.

We had a male caller contact the BUPA Employee Assistance helpline. He stated that he was experiencing stress at work. He had had stress management training and was aware of what the symptoms were. He was experiencing a few of these: tension headaches, back ache and at times lack of concentration. He noticed he had become tense and he was finding it more and more difficult to control his temper both at work and at home.

The telephone counsellor recognised that workplace stress was potentially just a symptom of a more deep-seated issue. She believed that by helping the caller manage his anger, much of the stress he believed he was experiencing would disappear. The telephone counsellor recommended the caller visit a face-to-face counsellor. He agreed and the details of the caller's situation were passed on to a counsellor who specialised in anger management.

The first session was arranged between the client and the counsellor he had been referred to. The BUPA counsellor employed solution-focused counselling to identify some helpful coping mechanisms to help the client avoid losing his temper. These strategies were at times as simple as walking away from the situation or counting to 10, but the client used them very effectively. Another one of the sessions concentrated on identifying particular situations, both in the workplace and at home, which had triggered the client's temper in the past. By identifying these situations the client was able to predict when these might occur and therefore either avoid them or mentally prepare himself for them.

By employing solution-focused counselling the benefits are visible rapidly. This type of counselling allowed this individual to identify areas of his life where the probability of getting angry was elevated. He could also take away practical strategies which equipped him to cope with this issue if it arose in the future.

Bereavement

Sometimes it is appropriate to refer a caller to face-to-face counselling immediately after the initial assessment by our qualified telephone counsellors has been completed. One such example, was when a caller telephoned the helpline because her partner, aged 38, had died unexpectedly. She was having trouble coming to terms with his death and coping on her own with her two year old son. Every time she looked at her son she was reminded of her husband and was finding the situation more and more difficult to deal with. She had a good support network that had encouraged her to seek professional help.

The initial assessment conducted by the counsellor who answered the call highlighted the need for face-to-face counselling. A bereavement counsellor was found near the caller's home and an appointment was made for a time when her mother was able to look after her son.

The bereaved individual attended a number of counselling sessions with the face-to-face counsellor. The counsellor encouraged her to speak about her partner and the consequences his death was having for her and her son. It became apparent that the woman was feeling really angry that her partner had left her and her son to face life without him. She perceived it to be wrong to feel angry and felt that she didn't want to communicate this emotion to her support network for fear of being judged. The counsellor assured the women this was a normal part of the grieving process. By normalising such emotions as anger, guilt, shock and denial the women was able to embrace the grieving process instead of controlling it.

The counsellor was available to discuss the emotions that arose during the funeral, and was able to advise her on the best way to tackle her partner's death with her son. The sessions provided by the BUPA Employee Assistance allowed this individual to adjust to, and continue, the grieving process that all individuals encounter when losing somebody close to them.

In such instances, there may be a requirement for support further down the line. BUPA Employee Assistance is at the end of the telephone 24 hours a day, 365 days a year to help in the future. All the details of this case are available to our counsellors, which would save the individual the distress of repeating her circumstances should she need further support. Also, if it is needed we can put individuals in contact with charitable organisations who can provide support and advice during the bereavement process.

Financial pressures

Our counsellors often receive calls from individuals who are worried about their financial affairs. One instance was a call from a gentleman who not only had the day-to-day financial obligations of looking after a family, he was also responsible for paying off both his own and his wife's debt.

Our qualified debt counsellor encouraged him to look at his spending patterns. She talked him through possible options for increasing income, minimising expenditure and contacting creditors.

As the conversation unfolded our trained debt counsellor identified other issues that were having a negative impact on his life and therefore needed addressing. One large source of stress for him stemmed from his wife being an alcoholic. He was reluctant to seek any support, particularly from his family, because he didn't want others to judge his wife. This had a tremendous impact on his home life but was also spilling over into his worklife.

After the counsellor had conducted her assessment, a debt pack designed by our team of financial advisers and our debt counsellors was sent to the client. This provided written advice about debt management and letter templates to use to notify creditors of his situation. This pack is designed to provide clarification of the verbal advice given by our counsellors over the telephone. Additionally, face-to-face counselling was offered to both him and his wife. He accepted the counselling and attended several solution-focused counselling sessions. He also approached his wife about the services available and she attended separate sessions to address her alcohol problems.

The gentleman called back to thank and update the counsellor who had originally taken this call. The caller's financial issues were being remedied because, not only were the underlying issues being addressed, but a repayment plan had been agreed with the creditors which eased the financial pressure the caller was experiencing. His wife had returned to part-time work that had increased the family's income. Her alcohol consumption had also lowered considerably which meant their expenditure had also dropped. The wife had been referred on to a counsellor provided through a charitable organisation for longer-term treatment after the face-to-face sessions provided by her husband's company, as part of BUPA Employee Assistance, had been completed.

Personal and work life: an integrated approach

A male caller in his twenties telephoned the BUPA Employee Assistance helpline wanting advice and guidance on his relationship with his girlfriend. As the conversation unravelled it became apparent that this is not the only concern affecting his life. Most problems do not occur in isolation, they are usually tightly intertwined with other aspects in one's life.

After spending some time on the telephone to one of our qualified counsellors the caller's situation became clear. The caller was having problems communicating with his girlfriend. She was being pushed away because he was unsure what he wanted and was therefore contemplating finishing the relationship. The caller's parents had broken up and each parent was treating him as a go-between. He felt trapped in the middle of his mother and father, and felt like his feelings about the situation did not matter to either of them. This meant he had stopped being assertive and had stopped trying to express his feelings, not only to his parents, but also to his girlfriend and at work.

Other problems at work revealed themselves in his second call to the telephone counsellor. It was evident he also felt trapped within his job. He felt insignificant and generally discouraged. The counsellor and the caller discussed the different options of how he could remedy the situation at work. The caller identified a plan that would provide him with more responsibility but would also free up some of his manager's time. Our qualified counsellor encouraged him to communicate these ideas to his manager.

During the third telephone call, the caller stated that his manager had welcomed the change. By having the confidence to voice his opinions at work, and gain a positive outcome from doing so, a knock-on effect was seen in other areas of his life. He was able to express to his girlfriend what he wanted from their relationship and was also able to stand up to his parents. This third telephone call gave the telephone counsellor dealing with the case enough information to close the case. The caller had been lifted from his state of despair. He had gained sound advice, support and guidance from a qualified professional, which had significantly improved the quality of both his personal and work life.

Occupational influenza vaccination programmes are worthwhile in UK

A decision tree model was constructed using published sources to consider the economic impact of an occupational influenza vaccination programme in the UK (using InfluvacÒ). Costs and benefits for a business employing 1,000 adults earning the national average UK wage were identified from the employer's perspective. The model assumed that 95 percent of employees would be absent from work after contracting influenza for a mean of five days and that productivity would be reduced by 60 percent for one day by 85 percent of sick employees returning to work.

If the incidence of influenza in the community is 6 percent, the expected probability of an employee being absent from work is reduced from 5.7 percent to 1.8 percent (with 100 percent employee vaccination), with a reduction in absenteeism due to an influenza outbreak of 220 days per 1,000 employees. The expected return on every £1 invested by an employer would be £1.03, £3.09 and £5.15 (2000 values) with annual incidences of influenza in the community of 2 percent, 6 percent and 10 percent, respectively.

Source: Das Gupta R, Guest JF. A Model to Estimate the Cost Benefit of an Occupational Vaccination Programme for Influenza with InfluvacÒ in the UK. Pharmacoeconomics, 2002: 20(7); 475-84

Health promotion and fitness programmes reduce healthcare costs

A review of the published literature on the ability of health promotion programmes to reduce employee-related health care expenditures and absenteeism considered 72 papers. It attempted to answer two questions: 1) Do individuals or populations with high health risks have worse financial outcomes than individuals or populations with low health risks? and 2) Do health promotion programmes improve financial outcomes?

The data strongly suggest that high levels of stress, excessive body weight, and multiple risk factors are associated with increased health care costs and illness-related absenteeism. The associations between seat belt use, cholesterol, diet, hypertension, and alcohol abuse and absenteeism and health care expenditures are either mixed or unknown. Health promotion programmes are associated with lower levels of absenteeism, and health care costs and fitness programmes are associated with reduced health care costs. Ideally, programmes should be designed to reduce elevated health risks and help low risk employees retain this status.

Source: Aldana SG. Financial Impact of Health Promotion Programs: A Comprehensive Review of the Literature. American Journal of Health Promotion, 2001: 15(5); 296-320

Worksite health promotion programmes reduce disability-related absence

Previous studies have shown that the highest rates of non-fatal workplace injury and illness occur in the manufacturing industry and that absence days are higher among those with more health risks. A six-year study (1995 - 2000) in a manufacturing company considered the impact of health-promotion programme participation on short-term and long-term disability absence days for 4,189 active, hourly paid, male employees.

The percentage of non-participants absent on any given day due to disability was consistently greater than that of participants. Furthermore, the average number of disability absence days incurred by non-participants significantly increased from baseline to program year 5 compared with participants. Non-participants had an average increase of 1.2 disability absence days per year more than participants (an increase of 3.6 days per year compared with 2.4 days). Those with more health risks incurred higher total disability absence days. The total amount saved each year in disability absence days for the 2,596 programme participants was $623,040, resulting in a savings-to-cost ratio of 2.3 per year.

Source: Schultz AB, Lu C et al. Influence of Participation in a Worksite Health-Promotion Program on Disability Days. Journal of Occupational and Environmental Medicine, 2002: 44(8); 776-80

Employees' risk profiles improved by large-scale health and wellness programme

Johnson & Johnson restructured their work-based Health and Wellness Programme, increasing the emphasis on health promotion and disease prevention. The programme includes pre-, at- and post-event management activities and there are financial incentives to participate. This study reports on its effectiveness in reducing 13 health risks categories in 4,586 employees who participated in two serial screenings with a minimum of one year between screenings. It also examines the impact of participation on health risk factors by high-risk employees in an intervention programme called Pathways to Change.

There was significant risk reduction in eight of 13 risk categories examined for all employees who participated in 2 health risk assessments over an average of 2¾ years. When comparing Pathways to Change participants with non-participants, participants outperformed their non-participant counterparts in six of the 13 categories, but performed worse in five other categories that were not specifically targeted by the high-risk programme (no differences were found in two categories).

Source: Goetzel RZ, Ozminkowski RJ et al. The Long-Term Impact of Johnson & Johnson's Health and Wellness Programme on Employee Health Risks. Journal of Occupational and Environmental Medicine, 2002: 44(5); 417-24

Health and wellness programme delivers substantial health and economic benefits

Another study of the Johnson & Johnson Health & Wellness Programme considered its long-term impact on health care utilisation and expenditure. This comprehensive programme focuses on prevention, self-care, risk factor reduction, and disease management and there are financial incentives to participate. Data for employees' health care utilization and expenditure were analysed for up to five years before and four years after the new programme was implemented. Multiple regression models controlled for confounding variables.

Results indicated an average reduction in medical care expenditures of $224.66 per employee per year over the four-year programme period. These benefits came from reduced in-patient use ($119.67); fewer mental health visits ($70.69); and fewer out-patient and doctors' office visits ($45.17) compared with the baseline period. Savings were offset by a small increase in emergency department use ($10.87). Most benefits occurred in years 3 and 4 after the start of the programme.

Source: Ozminkowski RJ, Ling D et al. Long-Term Impact of Johnson & Johnson's Health and Wellness Programme on Health Care Utilization and Expenditures. Journal of Occupational and Environmental Medicine, 2002: 44(1); 21-9

Worksite healthy lifestyle incentive programme modifies health risks

A four-year study examined the impact of an incentive-based worksite health promotion programme (the Healthy Lifestyle Incentive Programme) on modifiable health risk factors among county-level government employees. The programme encouraged employees and their spouses to adopt or maintain healthy lifestyle behaviours. Participants attended an annual health screening and received financial rebates for good-health practices. Data were collected at baseline and then annually for 304 full-time employees who participated over the four years.

Significant improvements were seen in body fat; cholesterol; blood pressure; physical activity; smoking prevalence; systolic and diastolic blood pressure; seat belt use; and overall physical health amongst the higher-risk and lower-risk groups. Annual financial rebates averaged $102 (range: $75 - $300), increasing from 66% of participants during year 1 to 84% during year 4. Although participation in such schemes by higher risk employees can significantly reduce various modifiable health risks, it is also important to encourage lower risk employees to participate to try to maintain their low risk status.

Source: Poole K, Kumpfer K et al. The Impact of an Incentive-based Worksite Health Promotion Programme on Modifiable Health Risk Factors. American Journal of Health Promotion, 2001: 16(1); 21-6

Comprehensive worksite health promotion programme reduces health risks

A study of health risk changes among participants of a multi-component worksite health promotion programme (the LifeSteps Program) sponsored by the United Auto Workers and General Motors considered the programme's impact on 13 selected health risk factors. A baseline health risk assessment was undertaken of 12,984 active employees who volunteered in each of two programme years, and programme participation records were also studied. As well as the nationwide health promotion programme, a pilot programme including additional support for high-risk participants was implemented in two cities.

A greater decrease in the number of health risks was observed with increased programme participation. The decrease was significantly related to the number of baseline risk factors and eligibility for high-risk programmes. The number of participants at low risk status increased from 70.1 percent to 71.3 percent at year two among nationwide participants and from 52.4 percent to 58.9 percent among pilot participants.

Source: Yen L, Edington MP et al. Changes in Health Risks among the Participants in the United Auto Workers-General Motors LifeSteps Health Promotion Programme. American Journal of Health Promotion, 2001: 16(1); 7-15