Health risk influence on medical care costs and utilization among 2,898 municipal employees.

INTRODUCTION: Although worksite health promotion programs are credited with stabilizing medical benefits costs, research is needed to characterize the medical costs of cohorts with selected health risk factors. The purpose of this study was to compare medical cost outcomes in City of Birmingham, Alabama, employees who differ on selected health risk factors. METHODS: Health risk appraisal and medical claims cost data were examined in 2,898 employees participating in health screening during 1992 and 1993. Probit analysis was employed to test the null hypotheses that there are no differences in (1) probability of medical service utilization and (2) probability of medical service cost quartile (high, moderate, and low) between groups characterized by risks. Age, gender, race, education, marital status, and diabetes were included as covariates in each model examined. In addition, smoking habits was included as a covariate in models involving risk taking behavior and psychosocial risk. RESULTS: Significant differences in medical care utilization and costs were found between risk groups based on psychosocial risk, cardiovascular disease risk, and total risk. No association was found between risk-taking behavior and utilization and costs. CONCLUSION: Subjects reporting psychosocial, cardiovascular disease, and total risk factors were more likely to use medical services and to be in the high or high/moderate cost categories.

Personal health-risk predictors of occupational injury among 3415 municipal employees.

Little information exists about the effectiveness of health-promotion programs in reducing occupational injury rates. A historical cohort study was conducted to examine the relationship between personal health-risk factors and risk of occupational injury. Workers were grouped on the basis of nonoccupational risk-taking behaviors, psychosocial risks, cardiovascular risk factors, and a total risk-factor variable. All analyses were controlled for sex, smoking status, age, and job classification. An increased risk of occupational injury (P < .0001) was found to be significantly associated with nonoccupational risk-taking behavior. This association may be the result of continued risk-taking behavior in the occupational environment, or assignment of risk-taking individuals to more hazardous job tasks. Psychosocial, cardiovascular, and total risk-factor variables were not associated with an increased risk of occupational injury.

The impact of a comprehensive medical benefit cost management program for the city of Birmingham: results at five years.

Double digit annual increases in the cost of medical benefits represent one of the major financial challenges for many private and public sector employers. Gaining greater control is a top priority. Since the procurement, administration, and delivery of employee/dependent medical care is a highly complex venture, it is unlikely that any one activity will contain costs effectively. This report examines a comprehensive cost management effort for the municipal government of the city of Birmingham, Alabama, which included health promotion, medical plan redesigning, managed care, and "how to use the medical system" education programs. The $3 million project was funded by the National Institutes of Health and the employer and conducted from 1985 to 1990. In 1985, medical benefits expenses for the 3,586 employees were $2,047 per employee which was about $400 above the state of Alabama per employee average. In 1990, for 4,000 employees, it was $2,075 which was $922 below the state average. While the project design does not permit a precise evaluation of the exact impact of each of the cost containment activities, attempts are made to estimate their impact. Several health promotion activities, which may be unique to this project, including the all-employee medical screen, are presented and evaluated.

Promoting physical activity in low-income African-American communities: the PARR project.

Data suggest that low-income and minority individuals are less physically active than the general population. We conducted a constituency-based physical activity promotion program, the Physical Activity for Risk Reduction (PARR) project, from 1988 to 1991, with residents of rental communities administered by the Housing Authority of the Birmingham District in Birmingham, Alabama. Data collected through focus groups and by survey of randomly selected residents' exercise practices, beliefs, barriers to and facilitators of physical activity were used to develop specific intervention programs that were implemented and evaluated in six intervention and two control communities through surveys and process evaluations. Trained community residents conducted data collection and interventions. Ninety-nine percent of respondents in the baseline survey were African Americans. Thirty-one percent reported no participation in any of 13 physical activities in the previous year. Significant differences (P < .05) in average attendance by community at group exercise sessions indicated substantial variability in effectiveness of the intervention, due at least in part to factors related to both the communities and the leaders. This variability appeared to explain patterns of change in preintervention and postintervention physical activity scores in intervention communities. Data and experiences from PARR will be applicable to the delivery of similar types of health-related programs in undeserved communities.

Cost-effectiveness of a back school intervention for municipal employees.

This study investigated the effect of a back school rehabilitation program on lost work time, lost time cost, medical cost, and number of injuries in municipal employees. Seventy back-injured workers who participated in a 6-week back school were compared on the dependent variables with 70 randomly selected back-injured city employees who had not participated in a back school. Back school participants demonstrated a significant decrease on all dependent variables. Back school participants had significantly fewer injuries in the 6-month postintervention period. No statistically significant differences were found between groups on the time and cost variables. Actual dollars saved in lost time and medical costs between groups was of practical value to the city. Study findings offer support for the back school as a cost-effective measure.

Effects of back school education and exercise in back injured municipal workers.

Low back injury is the leading cause of compensable injury. A National Health Objective for the year 2000 is to increase to at least 50% the number of worksites offering back injury protection programs. The 6 week Back School intervention included exercise and education. A portion of the sample of 74 back injured municipal employees also was assigned randomly to a counseling intervention. Pre-intervention and post-intervention testing revealed significant posttest increases in back strength and flexibility. Significant improvements also were noted in psychological well being, depression, anxiety, and perceptions of pain. No significant differences were found, on any of the measures, between employees who did and who did not receive the counseling intervention. Methodological concerns relate to the possibility of sampling bias and instrumentation. Future research with control groups is needed, as well as the testing of interventions that may be both effective and require less work release time.

A flexibility intervention to reduce the incidence and severity of joint injuries among municipal firefighters.

The present study of 469 municipal firefighters examined the effect of flexibility training on the incidence and severity of joint injuries. Both flexibility measures and costs (lost time and medical care costs) were investigated in this study. Significant differences were found in flexibility scores of the experimental and control subjects with overall flexibility increased in the experimental group. Although incidence of injury was not significantly different for the experimental and control groups, injuries sustained by the experimental group resulted in significantly less lost time costs. Findings indicate that the flexibility training program had a beneficial effect on reducing the severity and costs of joint injuries in this firefighter population.