The financial impact of changes in personal health practices.

The impact of changes in health practices on medical claims costs between 1985-1987 and 1988-1990 was examined among 796 employees. Employees completed a health risk appraisal in 1985 and 1988 and were categorized into health risk levels. High-cost status and high-risk status were significantly associated at both times. The percentage of employees with high-risk status decreased from 31.8% to 25.3% between 1985 and 1988 (P < 0.01). Changes in average costs and the percentage with high-cost status followed the risk change. The largest increase in average costs occurred in employees who moved from low-risk to high-risk status. The greatest reduction in average costs occurred in employees who moved from high-risk to low-risk status. Median costs were not as sensitive to risk change. The findings provide strong evidence that improving individual health status is associated with financial benefits.

Corporate medical claim cost distributions and factors associated with high-cost status.

Medical claims cost distributions and factors that relate to these costs were studied among 7796 employees who selected an indemnity medical plan for at least one year during 1985 to 1990. Descriptions for medical claims costs were presented for both single- and multiple-year time periods. Factors that associated with high cost status were studied by using multiple logistic regression models. Employees at or above the top tenth cost percentile were accounted for approximately 80%, 65%, and 58% of the total employees' medical costs to the employer in single-year, 3-year, and 6-year periods, respectively. Bivariate analyses indicated tht six of the seven selected demographic variables were significantly related to cost status. When the multivariate models excluded health risk measures, four of the demographic variables and the frequency of health risk appraisal completion were significantly associated with cost status. When the multivariate models included health risk measures, the health risk measures became the dominant predictors of the high-cost status.

Prediction of prospective medical claims and absenteeism costs for 1284 hourly workers from a manufacturing company.

Multivariate regression models were developed to predict the employer's economic costs (medical claims payments and loss from employees' absenteeism) from selected health-related measures among 1284 hourly employees. Twelve health-related measures, mainly from a Health Risk Appraisal (HRA) completed in 1985, were selected as predictors. Regression models were developed according to the economic measures for the three subgroups (men under 35, men 35 or older, and women). All the regression models significantly predicted economic costs from selected health-related measures with a multiple R2 range of .23 to .13 (P less than .001).

Demographic characteristics of users of worksite health promotion written materials.

BACKGROUND: Despite a long history of work organizations supplying health-oriented written materials to employees, little was known about the underlying factors contributing to their use. Earlier findings suggested that demographics might play a role in this process. Therefore, this research attempted to define user profiles of four basic written materials commonly found in worksite programs: medical self-care guide, newsletter, health risk appraisal (HRA), and HRA individual report. METHODS: The results of a post-program questionnaire were collected from 10 work organizations using a commercial health promotion program (N = 5,167; 29.8%). After defining a user for each piece, chi-square and logistic regression determined proportional differences between users and nonusers by selected demographics. RESULTS: After controlling for variable interactions, the most likely user of the medical self-care guide was a non-white, lower educated female over age 40; the newsletter, a female over age 40; the HRA, a higher job rated female; and the HRA report, a female over age 40. DISCUSSION: Written materials may have a different use pattern than other program offerings, or different than what might have been suspected intuitively. Other than female gender, most demographic variables either offered insignificant or unexpected contributions to prediction models. These results suggest that written materials may have a wider appeal than previously recognized.

Comparing the predictive accuracy of health risk appraisal: the Centers for Disease Control versus Carter Center program.

BACKGROUND: From 1986 to 1987 the Carter Center of Emory University joined with the Centers for Disease Control (CDC) to develop a new, probability-based, adult health risk appraisal (HRA) instrument for the public domain. This new instrument is compared with the CDC HRA version to determine which is a more accurate predictor of mortality. METHODS: We compared predicted mortality risks from the CDC HRA and the Carter Center HRA with the observed mortality among 3135 smokers and never-smoking persons, aged 25 to 60, followed from 1959 to 1979 as part of the Tecumseh Community Health Study. RESULTS: When individuals were classified according to the difference between their actual age and risk age, for the CDC HRA, there was a progressively increasing risk of 10-year mortality as the difference increased. The Carter Center HRA did not show this trend. An analysis using relative operating characteristic curves showed that the mortality risk predictions for both programs were very similar for men and women. However, differences between actual age and risk age for the two programs were not similar for men or women, particularly older men. Therefore, actual age minus risk age for the CDC program was a more accurate predictor of 10-year mortality than was this difference for the Carter Center program. CONCLUSIONS: The results from both types of analyses suggest that the validity of risk ages obtained from the Carter Center version may not be sufficient to justify updating programs for those currently using the CDC instrument.

Associations between health risk appraisal scores and employee medical claims costs in a manufacturing company.

BACKGROUND: The bivariate relationships between 18 health-related measures on a health appraisal and prospective medical claims costs were examined among 1,838 employees for three consecutive years. METHODS: Employees were classified into high- or low-risk categories for each of the 18 health-related measures, and divided into high- or low-cost categories according to their averaged three-year medical costs respective to the mean of their sex/age subgroup. RESULTS: Average annual medical costs for the 18 health-related measures were $67 to $778 higher for the employees classified at high risk. The high-cost category was statistically associated with high-risk status in 11 of 18 health-related measures with a high-cost/high-risk to high-cost/low-risk ratio of 1.26 to 2.50. The average annual medical claims costs were also significantly related to number of high-risk classifications. DISCUSSION: This study provides strong statistical evidence that, regardless of age and sex, employees in this sample with positive behaviors cost less in medical claims from 11 of 18 health-related measures.