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by Donald B. Ardell, Ph. D.
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Wellness in the Headlines
(Don's Report to the World)

A REAL Wellness Approach To Worksite Health Promotion: Shift Responsibilities (and Opportunities) To Employees (Part One)

Friday September 7, 2007


Introduction
I have a worksite wellness-related idea. If implemented, it could lower employer health insurance costs and lead to advances in employee well-being.

These two advances, lower costs for companies and higher health status for employees, would render my idea prize-worthy, though perhaps not quite at the Nobel level. Why? Because the application of the idea is limited. It would NOT solve the biggest US health care system problems: The highest costs in the world, relatively poor health status outcomes (for example, 41st in life expectancy), uneven access, excessive utilization, waste, abusive practices (for example, overmedicated seniors) and the fact that nearly 50 million are uninsured and thus unprotected, unable to pay for sickness care. So, don't expect miracles from my worksite wellness-related idea. In fact, be rational and don't expect miracles, from anything. But, that's another topic for another day.

Moderate Your Expectations
Despite its limitations, my idea might still be worth considering, especially if interested in corporate benefits in general and worksite health insurance plans in particular. Of course, the idea will very much appeal to those involved in or affected by worksite health promotion or wellness.

Maybe later I can come up with an idea to mitigate the bigger problems, particularly quality care for all at affordable prices in a system that promotes and supports healthy lifestyles. Personally, I think universal health care has to be part of a broader reform plan in America. When that happens, partial changes, such as the one I am about to propose, will not be needed. I do favor universal care, or "socialized medicine," as champions of the survivalist private enterprise system tend to call it. I happen to think that universal care need not be an expensive boondoggle that appeals only to godless commies who would gut free and sacred enterprise and prevent patriotic citizens from freely choosing their own doctors -- and getting quick medical attention when and where they need it from whomever they choose to provide it.

The Need for My Idea
The need for a proposal that would lower company health insurance costs and boost employee health status is great. The Kaiser Family Foundation recently reported, "60% of businesses offered health benefits in 2005, down from 69% in 2000. Employer premiums for family coverage rose 81% since 2000 to $11,480 annually." (Source: Chad Terhune, "Employers Turn To Alternative For Insuring Staff," Wall Street Journal, July 30, 2007, Page A1.)

An idea that would lower employer health insurance costs AND better employee health status should be described at a level of depth at least as comprehensive as the Warren Commission Report on the Assassination of President John F. Kennedy, if not that of Winston Churchill's Memoirs of World Wars I and II. Alas, a couple pages will have to suffice for my company health insurance/worksite wellness idea, for now. Forgive, please, if a few implementation details are overlooked.

Better Than a New Paradigm
What I have in mind is a reform that can be instituted by any company at any time -- a shift in responsibility for employee health from employer to employees. With the shift would come a major change in the nature of worksite wellness from medical management and traditional health education to REAL wellness. REAL wellness has been described in previous essays. Essentially, it means individual practices and workplace cultures that address the nature and approaches to advancing positive mental and physical health status, as opposed to programming focused on medical testing, risk avoidance and illness management. In REAL wellness, the agenda is as much about philosophy, community, emotional well-being and effective decision-making as it is to health and fitness topics.

The embrace of accountability or personal responsibility is the "zeitgeist" of the wellness movement. It is a foundation element, or should be, of the mindset associated with the values of fitness, critical thinking, the quest for meaning and all the other skill sets associated with a wellness mindset or philosophy. Given the meaning of this German word, the idea of reforming company health insurance and health promotion is a fitting zeitgeist that "fits the spirit of our time." The costs of employer-subsidized medical care and poor worker health status constitute a crisis at the typical workplace. We need a new zeitgeist of expectations for health insurance as an employee benefit. Consider the origins of employer paid health insurance in the early 1940's, and compare the needs then with conditions today, more than half a century later. Such a review will make clear that the current zeitgeist entails a preoccupation with low payoff illnesses and diseases, not advanced states of physical and emotional aliveness. Let's do more FOR employees by asking more OF them. Let's give employees the opportunity to invest in their own well-being and to benefit from doing so -- even if a few might resist the privilege, at first.

The idea of shifting accountability would, in my view, lead to healthier employee lifestyles and attendant increases in both morale and productivity while lowering health care costs.

In the next essay, I'll describe the three main elements of the proposal, assumptions made and a few details of how this approach to worksite health insurance and health promotion would work. I'll also provide a commentary from an expert who has reservations about the idea, and my responses to his criticisms of the proposal. Meanwhile, stay well and look on the bright side of life.

Domain: purpose
Subdomain: applied wellness

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