Deepak Patel

Participation in Fitness-Related Activities of an Incentive-Based Health Promotion Program and Hospital Costs: A Retrospective Longitudinal Study

Purpose. A retrospective, longitudinal study examined changes in participation in fitness-related activities and hospital claims over 5 years amongst members of an incentivized health promotion program offered by a private health insurer. Design. A 3-year retrospective observational analysis measuring gym visits and participation in documented fitness-related activities, probability of hospital admission, and associated costs of admission. Setting. A South African private health plan, Discovery Health and the Vitality health promotion program. Participants. 304,054 adult members of the Discovery medical plan, 192,467 of whom registered for the health promotion program and 111,587 members who were not on the program. Intervention. Members were incentivised for fitness-related activities on the basis of the frequency of gym visits. Measures. Changes in electronically documented gym visits and registered participation in fitness-related activities over 3 years and measures of association between changes in participation (years 1—3) and subsequent probability and costs of hospital admission (years 4—5). Hospital admissions and associated costs are based on claims extracted from the health insurer database. Analysis. The probability of a claim modeled by using linear logistic regression and costs of claims examined by using general linear models. Propensity scores were estimated and included age, gender, registration for chronic disease benefits, plan type, and the presence of a claim during the transition period, and these were used as covariates in the final model. Results. There was a significant decrease in the prevalence of inactive members (76% to 68%) over 5 years. Members who remained highly active (years 1—3) had a lower probability (p < .05) of hospital admission in years 4 to 5 (20.7%) compared with those who remained inactive (22.2%). The odds of admission were 13% lower for two additional gym visits per week (odds ratio, .87; 95% confidence interval [CI], .801—.949). Conclusion. We observed an increase in fitness-related activities over time amongst members of this incentive-based health promotion program, which was associated with a lower probability of hospital admission and lower hospital costs in the subsequent 2 years. (Am J Health Promot 2011;25[5]:341-348.)

The Association Between Medical Costs and Participation in the Vitality Health Promotion Program Among 948,974 Members of a South African Health Insurance Company

Purpose. Examine the association between the levels of participation in an incentive-based health promotion program (Vitality) and inpatient medical claims among members of a major health insurer. Design. A 1-year, cross-sectional, correlational analyses of engagement with a health promotion program and hospital claims experience (admissions costs, days in hospital, and admission rate) of members of a national private health insurer. Setting. Adult members of South Africas largest national private health insurer, Discovery Health. Insured members were also eligible for voluntary membership in an insurance-linked incentivized health promotion program, Vitality. Subjects. The study sample included 948,974 adult members of the Discovery Health plan for the year 2006. Of these, 591,134 (62.3%) were also members of the Vitality health promotion program. Measures. The study sample was grouped based on registration and the level of engagement with the Vitality health promotion program into the following: not registered (37.5%), registered but not engaged with any health promotion activity (21.9%), low engagement (30.9%), and high engagement (9.5%). High engagement was defined a priori by the accumulation of an arbitrary number of points on the Vitality program, allocated against specific activities (knowledge, fitness-related activities, assessment and screening, and healthy choices). Hospital admission costs, the number of days in hospital, and hospital admission rates were compared among highly engaged members and those members who were not enrolled in the program, nonengaged, and lowly engaged. Data were normalized for age, gender, plan type, and chronic disease status. Results. Highly engaged members had lower costs per patient, shorter stays in hospital, and fewer admissions compared with other groups (p < .001). Low or no engagement was not associated with lower hospital costs. Admission rates were also 7.4% lower for cardiovascular disease, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases in the highly engaged group compared with any of the other groups (p < .01). Conclusions. Engagement in an incentive-based wellness program, offered by a health insurer, was associated with lower health care costs.

The relationship between leadership support, workplace health promotion and employee wellbeing in South Africa

Leadership support has been identified as an essential component of successful workplace health promotion (WHP) programs. However, there is little research in this area and even less theoretical conceptualization on ways in which leadership support for WHP is related to improved employee wellbeing. In this paper, we developed and tested a model of leadership support for WHP and employee wellbeing outcomes using employer and employee data gathered from 71 South African organizations. A theoretical model based on social exchange theory was developed. It was hypothesized that perceptions of company commitment to health promotion mediates the relationship between leadership support, the provision of WHP facilities and employee wellbeing. A hierarchical structural equation modeling technique was used to test the model. We determined that leaders support for WHP was important insofar as they also provided health promotion facilities to their employees. No direct relationship was found between leadership support alone and employee wellbeing.

The healthiest company index: A campaign to promote worksite wellness in South Africa

Objective: To describe a 2010 initiative to encourage companies in South Africa to adopt workplace health promotion programs. Methods: Data documenting organizational efforts to improve workers health were collected from 71 participating employers and 11,472 workers completing health assessments. Organizational and employee health were scored on the basis of responses to the surveys that asked about facilities and programs offered, leadership support for health promotion, and employees health status. Results: In its first year, the initiative recruited 101 organizations and 71 qualified for the award. Results aggregated across these companies focus on elements constituting organizational and individual health, with specific measures that companies can review to determine whether they and their employees are “healthy.” Conclusions: The Healthiest Company Index provided useful baseline data to support employers efforts to develop and implement effective and impactful health promotion programs.

The relationship between workplace environment and employee health behaviors in a South African workforce.

Objective: To determine the relationship between the availability of wellness facilities at worksites and self-reported employee health behaviors (physical activity [PA] and nutrition [NUT]). Methods: Employers (n = 71) and employees (n = 11472) participated in the South African Healthy Company Index survey. The survey included self-reported clinical measures and lifestyle behaviors. A facility score was calculated, ranging from 0 to 100. Hierarchical linear models were used to calculate the relationship between facility scores and whether employees met PA and NUT guidelines. Results: The mean total facility score was 58.5 ± 25.5. The number of facilities at each worksite accounted for 5.4% of the variance in PA among employees (r = 0.054; P = 0.036). Higher facility scores were associated with better NUT habits among employees. Conclusions: Employers providing wellness facilities are likely to have employees with better PA and NUT habits.

How do we measure up? A comparison of lifestyle-related health risk factors among sampled employees in South African and UK companies:

The need to address the growing prevalence of non-communicable diseases through changing the lifestyle behaviours that contribute to them has become a global priority. Settings-based health promotion strategies such as workplace health promotion programmes are growing in an attempt to start meeting this need. In order for settings-based health promotion programmes to be successful, they need to be based on the specific risk profiles of the population for whom they are designed. Workplace health promotion programmes are becoming popular in South Africa, but there are currently few data available about the health risks and lifestyle behaviours of the South African employed population. In order to obtain such data and reward workplace health promotion initiatives, Discovery Health initiated healthy company campaigns in South Africa and the UK. These campaigns took the form of a competition to assess the healthiest companies in each country. Through these campaigns, an extensive data set was collected encompassing UK and South African employees’ lifestyle behaviours and health risks. In this article, we used these data to compare self-reported physical activity levels, self-reported fruit and vegetable consumption, calculated BMI, self-reported smoking, mental health indicators, and health screening status of the UK and South African employee samples. We found significant differences across all measures, with the exception of self-reported fruit and vegetable consumption. The findings emphasise the importance of using local data to tailor workplace health promotion programmes for the population for which the programmes have been designed.