Mike Greyling

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.

Data analysis for the behavioural sciences using SPSS, S.L. Weinberg and S.K. Abramowitz : book review

This text makes a useful contribution to the available literature on statistical data analysis for the behavioural sciences as well as providing an innovative approach to the presentation ofsuch material. The authors successfully integrate instructions for the practical use of SPSS into a thorough and detailed statistical text that fluidly allows the focus to shift away from the calculations proper, towards a rich understanding and interpretation of the annotated statistical procedures. The text is not strictly an instruction manual for SPSS, but it does provide the reader with some simple guidelines for the operation of the software. As such, a reader equipped with a basic understanding of SPSS operation, and who is simultaneously working through statistical theory, will be able to follow the instructions and produce the appropriate results. However, the descriptions are not sufficiently detailed to serve as an introduction to the SPSS package for a novice user of the package. The text begins at the level of an undergraduate course in statistics (for the behavioural sciences) and covers the univariate material typical of the content of most undergraduate psychology texts. It also has a comprehensive section on multiple regression. While the pitch and level of the content may be considered appropriate for undergraduate and postgraduate students, there may not be sufficient breadth for a typical honours level course. The text focuses on the interpretation and meaning of the procedures and results rather than the intrinsic processes ofcalculation. The text does, however, retain many ofthe mathematical explanations and formulae needed for such calculations. As such, an individual not well versed in mathematics may well find the explanations too detailed and mathematically-oriented. The authors attempt to provide an easy-to-read and yet comprehensive coverage ofeach method. The unfortunate consequence is that text is bulky and may possibly prove intimidating to the average student. A major strength of the text is its focus on practical issues in the application of statistical methods. Importantly, it highlights the assumptions underpinning each method, how to examine them in SPSS, and what to do in cases where the assumptions are violated. The authors also attempt to move beyond simply examining statistical significance by providing some detail on effect size measures and the processes required for the provision of an interpretation. The text makes constant use of illustrative examples along with the results as produced by the SPSS system. The reader is guided through the printouts and helped to understand how they should be read and interpreted. At times, this becomes a bitExtracted from text ... 322 Title: Data analysis for the behavioural sciences using SPSS. Authors: S. L. Weinberg and S. K. Abramowitz Year: 2002 Publisher: Cambridge University Press ISBN: 0 521 632080 (hardback, 752 pages) This text makes a useful contribution to the available literature on statistical data analysis for the behavioural sciences as well as providing an innovative approach to the presentation of such material. The authors successfully integrate instructions for the practical use of SPSS into a thorough and detailed statistical text that fluidly allows the focus to shift away from the calculations proper, towards a rich understanding and interpretation of ..