Involuntary wellness programs: the case of a large US company

Date07 April 2015
Publication Date07 April 2015
AuthorDavide Secchi,Hong T.M. Bui,Kathleen Gamroth
SubjectHR & organizational behaviour,Global HRM
Involuntary wellness programs:
the case of a large US company
Davide Secchi
Department of Language and Communication,
University of Southern Denmark, Slagelse, Denmark
Hong T.M. Bui
Business School, University of Southampton, Southampton, UK, and
Kathleen Gamroth
Department of Human Resources, Chart Industries, La Crosse,
Wisconsin, USA
Purpose The purpose of this paper is to investigate recent healthcare reform in the USA, which
allows insurance companies to proactively intervene in improving the long-term health of employees,
by providing wellness programs as part of their benefits package.
Design/methodology/approach The authors present and analyze data on how employees of a
large US Midwest media and educationcompany (n¼154) perceive economic incentives toward well-
being. Data are collected using survey methods and analyzed with a logistic regression.
Findings This study suggests that fairness, accessibility, intention to switch to a healthier lifestyle
and desire to see more health-related initiatives affect the way employees seek to participate in the
new involuntary wellness programs. By contrast, satisfaction, participation, and income to not affect
how these new programs are perceived.
Research limitations/implications These findings suggest that human resource managers
should pay attention to employees who are not active in existing wellness programs, and provide
support during the transition toward the new involuntary programs, to avoid potential frustration,
demotivation, disengagement and, ultimately, decreasing performance among employees.
Originality/value The study is among the first to analyze involuntary wellness programs in the
USA, and it provides a basis on which to expand further studies. This research contributes to support
the idea that employee wellness is unlikely to be enforced by rule or policy.
Keywords Well-Being at work, Health insurance, Organizational behaviour, Employee health,
Wellness programmes, Economic incentives, Healthy choices
Paper type Research paper
1. Introduction
Although well-being is a popular concern in human resource (HR) management, the
vast amount of literature shows more of an interest in psychological well-being
(Alfes et al., 2012; Ashleigh et al., 2012; Brunetto et al., 2013; Kooij et al., 2013) than
proactive interventions for improving employee long-term physical health. This is
usually accomplished by providing wellness programs (WPs) as part of the employee
benefits package. This is especially important now, when two in three Americans are
estimated to be overweight (World Health Organization, 2010). WPs can be defined as
opportunities that organizations offer to their employees to: help them develop
healthier lifestyles (Benavides and David, 2010), cut costs (DeSimone and Harris, 1998),
reduce absenteeism, increase job satisfaction (Parks and Steelman, 2008), improve
productivity and generate savings (Baicker et al., 2010), and increase retention
(Yamamoto, 2011). The most common type of WPs include weight-loss programs,
on-site exercise facilities, gym discounts, smoking cessation programs, courses on diets,
Evidence-based HRM: a Global
Forum for Empirical Scholarship
Vol. 3 No. 1, 2015
pp. 2-24
©Emerald Group Publishing Limited
DOI 10.1108/EBHRM-09-2013-0031
Received 19 September 2013
Revised 4 February 2014
Accepted 26 February 2014
The current issue and full text archive of this journal is available on Emerald Insight at:
web resources for a healthier lifestyle, personal health coaching, and wellness
newsletters and health fairs (Mills et al., 2007).
The introduction of WPs in the workplace appears to benefit both organizations
and employees. For example, Mills et al. (2007, p. 20) found that a well-implemented
multi-component health promotion program can not only improve the health status
of employees but also improve their work performance.The implementation of WPs
indicate that the employer cares about their employeeshealth and well-being, which
can consequently increase motivation (Van den Broek et al., 2010), reduce turnover an d
absenteeism (Soane et al., 2013), and improve job performance (Wright and Cropanzano,
2004). In addition, WPs can help individuals reduce their healthcare costs (Naydeck
et al., 2008). Employers are beginning to see that making employees aware of their
current health conditions, and providing tools to help them attain a healthier state can
yield significant reductions in sick leave and medical claims costs, and can ultimately
improve performance.
Person et al. (2010) identified barriers to WP participation, including insufficient
incentives, inconvenient locations, time limitations, little interest in the topics
presented, scheduling, marketing, health beliefs, and lack of interest in the program.
These findings should facilitate organizations to plan suitable WPs for their employees.
Berry et al. (2010, p. 5) recommend six key factors for an effective workplace WP:
(1) multi-level leadership from all levels of managers to create a culture of health;
(2) alignment with an extension of an organizations identity and aspirations for being
well; (3) scope,relevance,andquality to possess comprehensive and excellent WPs;
(4) accessibility to low- or no-cost services, to make it fair to all employees; (5) partnership
to proactively collaborate with internal and external partners to provide desirable WPs ;
and (6) communication to create a clear message, that is widely accessible to all. Berry
et al. (2010) state that these six pillars would support WPssuccess, regardless of the
size of an organization.
Most of the existing literature refers to WPs as being voluntary. However, in
addition to voluntary WPs, many employers (or medical insurance plans) are beginning
to impose what we may call involuntary programs (Schmidt et al., 2010). In line with
this, the US Affordable Care Act (ACA) of 2010 has expanded health insurance plan
wellness incentives to up to 30 percent of total coverage costs (Harrington, 2010).
The ACA encourages health-contingent WPs, basing participantsrewards or penalties
on a given health target, e.g. weight loss, smoking cessation, reducing cholesterol, etc.
Thus, these involuntary programs, often called healthy or wellness premiums,place
surcharges on insurance premiums if employees do not follow what is required by the
program. This means that employees could be charged more money on top of their
normal premiums, deductibles or co-payments if they do not satisfy the health premium
We are not aware of any definition of involuntary WPs in the literature, but it is
clear that they are different from voluntary WPs. We define involuntary WPs the
initiatives that employers offer to their employees, aimed at increasing health and well-
being, which feature rewards and/or penalties for meeting or not meeting given health-
related targets. The emphasis on the word involuntaryhighlights the mandatory cost
(or surcharge) that the employee has to pay when health-related targets are not met.
Although this topic is vital to HR professionals and managers, especially those who are
in charge of employee well-being, hardly any HR scholars have conducted an intensive
study in this area to understand the impacts of such programs on both employers and
employees. Despite these programs being relatively new, a report from the RAND

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