Thursday, November 1, 2007

Remuneration for Healthy Workers: From Sticks to Carrot Sticks?

In July of this year Clarian Health of Indianapolis announced a new health and wellness program for its employees. Employees failing to meet minimum standards for body-mass index (BMI), blood pressure, tobacco use, glucose and cholesterol levels would have been fined $5 per condition per paycheck. Wednesday, NPR's Morning Edition reported that Clarian has revised its health program. The health care institution will not fine "unhealthy" employees, but will offer incentives to encourage healthier lifestyles. This news, also reported in the Indy Star (1 November 2007), will be welcomed by those who are concerned that personal health data, including genetic information, may someday be used in a discriminatory manner in the workplace. If the public strongly objects to requiring a person's BMI and tobacco use to be considered as conditions of employment, it seems even less likely an employer could successfully use a genetic test indicating, for example, an increased risk for breast cancer. Nevertheless, it is still possible, if not likely, that genetic information could be coupled with health-indicators to assess the health risks of individual employees. These individuals might also be encouraged with "incentives" to adopt healthier lifestyles. Before such practices are implemented, employers should think carefully about how employees will interpret these policies. When "unhealthy" individuals are identified with genetic or other bio-information and required to meet certain health goals to receive incentives, are "health incentives" nothing more than repackaged "disincentives"? Could it be that what was once a "stick", is now a "carrot stick"? - J.O.

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