The Impact of Participation in Health Promotion on Medical Costs: A Reconsideration of the Blue Cross and Blue Shield of Indiana Study

Abstract

PURPOSE: The purpose of this study was to investigate whether participation in a comprehensive worksite health promotion program was associated with reduced employee health care costs. DESIGN: Four independent study groups, two treatment and two comparison, were identified based on type and date of first participation in the intervention. Two years of pre-program health cost data and five years of post-program data were collected for each subject. The Jonckheere-Terpstra statistical test was used to analyze the data. SETTING: The health promotion program was offered at Blue Cross and Blue Shield of Indiana corporate headquarters. The study period began on January 1, 1976, and continued through December 31, 1982. SUBJECTS: Seven hundred and forty-three men and women employed continuously by Blue Cross and Blue Shield of Indiana throughout a seven-year period were studied. INTERVENTION: The health promotion program consisted of four progressive phases which involved 1) health risk reduction mass education, 2) completion of a health risk appraisal and risk reduction counseling, 3) health promotion classes such as smoking cessation and nutrition education, and 4) follow-up and maintenance. MEASURES: The principal dependent variable was pre-program to post-program changes in health costs as measured by employee health care expense claims paid for by the company's health insurance plan. RESULTS: This study found that program participation was not associated with reduced health care costs. CONCLUSIONS: It would be prudent to remain guarded about the health cost savings effects of worksite health promotion programs.