Wellness Programs May Cross Ethical, Legal Boundaries

No consensus on whether they will deliver health or cost benefits

WEDNESDAY, July 9 (HealthDay News) -- Wellness programs provided by employers and health plan providers with incentives for participation may be pushing the limits of legality, according to an article published in the July 10 issue of the New England Journal of Medicine.

Michelle M. Mello, J.D., Ph.D., and Meredith B. Rosenthal, Ph.D., of the Harvard School of Public Health in Boston, write that in 2006, 19 percent of employers with at least 500 employees offered wellness program incentives to staff, up from 7 percent of companies in 2004. Incentives for participation include prizes, cash or payment waivers, but some plans go beyond incentives for participation into penalties for health risks such as smoking or obesity.

However, federal laws (including the HIPAA non-discrimination rules and the Americans with Disabilities Act) prohibit discrimination on the grounds of health status, including for the provision of health insurance benefits, and the general rule of thumb that emerges from the relevant laws is that wellness program incentives can only pay for participation, not performance, the authors write.

"There is every reason to expect that over time employers and health plans will become more involved in encouraging behaviors that reduce health risks," the authors write. "It remains to be seen, however, whether programs designed to stay within the boundaries of the law can be effective in reducing health risks and health care costs."

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