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2016-03-15  杂谈婚姻

Paying Employees to Lose Weight

IF your employer offered you $550 to lose weight, an amount that would be deducted from your health insurance premiums next year, would that provide the motivation to help you finally shed those pounds?


Roughly four out of five large employers in the United States now offer some sort of financial incentive to employees to improve their health. The Affordable Care Act has encouraged the creation of such programs by significantly increasing the amount of money, in the form of a percentage of insurance premiums, that employers can reward (or take away) to improve factors such as body mass index, blood pressure and cholesterol, as well as for ending tobacco use.

在美国,大约五分之四的大型雇主现在都向员工提供某种形式的财务激励,希望以此改善他们的健康。为了鼓励雇主推出这种方案,《平价医疗费用法案》(Affordable Care Act)以在保费中扣除一定比例的形式,大幅增加了雇主可以奖励(或扣除)的金额,只要员工改善了身体质量指数、血压、胆固醇等指标,以及停止吸烟,就可获得。

These programs make intuitive sense. But do they work?


We and several colleagues recently conducted a yearlong trial to test whether the promise of $550 off next year’s health insurance premium, paid out over the course of that year, could motivate employees to lose weight. After one year, as we recently reported in the journal Health Affairs, employees randomly assigned to a control group that received no financial incentive had no change in their weight. But employees who were offered a $550 premium reduction didn’t lose weight either.

我们和几个同事近期进行了一个为期一年的试验,测试第二年健康保险费减除550美元的做法,是否可以激励员工减肥,这笔钱会在一年的时间中分期发放。就像我们在《健康事务》杂志(Health Affairs)上的报告中写的那样,一年以后,没有参加财务奖励方案的随机员工对照组在体重上没有变化。但是参加了550美元方案的员工们也没能减肥。

One reason that these rewards were ineffective was that they were provided too far in the future. If you lose weight today you may not receive any reward until next year. Next year is a long way off, particularly if there is a cookie in front of you right now.


A second reason was that while a premium discount of $550 sounds motivating, it is only about $20 per biweekly paycheck. What’s more, that $20 is typically deposited directly into a bank account that you may never review carefully, and even if you did, is bundled with your total paycheck and the total funds in your account. A delayed incentive broken up into small increments and directly deposited among much larger amounts of money is not likely to overcome the forces that have always made losing weight hard.


This doesn’t mean that workplace financial incentives to promote health can’t be effective. But it does suggest that adjusting people’s health insurance premiums is not a good way to motivate them to lose weight. Such incentives need to be designed better.


Financial incentives can work well — if they are separated from insurance premiums. In recent years, we’ve studied other weight-loss interventions in employees, using similar amounts of money, that did work. In a study published in 2013 in The Annals of Internal Medicine, we found that you can encourage weight loss if you put employees in groups in which only those who succeed in achieving a monthly weight-loss goal get rewarded. This works, probably because people hate the idea of seeing others in the group collect a prize that might have gone to them if only they had tried a little harder.

财务奖励举措可以十分有效,前提是要与健康险保费分开。近些年来,我们研究了其他利用相同数目的资金干预员工减肥的奏效方案。在《内科学年鉴》(The Annals of Internal Medicine)2013年发表的一篇论文中,我们发现如果将员工分组,只有那些成功完成每月减肥目标的员工可以获得奖励,就能够鼓励员工减肥。这之所以行得通,可能是因为人们不愿意看着组里的其他人获得奖励,而如果他们再努力一点,奖励就可能是他们的。

Another example: Two of us (Professors Asch and Volpp) and colleagues conducted two large studies, one at General Electric and another at CVS, published in The New England Journal of Medicine in 2009 and 2015, respectively. Both studies found that participants who received cash or checks of $750 to $800 over the year quit smoking at triple the rate of a control group.

另一个例子:我们当中的两个人(阿施教授和沃普教授)和同事们在通用电器(General Electric)和CVS公司开展了两项大型研究,研究结果分别于2009年及2015年在《新英格兰医学期刊》(The New England Journal of Medicine)发表。两项研究都发现,一年中为了获得750美元到800美元现金或支票而戒烟的人数是对照组的三倍。

And last month, we published a study online in The Annals of Internal Medicine that tested ways to encourage employees to be more physically active. A group of 281 employees were given a goal of taking at least 7,000 steps a day, measured using the accelerometers in their smartphones. By random allocation, some employees were assigned to the control group and were just given feedback about their step counts. Another group could earn $1.40 every day the 7,000-step target was reached — that’s $42 per month. Those in a third group were told that each month they would start with $42 in an account and $1.40 would be taken away every day they didn’t meet the goal (though no participant could end up worse off financially than when he started).


From a purely economic standpoint, the motivation for these last two groups ought to be the same: In each case at the end of the month you are $1.40 richer for each day you walked at least 7,000 steps. But from the standpoint of human psychology, there’s an important difference, for as much as people like to earn $1.40, they really hate to lose $1.40 — a phenomenon known as “loss aversion.”


We ran the study for three months, and even with regular feedback, employees in the control group achieved the step goal only 30 percent of the time. Employees who earned $1.40 for every day they met their goal achieved the step goal 35 percent of the time — a figure statistically no different than that of the control group. By contrast, those who stood to lose $1.40 for every day they didn’t meet their goal achieved that goal 45 percent of the time.


As all these studies suggest, companies can improve the health of workers, but only if they are smart about it.





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