This analysis suggests a future for ‘‘wellness’’ initiatives: a great deal of negative wellness [basically, underwriting, cost shifting, or back-door risk-rating] in the form of crude insurance rate or hiring discrimination, diverse and visible but largely cosmetic wellness programs used as cheap recruitment and retention, or corporate public relations. There will be some scope for positive wellness [investment in health promotion] in the same high-skill or low-turnover firms that have incentive to train employees. Just as American employers routinely demand skills from employees and then complain to governments when the requisite skilled employees do not appear in the open market, we should expect that American employers will be much more likely to demand health from prospective employees than they are likely to actually invest in it. Negative wellness policies and continued underprovision of population health is consequently the likely future.
That’s from Scott Greer and Robert Fannion. The basic insight, which the paper spells out multiple times, is that there’s little incentive for employers to make wellness investments in workers who aren’t likely to stay long enough to generate a positive return. However, shifting the cost of health care onto workers who, all else being equal, cost employers more in health care costs (e.g., smokers) is in employers’ financial interests.