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Costs due to lost productivity through absenteeism and presenteeism greatly increase the expense of common chronic health conditions beyond the medical/pharmacy charges according to a retrospective study involving 15,380 workers at four companies. Back and neck pain expense, the most costly chronic health condition, doubled when considering absenteeism/presenteeism. A company’s bottom line can be optimized, according to authors Loeppke et al., by appreciating the full cost of health conditions and including health enhancement interventions aimed at reducing absenteeism/presenteeism.
Study Design
Abseteeism/Presenteeism Measurement Tool
The Health and Work Performance Questionnaire (HPQ) is a validated self-reporting survey developed for the World Health Organization. It captures the amount of:
- absenteeism – the sum of time the worker is away from work, time loss while the worker is at work and extra hours needed to work in order to complete job responsibilities; and
- presenteeism – the time loss while at work due to the health condition,
relative to 27 chronic health conditions (including arthritis, back/neck pain, fatigue, headache, and chronic pain).
The summation of absenteeism/presenteeism time loss for workers with a specific health condition was compared to absenteeism/presenteeism time loss for workers without that condition.
An overall monetary value of absenteeism/presenteeism lost time was calculated by multiplying:
- total lost workdays for each health condition
- number of employees in the sample
- average salary per day
- fringe benefits benefits adjustment
- industry-specific worker absence multiplier
Medical Claims Cost Estimation
Paid medical claims that occurred during the 12 month period prior to the application of the HPQ survey were reviewed. The claim diagnosis was matched to the HPQ survey health condition. Costs related to conditions not identified by the HPQ survey were categorized as “other”. The amount paid on a claim was considered the company’s cost burden (it was understood that this amount is influenced by numerous factors such as benefit plan design, discounts, employee deductibles, co-pays, etc.).
Pharmacy Claims Cost Estimation
Paid pharmacy claims made during the 12 months prior to the HPQ survey application were assessed. Medications used to treat chronic conditions were identified. When a medication could have been used for more than one chronic condition, the cost of the drug was weighted in proportion to the prevalence of the diagnosis to which it could be applied.
Subjects
HPQ surveys were disseminated to over 57,000 workers at four companies. There was a 26.7% return (15,380 employees) with some extrapolation required from one company.
Other Findings and Opinions
The ten most costly chronic health conditions in rank of expense (from greatest to least) were:
- Back/neck pain
- Depression
- Fatigue
- Other chronic pain
- Sleeping problem
- High cholesterol
- Arthritis
- Hypertension
- Obesity
- Anxiety
The authors noted this ranking varied by employer and encouraged companies to measure their own productivity/medical/pharmacy costs to identify the best health enhancement program strategies relative to their employees’ conditions.
Human resources are recognized by business as strategically important relative to profits, hence, the development of training programs, investment in technology to enhance human performance, and various employee incentive initiatives. Good employee health should be considered as part of this paradigm. Understanding the full cost of poor health is necessary when prioritizing and planning an organization’s health enhancement initiatives.
This research will have a second phase which will expand the application of study measurements to ten companies.
Study Limitations
The authors identified several concerns including:
- Challenges in data collection
- Potential for selection bias since employees voluntarily completed the HPQ survey
- Underestimation of pharmacy costs for some conditions due to an under-representation of drugs for identified chronic health conditions
- Underestimation of total health costs since workers’ compensation and disability costs were not included
Article Title: Health and Productivity as a Business Strategy
Publication: Journal of Occupational and Environmental Medicine 49: 712-721, 2007
Authors: R Loeppke, M Taitel, D Richling, T Parry, R C Kessler, P Hymel, and D Konicki
Tim Villnave, MSPH, is an ergonomics consultant in the Division of Risk Management for the State of Utah.