Heidi Allen, a professor at Columbia University's School of Social Work, believes that paid time off may be the best way to encourage employees to adopt healthy habits, and she proposes that employers in the federal government experiment with programs based on this incentive. I recently spoke with Allen—a former government employee herself, having worked as an analyst for Oregon's Health Policy and Research office—about her idea. Our exchange has been edited and condensed.
(Pete Ryan)Can you explain your idea?Employers are investing more and more every year in employee wellness initiatives, with mixed results. The need to curb health care costs by addressing the increased prevalence of chronic disease seems self-evident, but how to do this hasn't been. It certainly doesn't seem like newsletters that encourage exercise and contain healthy recipes are a powerful intervention. My idea is that employers should define what specific healthy behaviors they want from their employees, and then offer employees time off as a reward for doing them.
What problem does this solve?There are many reasons that health care costs continue to rise, but one of them is simply that people are living sicker for longer. Employers, who partially bear the burden of increasing health care premiums, have become interested in the notion of employee wellness as a means to save money. A recent study suggested that the average employer spends almost $700 per employee per year on wellness programs, with larger employers spending even more than that. The efficacy of these programs has been mixed and largely modest, with programs that target chronic-disease management having the highest payoff. We need to prevent chronic disease by keeping people active. Things like exercise and healthy eating habits get harder to do the longer you go without doing them.
How does the federal government fit into this proposal?There are many employers that this model wouldn't work well for—people that bill hourly, for example—but the government, including the federal government, is an enormous employer and has already been investing resources in likely ineffective wellness programs. People sit at desk jobs and slowly gain weight year after year of employment, contributing to high chronic-disease burden, disability, and high health care costs. I think Washington should pilot the program with federal employees. For an enthusiastic employer who wants to invest early in employees that they plan to keep for decades, implementing this as a carefully-designed experiment that competes with other incentives is a terrific place to start.
Why do you think time off is better than other incentives?Currently employers use things like information and encouragement, discounts on gym memberships, and health insurance premiums—and, less often, cash—to get employees to participate in wellness efforts. But small amounts of money might not be meaningful for middle-income employees. We need stronger incentives. To get more vacation time, government employees have to be promoted to management or earn it through accrued years of employment. Time off to spend with friends and family for travel or recreation would be highly incentivizing, and also good for employees' mental and emotional well-being.
The cost of the intervention is mainly lost productivity. But if you could increase employee productivity by an equal amount by having healthier employees, you would break even while spending very little.
What got you thinking about this?I used to work in government, and I think that's probably where my enthusiasm for this project starting in government comes from. Government is a place where people start their careers as young adults and often stay until retirement. It's also a place where it's hard to earn vacation time, so time is particularly valuable and motivating for people. When I was a government employee, I would have dragged myself to the gym three times a week, every week, every year, if someone told me I could earn two weeks more vacation doing it. And I think that's true for a lot of people. I think many people would participate in a program like this for time off that would be impossible to get otherwise.