Healthcare Education: The Enduring Myth

Since about 1980, healthcare “experts” have been getting a tremendous amount of attention with claims that patients need to be better educated about their health and more “engaged." Let’s review a little history and see how that plan has worked. Around 1975, healthcare spending and insurance premiums started surging about 12% 15% per year. Those spending increases spurred the development of health maintenance organizations (HMOs), preferred provider organizations (PPOs) and other forms of managed care. A common word to describe those spending increases was “skyrocketing.” “Experts” thought that better-educated consumers would help contain rising costs, so, starting about 1980, companies started flooding their employees with brochures, information packets of various levels of glossiness, paycheck stuffers, break-room posters, table tents, meetings, health fairs, etc. But employees didn’t get much use out of that education (read: ignored it), and it certainly was not effective in changing consumer speeding habits. Starting in the 1990s, companies additionally set up or “rented” websites, both intranet and Internet, where employees could access health information. Problem is: Employees rarely accessed them. In the 2000s, companies started setting up special Internet sites for employees, ones that included employees’ personal health information. Sounds terrific, right? Just what the doctor ordered, right? The problem was: Few employees used such sites. Some were very expensive, but one in a hundred workers -- or fewer -- ever used them. Even fewer used them more than once. The truth is that employees have never trusted their employers or its agents or insurers for health information. Where do they want to get health information? From their doctors, of course. Wellness became popular as a way to drive consumer education and “engagement” (whatever the term “engagement” means). When employers began to realize that was not working, they typically changed wellness vendors. When that failed (predictably), employers tried to provide incentives to employees to become educated and “engaged.” After more failure, employers moved to the latest iteration: coercive wellness and education programs. But if all the other iterations of wellness-style employee education worked so well, why coerce employees? My prediction: The end is near. Big penalties designed to improve employee “engagement”? Gimme a break. Coercion leads to more distrust, lampooning, disloyalty, unionization, etc. Look at the mess Penn State created, or CVS. What were they thinking?  Perhaps this: The beatings should continue until morale improves. Or, as Al Lewis and Vik Khanna say in Surviving Workplace Wellness, employers are going to make their employees happy whether they like it or not. Alas, lately I’m seeing a resurgence in 1) the notion of flogging employees until “engagement” improves and 2) a new concentration on more gimmicks to educate consumers/patients. Using coercion to improve employee engagement?  Have HR executives gone off the deep end? Hmm. Makes you wonder.