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Insurance and Employment Don't Equal Healthy Behavior, Study Finds

Elyas Bakhtiari, for HealthLeaders Media, April 30, 2010

Employed and insured Americans aren't meeting recommended health behavior guidelines, particularly when it comes to taking advantage of preventive services like immunizations and cancer screenings, according to a new study.

Overall, utilization of preventive services was poor, even among those with access to care. Nearly 74% of insured workers don't get influenza vaccines, and nearly half fail to undergo recommended preventive screenings for colon cancer. Most insured adults aren't following basic healthy lifestyle guidelines, such as eating the recommended amount of fruits and vegetables and getting enough daily exercise.

Researchers looked at the prevalence of healthy behaviors only among insured workers, based on data from nearly 160,000 participants in a Centers for Disease Control and Prevention telephone survey of adults under 65. The findings appear in the May-June issue of the American Journal of Health Promotion.

"Previous research has shown that insured people and employed people are better off than the uninsured, but we wanted to take that out of the equation and ask, 'How are they doing?'" says M. Courtney Hughes, PhD, who led the study with a team of researchers at the University of Washington School of Public Health. "We found they're not OK because they're not meeting recommendations."

The researchers also looked at disparities among the insured. Although health outcome and behavior disparities are well-documented between insured and uninsured populations, they also exist within the population of insured workers. For instance, nearly 35% of insured women in households making less than $15,000 per year forgo recommended breast cancer screenings, compared to only 19.6% in households making greater than $50,000. Similar disparities were seen along race and education lines.

Respondents said cost was a factor in preventing a physician visit more often than not, but it wasn't the only factor. Many of the barriers are related to access and education, says Hughes, who has founded Approach Health, LLC, a health behavior consulting company in San Diego. Employers could improve access with services like onsite screenings and childcare, and taking health literacy into account could reduce the disparities, she adds.

Poor compliance with health guidelines has implications for both policy makers and employers, she says. Companies not only lose money in medical costs when insured employees don't take preventive measures, but they also lose productivity when more complicated medical conditions arise.

And for policy makers interested in expanding access, the results suggest providing insurance alone isn't enough when many of the insured aren't utilizing recommended services. A large number of costly, chronic conditions are tied directly to health behaviors.

"Outcomes are strongly affected directly by these health behaviors," Hughes says. "That's what's driving our healthcare costs."


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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