Revising Employee Benefits for the Sake of Health
Condition: Healthy
Study type: Observational

Summary: 
      This study will explore ways in which employee benefits may be designed to improve people's
      health, through examining the viewpoints and preferences of low-income people. A person's
      health is affected not only by being able to receive health care but also by several factors
      such as income and education. People with lower incomes have been found to be not as healthy
      as those with higher incomes. While the governments of many countries in the Organization for
      Economic Cooperation and Development are currently working on public policy to address this
      topic, the likelihood is small that the United States, given its market-based economy, will
      do the same. However, owing to the heavy reliance in the United States on employer-sponsored
      health insurance, it would be useful to explore the possibility of insuring some of the
      measures that people can take to improve their health, and to do that through employee
      benefit packages. Solutions might include extended unemployment insurance, more education,
      job training, exercise programs, help for housing, disability insurance, and extra retirement
      benefits.

      Adults who have a minimum of a sixth-grade reading level, have low incomes, are English
      speaking may be eligible for this study. For recruitment, 400 people who live and work in the
      Washington, D.C, area will be invited to participate, and about12 people will take part in
      each session. Unless people in the study participate during working hours, they will each be
      paid $75 at the conclusion of the session.

      The study consists of one phase, in which participants will engage in a group exercise that
      lasts for approximately 2-1/2 hours. During that time, participants will have the chance to
      say what employee benefits they would choose, if the opportunity arose, to improve their
      health. They will first make those choices by themselves and then make choices along with
      other people in the group. While group members talk, the discussion will be recorded on a
      tape recorder. Participants will be asked to give information about themselves and their
      opinions but will not be asked for any information that identifies them personally, except
      for data needed to pay participants with a paycheck. They will also get to use a computer and
      will be shown how to use it, if necessary. If videotaping or photographs are done during the
      exercise, the investigators of the study will ask for separate signed permission to do so.
      Participants will be asked to respect the privacy of others in the group and to not discuss
      the opinions of others after leaving the session.
    

Detailed description: 
      An individual's health is affected not only by access to health care but also by a number of
      determinants such as income and education. Individuals with low incomes are not as healthy as
      those with higher incomes. Thus it seems important to explore possible avenues for improving
      the health of low income individuals with an eye toward ameliorating the complicated
      determinants of health status, aside from health insurance. Many countries in the
      Organization for Economic Cooperation and Development (OECD) are currently developing public
      policy to address this issue. In the U.S., however with its market based economy, the
      likelihood of adopting this public policy approach is small. Given that reality, is it
      possible to explore other avenues such as designing employee benefit packages with the aim of
      ameliorating the socio-economic determinants of health?

      Objective: The goal of this project is to explore the feasibility of designing employee
      benefits in a manner that may improve their health, by ascertaining the perspectives and
      preferences of low income employees regarding employee benefits designed to ameliorate the
      social determinants of health. Four hundred male and female low-income individuals recruited
      from clinical, community, and employment settings will participate in small group exercises
      in which a facilitated discussion will take place using a previously tested group decision
      tool (CHAT: Choosing Health plans All Together) that has been modified for this project. Data
      will be anonymously collected regarding socio-demographic characteristics, attitudes toward
      health, preferences for possible employee benefits and assessment of the exercise. Group
      discussions will be audio-taped. Data will be analyzed quantitatively to determine
      preferences of employee benefits and socio-demographic factors associated with these
      preferences. Discussions will undergo qualitative analysis go explore the underlying reasons
      for participant preferences. Participants will receive $75 dollars as compensation for their
      participation unless they participate during working hours.

      Risks and Benefits: Given the anonymous nature of the data collection we anticipate no risks
      other than those entailed in discussion of poor health outcomes associated with lack of
      insurance and low income. Participants may benefit from learning about factors that improves
      health status.

      Outcome and Meaning to the Field: Study results will yield information about what employee
      benefits would be of utmost priority to low income employees. This is unique information that
      may contribute to efforts to find affordable strategies for ameliorating the socio-economic
      determinants of health for the low-income working population in the US.
    

Time perspective: Prospective
Keywords: Employee Health; Insurance Benefit; Fringe Benefit; Health Status; Socioeconomic Factors