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WELLNESS UPDATE
U.S. employers and workers are simultaneously taking
steps to address rising medical costs and better
manage health care benefit spending.
Recessions typically lead to an increase in health
benefit utilization by employees and a corresponding
increase in the cost of such programs to employers.
However, 84 percent of employers who participated in
a recent survey said their company is unlikely to
eliminate any health or group benefit programs to
cut expenses.
Survey respondents said their companies are more
likely to intensify efforts to understand the root
causes of increasing costs (77 percent) and add
wellness programs to improve health-related
behaviors and increase employee engagement (76
percent). Meanwhile, employers remain selective in
planning workforce pay and benefit cuts, according
to the survey, Leading Through Unprecedented Times,
which was conducted in November by Mercer, a global
company specializing in complex human capital
management issues.
The survey of 1,028 human resource and finance
professionals representing organizations with
operations in more than 100 countries touches on
talent, compensation, benefits and related
investment challenges arising as a result of the
recession. “In recent months, many multi-national
companies have been managing compensation costs and
workforce levels aggressively while working to keep
employees engaged and productive,” said Patricia
Milligan, Mercer’s chief markets officer. “But our
survey shows that, at least as a group, most of
these companies have refrained from taking severe
and broad-based steps” such as deep workforce cuts,
across-the-board salary freezes, reductions in
defined contributions or the elimination of certain
health benefit programs. However, Mercer predicts
many fundamental human resource-related decisions
are likely to be revisited in response to year-end
results and updated economic forecasts for 2009.
“This is a balancing act,” Milligan said.
“Discussions with our clients indicate that more
dramatic actions are being considered by boards and
senior management should the downturn become deeper
or prolonged. It is also likely that companies
learned important lessons in previous economic
downturns about the importance of talent in creating
competitive advantage, and so are reluctant to take
actions that could hamper their recovery once the
economy improves.” Among signs of the times, the
Society for Human Resource Management’s Leading
Indicators of National Employment® Report forecasts
a 23.3 percent drop in manufacturing sector hiring
and a 19.5 percent drop in service sector hiring
compared to the same period last year.
In addition, a growing number of employers,
including the federal government, are enacting pay
freezes. President Obama’s order to freeze pay for
White House employees earning more than $100,000
sent a message to a nervous country: “We're in this
together,” the Associated Press reported.
Employee Outlook
Watson Wyatt, another prominent global human
resources and benefits management firm, released
data from Employee Perspectives on Health Care, its
survey of 2,487 employees of large U.S. companies,
in December. Among the findings, 66 percent of
employees are taking steps to improve their personal
care, up four percentage points from 2007.
Meanwhile, the number of employees willing to pay
higher premiums to keep deductibles and co-pays
lower and more predictable appears to be declining:
19 percent of respondents were willing to do so in
2008, compared to 38 percent in 2007. “Workers will
continue to look for avenues to save money in tight
times,” said Cathy Tripp, national leader of
consumerism at Watson Wyatt. “In the current
financial climate, employers stand to gain from
reinforcing messages on preventive care, wellness
resources and the importance of following prescribed
drug regimens.
There are a number of behaviors that, if embraced
today, will lead to substantial health cost savings
in the long term.” However, despite the opportunity
to save money, the survey found some workers are
taking actions that could lead to higher costs in
the future. For instance, the survey found that 17
percent avoided a recommended doctor’s visit because
of the cost. Similarly, 17 percent did not fill a
prescription or skipped doses of prescribed medicine
(Table 1). “The health-wealth connection is more
clear than ever, as pressures from high health costs
continue to pose challenges to both companies and
employees,” Tripp said. “Open communication and
clear, concise educational tools are effective ways
to help employees realize the many steps they can
take to manage costs without compromising care.”
For more information:
Mercer:
www.mercer.com/unprecedentedtimes
SHRM:
www.shrm.org
Watson
Wyatt:
www.watsonwyatt.com/us
Table 1: Actions taken by employees to help
cut health care costs.
Source: Watson Wyatt,
N=2,487
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Action
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Taken in 2007
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Taken in 2008
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Tried to improve personal care
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61%
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66%
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Chose a lower-cost drug option
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42%
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46%
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Visited the doctor only for serious
condition/symptom
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35%
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40%
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Saved money in an account used only for
medical expenses
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15%
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20%
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Skipped a recommended doctor’s visit
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NA
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17%
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Did not fill a prescription or skipped doses
of prescribed medicine
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13%
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17%
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Used company-sponsored wellness programs
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NA
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16%
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Talked with my doctor about seeking more
affordable treatments
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9%
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14%
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Looked for less expensive health care
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4%
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8%
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Negotiated lower prices with my doctor
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1%
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2%
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Source: Health Goals
Partners, Vol. 17, No. 1
Published by the National Association of
Occupational Health Professionals
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OCCUPATIONAL MEDICINE UPDATE
HYPERTENSION AND THE DOT PHYSICAL EXAMINATION
Update provided by Daniel Waksman, DO,
Mercer-Health Occupational Health
As most people know, hypertension, or high blood
pressure, is one of the major risk factors for
coronary heart disease. Hypertension can be caused
by a number of factors; genetics, sedentary
lifestyle, poor diet, stress, and cigarette smoking
being some of the most common.
In addition to causing medical problems, high blood
pressure can also prevent a person from passing
their DOT physical examination. The Department of
Transportation requires a blood pressure of less
than or equal to 140/90. This is a requirement that
leaves no room for compromise.
When presenting for a DOT examination, there are
certain things a driver may do in order to obtain an
accurate blood pressure. The easiest, and probably
the least often done, is to not consume any caffeine
prior to the exam. This would include coffee, tea,
or soft drinks.
It is well known that caffeine will raise a person’s
blood pressure. It causes the blood vessels in the
body to constrict (become narrower), causing the
heart to work harder to pump blood to all the vital
organs of the body.
A person presenting for their DOT examination with
an elevated blood pressure about 140/90 may expect
to encounter the following scenario:
After initially finding an elevated blood pressure,
the driver may be asked to sit in a dimly lit room
for a short period of time to help them relax and
lower the blood pressure. After 3 attempts, the
lowest blood pressure obtained will be the one
documented on the chart.
If everything else on the exam is satisfactory, the
driver may be given a three (3) month DOT card; this
gives them the opportunity to get together with
their primary care physician to devise a way to
lower the blood pressure to 140/90 or less. This may
include diet modification, exercise, or medications.
The driver should also be given a letter explaining
what must take place prior to their receiving their
permanent card. Generally, a letter is required from
the primary care physician documenting the method of
treatment for the high blood pressure, two (2) blood
pressure determinations taken on different days that
are 140/90 or less, and a statement stating the
physician believes the blood pressure is under
satisfactory control and the driver is healthy
enough to drive a truck. This letter must be on the
physician’s office letterhead and forwarded to the
Occupational Health office where the driver will be
retaking the exam.
If the driver then passes the exam, he/she will be
issued a 1 year DOT card. Per DOT requirements, a
person with a diagnosis of hypertension must be
re-examined yearly. If the driver is still unable to
pass at this time, they may be disqualified until
better blood pressure control is obtained.
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