Nearly half of the 3,000 American workers surveyed by HR consulting firm Hewitt Associates said they'll keep their employer-sponsored health insurance in the next three to five years. But more than one-third (35 percent) would consider dropping their employer plan if they can purchase similar coverage for a lower cost somewhere else.

Experts say new health care reform legislation is pushing employers to realign their health benefits. Currently, the majority of Americans (61 percent) currently use employer-sponsored health care coverage as medical needs arise and participate in healthy living/wellness programs, according to Hewitt.

"Workers clearly appreciate the value of the health care coverage their employers offer to them and their families," said Helen Darling, president of the National Business Group on Health, a nonprofit association that represents more than 280 large U.S. companies, in a press release. "Health care reform legislation will lead some employers to rethink their health benefits strategy, but employees overwhelmingly prefer and expect to see their employers continue to provide coverage in the future."

Hewitt and National Business Group on Health's survey reveals five key insights into how employees and their dependents view health care:

Employees know how to get healthy, but many aren't taking action. Employees and their dependents are more involved in managing their health and health care options than ever before and know what actions will lead to better health. Most (84 percent) believe making smart choices in daily life leads to good overall health, and almost three-quarters (72 percent) think good health is a result of getting regular preventive care. However, this understanding does not seem to be translating into individuals taking actions that will directly improve their health. Only half of employees think they do a great or good job of eating healthy, while less than half (46 percent) reported doing a great or good job of exercising on a regular basis.

Participation in health programs is low, but satisfaction is high. Employees and dependents say they know what actions they need to take to get and stay healthy, but participation in many employer-provided health improvement programs is not as high as employers would like.

The most popular programs include biometric screenings (61 percent), followed by online health information tools (53 percent) and health risk questionnaires (41 percent). Stress management programs and employee assistance programs (EAPs) were the least popular, with just 9 percent participation in each.

Despite low participation rates, the Hewitt/National Business Group on Health survey shows that workers who take advantage of available programs, tools and services are generally satisfied with them. The programs with the highest employee satisfaction rates include blood screenings (91 percent), on-site health centers (83 percent) and physical fitness programs (78 percent).

Assistance with stress reduction/management and help with claims resolutions were among the programs with the lowest levels of satisfaction (60 percent respectively and 59 percent respectively).

Internal motivators can be just as effective as financial ones. Many employers presume that offering cash incentives in exchange for participation will generate the best results and incent employees to participate in health care programs.

However, the Hewitt/National Business Group on Health survey shows that employees are equally motivated by both intrinsic factors and the use of incentives or penalties. Nearly half (48 percent) would complete a health risk questionnaire (HRQ) without any incentive because it is "the right thing to do." Twenty-nine percent would participate in a HRQ for an incentive and almost the same number (28 percent) would complete it if there was a penalty. Further, 44 percent of employees would participate in a wellness or health improvement program offered by their employer because it's the right thing to do compared to almost a third (32 percent) who would participate if they were incented and 30 percent who would participate under threat of a penalty.

"The reality is that we all need a nudge at times to make the right health choices, and we learned through this research that the nudge doesn't always have to involve money," said Joann Hall Swenson, a principal and health engagement leader at Hewitt Associates, a global human resources consulting and outsourcing services company. "Financial incentives can work well, but organizations should also harness the power of intrinsic motivators like people wanting to stay alive and well for their families. The trick for employers is finding the right blend of motivators that works for their population."

Skepticism and confusion get in the way of healthy actions. Further complicating the disconnect between workers' intentions to get healthy and their actions, a majority of workers and dependents are confused when it comes to which information to trust and what to do about their health.

The top employee obstacles to making informed health care choices? Not knowing which information to trust (58 percent), followed by confusion over what is covered by the plan (54 percent), not knowing how much things cost (47 percent) and ability to quickly see a doctor when needed (42 percent).

"Companies need to remove as many barriers as they can that get in the way of employees taking the right actions--whether those are administrative, financial, geographic, or environmental," explained Cathy Tripp, a leader and principal in Hewitt's Health Management practice.

Workers want targeted and personalized communication. To help cut through the clutter of health care messages, employees and their dependents are asking for more personalized communication that is relevant to them. Almost half (44 percent) want customized, targeted reminders that are appropriate for them based on factors such as their age and gender, 41 percent would like personalized health program recommendations, and 40 percent requested online personal health records.

"Workers know what they need to do to manage their health, but unfortunately that's not enough," said Darling. "To turn this knowledge into positive actions, individuals need very specific tools, tactics and motivation. As employers consider making changes to their health care benefits in response to health care reform, they have a great opportunity to revitalize their existing strategy and create programs that will promote workforce health and productivity and hold down overall health care costs."

Instant Insights /

Hewitt: One-third of workers could drop employer health coverage

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