CVS Caremark (CVS) recently made headlines for rolling out a $600 penalty on workers who fail to report biometric data such as weight, body fat, blood sugar, and cholesterol in an annual screening. The controversial move is likely just the start of a new wave of workplace programs that aim to encourage healthier employee behavior through targeted incentives.
最近，美国CVS Caremark（CVS）公司登上了报纸头条，原因是该公司规定，那些在年度体检中未向公司汇报体重、体脂、血糖和胆固醇等健康数据的员工将被罚款600美元。这一备受争议的举措只是该公司实施新一轮职场健康计划的前奏，目的是通过定向激励措施来鼓励员工追求更加健康的生活方式。
"You're going to see over the next three to five years lots of employers rewarding employees for successfully improving their health risk," says Jim Winkler, chief innovation officer for HR consultancy AON Hewitt, which found that 58% of the nearly 800 employers it surveyed plan to penalize workers who fail to take appropriate actions to improve their health.
人力资源咨询公司怡安翰威特（Aon Hewitt）首席创新官吉姆•温科勒说，“人们将看到，在未来3至5年内，很多公司会奖励那些成功降低自身健康风险的员工。” 怡安翰威特通过对约800家公司的调查发现，58%的公司打算对那些不采取适当措施来改善自身健康状况的员工予以罚款。
Of the $2.7 trillion spent each year on health care, about 50% to 60% relates to conditions that could be improved through changes in diet, exercise, and stress management, says Adam Bosworth, co-founder of online wellness company Keas and former head of Google Health.
面对不断攀升的医疗保险成本，企业正扩大健康计划的外延。怡安翰威特的数据显示，2013年，人均医保成本预计将达到11,188美元（69813.12元人民币），而2007年为7,874美元（49133.76元人民币）。很多公司已将单一的奖励健康生活调整为奖励与处罚并举。在线健康咨询公司KEAs联合创始人、谷歌健康（Google Health）前任主管亚当•博斯沃思表示，美国公司每年要在医保上花费2.7万亿美元（16.848万亿元人民币），其中约50%-60%的资金都用在了那些可以通过饮食调整、运动和缓解压力来治疗的疾病上。
The recently passed Affordable Care Act clarified employers' ability to financially penalize employees for unhealthy behavior. The act raised the allowed penalty, or reward, to 30% of health care premiums, from 20%. The federal health care reform package also cast a spotlight on the effectiveness of using payments and fines to influence employees' behavior -- regardless of whether they are weighted more on punishment or rewards.
最近通过的美国平价医保法（Affordable Care Act）明确指出，企业可以对员工的不健康生活方式进行经济处罚。该法案将罚款或奖金占医保费用的比例从20%上调至30%。联邦医保改革一揽子方案还对奖金或罚款能否有效影响员工的行为进行了探讨——不管企业更看重的是惩罚还是奖励。
"These programs, when it comes to obesity and weight management, are simply not very effective. All the studies have shown a very marginal weight loss over 12 months," says Morgan Downey, editor and publisher of The Downey Obesity Report, which covers science and public policy on obesity. "The best scientists and clinicians in the world have trouble getting these conditions under control. Why do we think HR can do it?"
《唐尼肥胖报告》（The Downey Obesity Report）编辑、出版商摩根•唐尼说：“对于肥胖和体重管理来说，这些方案并不是很奏效。所有的研究都显示，员工在12个月内减掉的体重微乎其微。世界上最好的科学家和医学家都对控制这些问题感到头疼，我们为什么要指望人力资源部门能做到这一点呢？” 《唐尼肥胖报告》主要报道与肥胖有关的科学和公共政策。
Unlike smoking, high blood pressure, and glycemic control -- issues that physicians have a range of options to treat and control -- there are no clinically proven pharmaceutical or treatment protocols for obesity, says Downey. Moreover, the federal regulations proposed under health care reform contemplate such possibilities as an employer requiring its entire workforce to achieve a body mass index of 27, and fining those who cannot meet the standard or make consistent progress toward it.
唐尼说，与抽烟、高血压和血糖控制（医师可以通过很多方法来治疗和控制这些症状）不同的是，目前没有有效的临床药物或治疗方案来解决肥胖问题。此外，医保改革中提到的联邦法规也探讨过是否实施此类措施，即公司要求所有员工的体质指数达到27，并对那些无法达到这一标准的员工或难以取得持续进步的员工处以罚款。
A majority of adult Americans are overweight or obese. Most fail in their attempts to lose weight, researchers find, but the majority of those who succeed return to baseline weights within five years. "The majority of American women are on a diet at a given time," says John Cawley, a Cornell University economist and public policy professor. "It's not that people don't know, and it's not that they aren't trying. It's that these are really hard behaviors to change."
大部分美国成年人都超重或患有肥胖症。研究发现，大部分人的减肥努力都以失败告终，而且大多数成功减肥的人也都在5年内恢复了基准体重。康乃尔大学（Cornell University）经济学家约翰•考利表示：“大多数美国女性随时随刻都在节食。人们其实也意识到了这个问题，他们也曾努力过。但是要改掉这些顽固的习惯谈何容易。”
A recent study of a workplace program that offered financial incentives for losing weight to 2,635 workers found only modest weight loss and a high dropout rate, according to Cawley, who published this study with Joshua Price of the University of Texas at Arlington. "We're at an early stage with figuring out how to optimally design these incentive schemes," says Cawley.
考利最近对奖励减肥的职场政策开展了一项研究，对象涉及2,635名员工。该研究发现，员工的减肥效果很一般，而且中途退出的比例很高。考利与德州大学阿灵顿分校（University of Texas at Arlington）的乔舒华•普莱斯共同发表了这篇研究报告。考利说：“我们试图找到设计这些激励方案的最佳方法，目前我们还处于起步阶段。”
Culture and level of trust within an organization are the most important elements of a wellness program, according to Winkler. Rewards or penalties around healthy behavior must be give in the context of information, interventions, and programs that make it possible for employees to reach their health goals. Programs that are personalized to the workers' personalities, health risks, and other variables are more likely to be successful -- but are also harder to administer.
温科勒指出，机构内部文化和信任度是健康方案最重要的元素。公司在实施与健康行为有关的奖励或惩罚措施时必须提供相关的信息、干预和方案，使员工有可能实现健康目标。依据员工个性、健康风险和其他因素所制定的个性化方案获得成功的可能性更大，但是也更难以管理。
Eight primary risks can drive up health care costs and lead to diseases: smoking, sedentary lifestyle, unhealthy diet, excessive alcohol use, lack of preventive screenings, patient non-compliance, inadequate sleep, and poor stress management. Rather than tackle all eight at once, an employer should assess where the greatest risks and costs exist among their employees and go from there, Winkler says.
推高医保成本并导致疾病风险主要有八种风险，它们包括吸烟、静态生活方式、不健康饮食、过量饮酒、缺乏预防性检查、病人不遵医嘱、睡眠不足和不良的压力管理。温科勒说，公司应评估员工的最大风险和成本，并从此处着手，而不是同时应付这八种风险。
But don't expect the same old glossy brochures and HR-speak as new programs roll out. Organizations are getting creative. "Employers that have had success in connecting with people to change behavior have used marketing tactics as opposed to traditional HR benefits communications," notes Winkler.
然而，不要以为公司会用花花绿绿的手册和人事讲座这种老套的手法来推出新的方案。美国大公司在这方面各显其能。温科勒表示：“那些成功促使雇员改变行为方式的公司所采用的是营销策略，而不是传统的人事福利沟通。”
Rather than simply threatening or bribing employees, a growing number of employers are launching competitions and gaming applications that encourage achieving health goals in a fun way. The Hewitt study found that 22% of employers surveyed are interested in incorporating gaming concepts into their wellness programs.
越来越多的公司采用竞赛和游戏等有趣的方式来鼓励员工实现健康目标。翰威特的研究发现，在接受调查的公司中，22%的企业愿意将健康方案与游戏理念进行结合。
Keas believes that penalties don't work in changing individuals' behavior, says Bosworth. Rather, the company has found success through a fun and social rewards-based approach that combines games, achievable goals, healthy habit building, and small coworker teams that support health goals. A case study Keas conducted at a Florida hospital found that 46% of employee participants improved their fresh produce intake and exercise, 16% improved their stress level, and 30% lost a modest amount of weight.
博斯沃思称，Keas公司认为惩罚难以改变个人的行为。该公司找到了一种成功的模式，它将有趣的、基于社会性奖励的方式与游戏、可实现的目标、健康习惯培养以及支持健康目标的小型同事团队相结合。Keas在佛罗里达州一家医院开展的一项案例研究显示，46%的参与者增加了新鲜农产品的摄入量，并加大了运动量；16%的员工降低了压力水平；30%的员工减掉了一定的体重。
Also going beyond monetary rewards or penalties is the Global Corporate Challenge, in which teams of employees compete in their virtual progress walking around the world, with a 16-week jump-start period beginning May 23 and another nine months of follow-up. "Payment doesn't encourage personal responsibility; it actually compromises it," argues GCC president and founder Glenn Riseley.
全球企业挑战赛同样超越了金钱奖惩的范畴。在这项赛事中，各公司员工组成的团队在虚拟环境中进行环球竞走比赛。比赛从5月23日开始，前16周是启动阶段，接下来是9个月的后续赛程。挑战赛总裁兼创始人格兰•莱斯利表示，“奖金并不能激发人们的责任感，实际上还会产生不利作用。”
At the end of previous years' challenges, participants lost an average of 9.9 pounds; 66% reported decreased stress; and of those with high-risk blood pressure, 54% had reached low-risk levels. Past participants include Pearson, Warner Brothers, and Rolls Royce, according to the GCC web site.
在前几年的挑战赛结束时，参赛者的体重平均下降了9.9磅；66%的人表示压力得到了缓解；在血压偏高的参赛者中，54%的人把血压降到了不那么危险的水平。挑战赛网站上的信息显示，参与这项赛事的公司包括培生集团（Pearson）、华纳兄弟（Warner Brothers）和劳斯莱斯（Rolls Royce）。
The vast majority of American companies, 83% according to Hewitt's survey, already offer incentives for participating in wellness programs. Expect more to expand those rewards and penalties to cover healthy behaviors and eventually to rest on specific results.
怡安翰威特的调查显示，绝大部分美国公司（83%）已通过激励政策来鼓励员工参与健康计划。与健康行为有关的奖惩制度预计会越来越多，而且最终会以具体指标为依据。
"A lot of people will feel that it's somehow mean to do this," says Cawley. "What's not fair is the current system where everybody else in the health insurance pool is subsidizing the health care costs of the morbidly obese."
考利说：“很多人都会觉得这样做有点不近人情。而真正不公平的是现在的体制，目前所有参与医保的人都在承担不正常肥胖所带来的医疗保健成本。”
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