Getting closer to the truth: Overcoming research challenges when estimating the financial impact of worksite health promotion programs

Estimating the true financial impact of worksite health promotion is complicated by a number of factors. Some of these are related to the feasibility of research designs. For example, it may be difficult, if not impossible, to conduct a randomized trial to assess financial impact, since worksites are not laboratories that can be easily controlled and employees deserve and preserve the right to choose whether to participate in health promotion interventions. Other complicating factors are due to data issues, such as the existence of many zero values of health expenditures or absence days for workers who remain healthy throughout the year, contrasted by the occurrence of a few extremely large outlier values for those who may be chronically ill. Methods for addressing these and other issues are described in this paper. We call for more sophisticated research methods than have been used in the past, to generate better estimates of financial impact, in which managers can place more confidence. We also call for government funding of impact evaluations, to aid smaller employers and others who cannot secure internal funds for a scientifically credible (and therefore policy-relevant) evaluation.