On Voluntariness in Wellness: Considering Organizational Health Contingent Incentives

Abstract

Some would argue that if taking an examination to receive an incentive is not mandatory, it’s voluntary no matter the size of the monetary reward. Others have concerns with how often employers use the word “required” when communicating how employees can earn an incentive. This in spite of clear rules that indicate “health contingent” incentive designs (those based on health measures rather than on completing activities) are an either/or proposition. That is, you can either earn (this amount) by (achieving a clinical standard) or by (participating in or attaining an alternative standard). This editorial examines the merits and demerits of organizational health contingent use of incentives. It is posited that employers can best satisfy a voluntariness standard in their use of financial incentives in wellness programs when the use of incentives are well integrated into a measurably robust, organizational culture that visibly values health; and when all employees are well versed in the meaning of, and opportunities for, reasonable alternatives for earning an incentive. Concerns about the administrative burden behind this idea and other potential unintended consequences of including measures of a culture of health to meet a voluntariness standard are also presented.