American companies systematically report the rising cost of health insurance is a major concern. Indeed, it is the biggest expense related to personnel, and the the cost of health insurance has consistently increased faster than inflation.

Surveys show that large self-insured employers have adopted a variety of strategies to reduce healthcare costs (e.g. move to high deductible healthcare plans) and, more productively, improve the value of healthcare spending (e.g. reduce cost sharing by employees for the value of services and drugs). The vast majority also offer wellness benefits to improve the health of their employees. Nonetheless, many of these efforts have been in vain: As healthcare costs continue to rise, the most rigorous studies of wellness programs show little effect on health outcomes, and evaluations of individual interventions to improve the value of health spending show no single solution Systematically reduces healthcare costs without compromising the quality of care or the health of employees.

How company policies are contributing to employee illnesses and rising healthcare costs is largely missing from the conversation about rising employee healthcare costs. Shift work and long working hours (for example, 12 hour shifts) increase employees’ risk of chronic illness, and our work has shown that this ultimately contributes to significant excess health care spending for companies. For an American manufacturer employing 2,600 shift workers, these costs were $ 1.3 million annually. Companies try to ensure safety in the workplace and prevent immediate injuries, in accordance with the requirements of the US Department of Labor Occupational Safety and Health Administration. However, relatively little emphasis has been placed on mitigating the chronic long-term health effects of shiftwork.

Perspectives of business leaders on shiftwork

We spoke with leaders in manufacturing healthcare benefits and employer healthcare coalitions in February and March 2021 and learned two things. First, companies rarely take health concerns and health expenses into account when making decisions about work schedules. While employee preferences are taken into account, shift policies are created based on production needs. Often, operations managers, who make decisions about production and shiftwork, and health delivery managers in human resources departments who focus on improving health and well-being while maintaining control. expenditure control, are disconnected. In some companies, they may not communicate at all. And their goals are often in conflict.

Second, the 24/7 production cycle, which requires shift work in manufacturing, is unlikely to change, despite new information about the high cost of shift work. One person we interviewed in February 2021 said: “We couldn’t produce enough [product] without teams… and we cannot afford to leave the machines on standby for 12, 16 hours a day… This would double the cost of [the product]. “

Recommendations

Given the inevitability of shift work in manufacturing and many other industries, we offer several recommendations. First, we encourage employee awareness of the link between shiftwork and chronic illness, as many of the employees we spoke with preferred 12 hour shifts. Initiating a discussion on the health effects of shiftwork seems to be a natural role for unions and other stakeholders who defend workers’ interests. A better understanding of the link between shiftwork and chronic disease risk may lead some workers to rethink their support and willingness to engage in shiftwork.

Second, business leaders in general management and human resources and production departments can recognize and resolve the mismatch between production and welfare goals. While efforts to improve health and wellness through employee benefits are well-intentioned, they are likely ineffective for a workforce prone to chronic disease because of their work. Shift work leads to higher healthcare costs, and companies could better direct their wellness efforts toward more intensive interventions that directly address circadian misalignment, sleep restriction, and social misalignment, which probably drive the negative effects of shift work.

Third, research should focus on interventions to mitigate the health effects of shift work. Research results must be practical and actionable to make it easier for employers to identify and select interventions with the strongest evidence and the greatest likelihood of improving the health of shiftworkers. It would be useful to have clear indications on the shift work schedules are the least harmful to workers.

However, the ability of researchers to produce this information will depend on the willingness of employers to participate in research trials and to randomize employees into different interventions, which many employers have historically avoided doing. Additionally, university-industry partnerships are more common in agriculture, engineering, physics, and chemistry than in healthcare, and companies rely heavily on benefits consultants to shape their healthcare strategies and of well-being. More experimentation is therefore needed to identify the best solutions to mitigate the health effects of shift work, and academic partners and other researchers are well placed to lead this work.

Policymakers in the United States, and the United States Department of Labor in particular, have largely been “Do not touch” on shift work. Instead, they focused on regulating overtime pay standards and limiting work hours for certain workers (for example, flight crews and commercial drivers). In Denmark, the National Council for Accidents at Work ruled that women who worked nights for an extended period and developed breast cancer were entitled to compensation from their employer’s insurance programs. Such payments are unlikely in the United States, but if future studies reveal a strong link between shiftwork and Medicare spending, which we suspect to exist, interest in regulating shiftwork – or for providing health interventions for shift workers – could increase to reduce Medicare. expenses.

Our work is supported by the Robert Wood Johnson Foundation (RWJF) through his Action policies program, which identifies policies, laws and other system and community levers in the public and private sectors that can support RWJF’s vision of working with others to build a Health culture. In support of this goal, our work has shown that shiftwork is harmful to workers and leads to excessive healthcare costs, but opportunities exist in several sectors to mitigate its damage.

Related reading

“A Business Case for Improving the Well-Being of Essential Shift Workers,” by Megan McHugh, Claude R. Maechling and Jane L. Holl, GrantWatch section of the Health Affairs Blog, October 28, 2020.