Paying Employees to Lose Weight
如果老板出錢，你愿意減肥嗎？

IF your employer offered you $550 to lose weight, an amount that would be deducted from your health insurance premiums next year, would that provide the motivation to help you finally shed those pounds?

如果你的雇主愿意出550美元（約合人民幣3500元）讓你減肥，這筆錢將從你明年的健康險保費(fèi)中扣除，這樣的激勵手段可以幫助你最終減輕體重嗎？

Roughly four out of five large employers in the United States now offer some sort of financial incentive to employees to improve their health. The Affordable Care Act has encouraged the creation of such programs by significantly increasing the amount of money, in the form of a percentage of insurance premiums, that employers can reward (or take away) to improve factors such as body mass index, blood pressure and cholesterol, as well as for ending tobacco use.

在美國，大約五分之四的大型雇主現(xiàn)在都向員工提供某種形式的財務(wù)激勵，希望以此改善他們的健康。為了鼓勵雇主推出這種方案，《平價醫(yī)療費(fèi)用法案》(Affordable Care Act)以在保費(fèi)中扣除一定比例的形式，大幅增加了雇主可以獎勵（或扣除）的金額，只要員工改善了身體質(zhì)量指數(shù)、血壓、膽固醇等指標(biāo)，以及停止吸煙，就可獲得。

These programs make intuitive sense. But do they work?

直觀來看，這種方案很有道理。但是它真的有效嗎？

We and several colleagues recently conducted a yearlong trial to test whether the promise of $550 off next year’s health insurance premium, paid out over the course of that year, could motivate employees to lose weight. After one year, as we recently reported in the journal Health Affairs, employees randomly assigned to a control group that received no financial incentive had no change in their weight. But employees who were offered a $550 premium reduction didn’t lose weight either.

我們和幾個同事近期進(jìn)行了一個為期一年的試驗，測試第二年健康保險費(fèi)減除550美元的做法，是否可以激勵員工減肥，這筆錢會在一年的時間中分期發(fā)放。就像我們在《健康事務(wù)》雜志(Health Affairs)上的報告中寫的那樣，一年以后，沒有參加財務(wù)獎勵方案的隨機(jī)員工對照組在體重上沒有變化。但是參加了550美元方案的員工們也沒能減肥。

One reason that these rewards were ineffective was that they were provided too far in the future. If you lose weight today you may not receive any reward until next year. Next year is a long way off, particularly if there is a cookie in front of you right now.

導(dǎo)致這種獎勵無效的一個原因是，它顯得太過遙遠(yuǎn)。如果今天你減肥，你可能直到明年才能拿到獎金。明年顯得遙遙無期，特別是當(dāng)一塊餅干就擺在你面前的時候。

A second reason was that while a premium discount of $550 sounds motivating, it is only about $20 per biweekly paycheck. What’s more, that $20 is typically deposited directly into a bank account that you may never review carefully, and even if you did, is bundled with your total paycheck and the total funds in your account. A delayed incentive broken up into small increments and directly deposited among much larger amounts of money is not likely to overcome the forces that have always made losing weight hard.

第二個原因是，雖然550美元的保費(fèi)折扣聽起來很激勵人心，但換算下來相當(dāng)于每兩周20美元。更重要的是，這20美元通常直接存入一個你可能永遠(yuǎn)也不會去仔細(xì)查看銀行賬戶，即使你查看了，它在你的賬戶中也是和總薪水和資金總額捆綁在一起的。一種拖延的、被分成小塊的、和更大的金額放在一起的激勵措施，不太可能克服一直橫亙在減肥路上的障礙。

This doesn’t mean that workplace financial incentives to promote health can’t be effective. But it does suggest that adjusting people’s health insurance premiums is not a good way to motivate them to lose weight. Such incentives need to be designed better.

這并不意味著用財務(wù)獎勵來改善健康的方式行不通。但它確實表明，調(diào)整人們的健康保險費(fèi)并不是激勵他們減肥的好方法。這種激勵方式在設(shè)計上有缺陷。

Financial incentives can work well — if they are separated from insurance premiums. In recent years, we’ve studied other weight-loss interventions in employees, using similar amounts of money, that did work. In a study published in 2013 in The Annals of Internal Medicine, we found that you can encourage weight loss if you put employees in groups in which only those who succeed in achieving a monthly weight-loss goal get rewarded. This works, probably because people hate the idea of seeing others in the group collect a prize that might have gone to them if only they had tried a little harder.

財務(wù)獎勵舉措可以十分有效，前提是要與健康險保費(fèi)分開。近些年來，我們研究了其他利用相同數(shù)目的資金干預(yù)員工減肥的奏效方案。在《內(nèi)科學(xué)年鑒》(The Annals of Internal Medicine)2013年發(fā)表的一篇論文中，我們發(fā)現(xiàn)如果將員工分組，只有那些成功完成每月減肥目標(biāo)的員工可以獲得獎勵，就能夠鼓勵員工減肥。這之所以行得通，可能是因為人們不愿意看著組里的其他人獲得獎勵，而如果他們再努力一點，獎勵就可能是他們的。

Another example: Two of us (Professors Asch and Volpp) and colleagues conducted two large studies, one at General Electric and another at CVS, published in The New England Journal of Medicine in 2009 and 2015, respectively. Both studies found that participants who received cash or checks of $750 to $800 over the year quit smoking at triple the rate of a control group.

另一個例子：我們當(dāng)中的兩個人（阿施教授和沃普教授）和同事們在通用電器(General Electric)和CVS公司開展了兩項大型研究，研究結(jié)果分別于2009年及2015年在《新英格蘭醫(yī)學(xué)期刊》(The New England Journal of Medicine)發(fā)表。兩項研究都發(fā)現(xiàn)，一年中為了獲得750美元到800美元現(xiàn)金或支票而戒煙的人數(shù)是對照組的三倍。

And last month, we published a study online in The Annals of Internal Medicine that tested ways to encourage employees to be more physically active. A group of 281 employees were given a goal of taking at least 7,000 steps a day, measured using the accelerometers in their smartphones. By random allocation, some employees were assigned to the control group and were just given feedback about their step counts. Another group could earn $1.40 every day the 7,000-step target was reached — that’s $42 per month. Those in a third group were told that each month they would start with $42 in an account and $1.40 would be taken away every day they didn’t meet the goal (though no participant could end up worse off financially than when he started).

上個月，我們在《內(nèi)科學(xué)年鑒》網(wǎng)站發(fā)布研究論文，這項研究測試鼓勵員工積極運(yùn)動的方法。281名員工要完成每天至少走7000步的目標(biāo)，通過智能手機(jī)上的傳感器計算步數(shù)。通過隨機(jī)分配，一些員工被分到對照組，只能得到有關(guān)其步數(shù)的反饋。另一組員工如果每天完成7000步的目標(biāo)，可以獲得1.4美元——每月總計42美元。第三組被告知相關(guān)賬戶每月初始就會收到42美元，但如果沒有達(dá)到目標(biāo)，每天就會扣除1.4美元（但沒有哪個參與者最終的金融狀況會比開始時差）。

From a purely economic standpoint, the motivation for these last two groups ought to be the same: In each case at the end of the month you are $1.40 richer for each day you walked at least 7,000 steps. But from the standpoint of human psychology, there’s an important difference, for as much as people like to earn $1.40, they really hate to lose $1.40 — a phenomenon known as “l(fā)oss aversion.”

純從經(jīng)濟(jì)角度來看，后兩個組的積極性應(yīng)該是一樣的：月底的時候，每天步行至少7000步都會讓他們多得1.40美元。但從人類心理學(xué)的角度來看，有一個重要的不同點，那就是人們雖然喜歡掙1.40美元，他們更加不喜歡損失1.40美元。這種現(xiàn)象叫“損失規(guī)避”。

We ran the study for three months, and even with regular feedback, employees in the control group achieved the step goal only 30 percent of the time. Employees who earned $1.40 for every day they met their goal achieved the step goal 35 percent of the time — a figure statistically no different than that of the control group. By contrast, those who stood to lose $1.40 for every day they didn’t meet their goal achieved that goal 45 percent of the time.

我們的研究持續(xù)了三個月。即便有著定期反饋，對照組的員工只有30%的時間完成了步數(shù)目標(biāo)。那些每達(dá)到目標(biāo)一天便能掙1.40美元的員工，有35%的時間實現(xiàn)了目標(biāo)。從統(tǒng)計角度來看，這個數(shù)字和對照組的結(jié)果沒什么不同。而相比之下，那些一天不達(dá)目標(biāo)便會失去1.40美元的員工，完成目標(biāo)的時間達(dá)到了45%。

As all these studies suggest, companies can improve the health of workers, but only if they are smart about it.

正如所有這些研究表明的那樣，公司能夠改善員工的身體健康，但前提是它們得聰明一些。