Companies have spent a lot of time and money looking for the best way encourage healthy behavior among employees while keeping a lid on health care costs. Deciding whether using the carrot or the stick is better is the subject of much debate.

A contest at the University of Arizona's Eller Center for Leadership Ethics pitted teams of students from 32 colleges in the U.S. and Canada who tried to design the best program for getting employees to make healthier choices.

The outcome?

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"The final teams all proposed using the carrots," said Paul Melendez, the center's founder and assistant dean of executive education. "They weren't as interested in the stick."

The 30 judges for the competition came from large companies, government and non-profits, where, Melendez said, they have all been talking about how best to administer wellness programs that lead employees to work out, lose weight and even agree to biometric testing.

The research until now into the best approach to getting the attention of workers while watching the company bottom line has leaned toward the stick approach, such as levying penalties for not meeting certain goals. Still, the research isn't definitive.

"The wellness programs have been around for decades," Melendez said, "but the research is very new."

The Patient Protection and Affordable Care Act has prompted new interest in wellness programs by allowing companies to give employees discounts on premiums for their participation.

The law's participation provisions, however, open up ethical concerns. Melendez listed privacy as one of one of the possible problems. Employers, through wellness coaches and others employed to carry out the programs, collect sensitive health information about employees. Critics cite the risk of the information being stolen and the impinging of employee autonomy as ethical concerns.

Melendez noted that one of the students participating in the competition laid out the possible pitfalls of even a voluntary wellness program.

"Let's say you have a really well-intentioned wellness program," he said. "What if someone doesn't want to participate? If a supervisor sees that you don't want to participate, will he think you're not part of the team? There's a lot of food for thought."

The judges for the competition, Melendez said, were excited by the creativity the students used to dangle the carrot in front of students. For instance, the winning team, from Simon Fraser University in Vancouver, British Columbia, advocated that companies tap into employees to design a custom wellness plan. Penalizing employees for such things as having too large a waistline was a non-starter for the teams, including the three other finalists – the University of Texas, Boston College and Queens University in Kingtson, Ontario.

One problem facing companies seeking to help employees be healthier is that short-term costs can be high. For instance, an increase in visits to the doctor and more use of prescription drugs can raise health insurance costs. But in the long run, Melendez said, a healthier work force can lower the price of medical care.

"If employers are going to be really interested in helping their employees be healthier," Melendez said, "they need to invest in capital like a gym or better cafeteria food."

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