Lessons for Small Business: Incentive Health Care and Risk Rating Practices


  • Suzanne Milburn State of Kansas
  • Ray D. Siehndel Washburn University
  • Joe Singer University of Missouri - Kansas City


As the health care system reform debate  continues, the central challenge of bringing nearly 38 million uninsured American workers under a quality health care plan remains the goal. Another objective that remains clear is that the plan to be implemented will follow the employer-based model which Americans' employers have crafted for over fifty  years.  Small business owners will be mandated to provide health insurance  to all  workers,  including  those who work part-time. This paper examines the health care incentive measures and risk rating practices perceived to be effective cost  control mechanisms for small business firms. Conclusions concerning a  well-designed  incentive program  are offered  within  the context  of the  Americans   With Disabilities  Act.


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Bri n k, S. Heal th R isk and Behavior; The Impact on Med ical Cos1 s

(Brookfield Wisconsi n: Mi l l i man and Robertson, I nc .. 1 987).

Brannen. K. And T. Begley, "The A1ncri cans Wit h Disabil i ties Act: What i t Means to S1nal l

Busi ness Owners", Journal of Small Busi ness Strategy. Vol. 6, No. I , Fal l 1 995: 79- 88.

Brisl i n, J. "The Effect of t he An1cricans Wi th Disabi l it ies Act Upon Medical

Insurance and

Empl oyee Bcncl'its" Em ployee Benefits Journal (March 1 992): 9-1 3.

Bu rner, Sal l y T., et. Al., Health Care Fi nanci ng Review (Fal l 1 992 )

Chapman, L. "R isk Rated I nsurance: Who's Risk and Who is at R isk ''" Paper presented at the

annual n1ccting of the Association i n Busi ness, San l)icgo, c:ali fornia. 29-3 Scptc1nhcr th

rough October 1 992.

Eisenberg, L. ··The Perils of Preven t ion: A Caut i onary Note,'' ]Jew

England Journa l of

Medici ne 297, No. 22 (December 1 977): 1 230-1 232.

"Employers' Cost for Employees Soar, "Nat i on 's Busi ness (May 1 992): 62.

Golaszcv.'ski , T. Et al , ''Integrated Health Care Cost Managen1cnt Strategy" Benefi ts Quarterl y

( fi rst q uarter 1 992): 41 -50.

Green, L. And Johnson. K . ''Heal th Edut:at ion and Hea l t h Pron1otion," Handhook of Health.

Health Care, and the Health Professions, ed. D. Mechanic (New York: The Free Press, 1983):


Hcrzl i ngcr. R . And Schwa11z . .I. How Co1npanics Tack l e Health Cat e Costs.

·'Part I , Harvard

Busi ness Review 63 ( 1 985): 69-81 .

Kael i n, M. ct al , ''Risk-rated Heal th Insurance Progra1ns: A Revi ew l)f Designs and

I111portant Issues," A1nerican Journal of Hea lth Pron1ot ion 7(2) ( Novcn1her/Decen1hcr 1


1 8-1 28.

K ah1nan. R . "'Costs and Benefi ts of Corporate Health Pron1ot ion," Fi t ness i n

Busi ness 2

( 1 987): 39-44.

Knowles, J. ''The Responsi bi l i ty of the Indi v idual." i n Doi ng Better and Feeling

Worse ed. H.

K nowles (New York: W.W. Norton 1977).

Lewis, S., "Life Under the ADA: Big Problem, or no Problem'!" Employee Health and

Fi t ness, Vol. 1 4, No. 1 0, (October 1 992): 134-136.

Penner, M. And Penner, S. ''Hospital Uti l i zat ion of Tohacco Users Vs. Nonusers i n an

H MO,''

Healt h Val ues (Jan uary/February 1 992): 1 7-22.

Penzkovcr, R. "Health Incenti ves Hel p Cl amp Costs," Personnel Jou rnal 68 ( 1 989): 1

4-1 1 8. Pol zer, K. "Strategi cs to Contai n Healt h Care Costs," Busi ness and Hea

lth 8 ( 1 990): 30-38. Priester, R . "Arc Fi nancial Incenti ves Pai r'!'' E1nploycc Benefi ts

Journal , (March 1 992).

State of Kansas Employee Ncwslellcr, KANSAGRAM 8 (Apri l 1 991 ): 3.

Stone, D. "At Risk i n t he Wel fare State." Social Research 56, No. 3 (Aut um n 1 989): 624.

"Study Li n ks Smok i ng, Genes," Lawrence Journal-World, 1 7 September 1 992. Sec. 72B, p.

Sugarman, S. "Employer Discri m i nation Against Workers wi t h "Unheal thy Li

festyle" I ndicators: Sonic Legal and Pol icy Issues,'' The Chal lenge of Financial Incent i ves

and Risk Rat i n g: A Col lect i on of Essays and Case St udies, ( March 1 992): 31 -37.

Terry, P. "A Dangerous Innovat i on," Healt h Manager's Action (25 February. 1 991 ): I , 8-9.

"Potential Pitfalls of Financial Incenti ves: The Costs of Try i ng lo Buy Behavior Change," The

Challenge of Financial Incen ti ves and Risk Rati n g: A Collecti on of Essays and Case St

udies, Washi ngton D.C. Washi ngton Business Group on Health (March 1 992): 1 9.

Vaughan, Terri M. And Diana Reed, "Heal th Care Benefi ts - The Banc of Small Busi nesses: What Do

We Really K now?", Journal of Busi ness and En trepreneurship, Vol. 4, No. I , March, 1 992: 91-92.

Veatch, R. "Vol untary Risks to Health," Journal of the American Medical Association 243,

No. I (4 January 1 980): 50-55.

Vi ckery, D. cl al. "Li festy le and Organi zat i onal Heallh Insu rance Costs." Journal of

Occupational Med ici ne, Vol. I 1 , No. 2 ( 1 994): 1 1 65-1 1 68.

Warner, K. El al. "Economic Implications of Workplace Health Promoti on Programs: Review of

the Li terat ure," Journal of Occupational Medici ne 30 ( 1 988): I 06-1 1 2.

Washi ngton Busi ness Group on Health. The Chal lenge of Fi nancial Incenti ves and

Risk Rating: A Collection of Essays and Case St udies. ed. Sonia Muchnick-Baku (March 1 992): 7:

-5 1.

Wi klcr, D. "Who Shou ld be Blamed for Bei ng Sick?" Healt h Education Quarterl y

4, No. I (Spri ng 1987): 1 1 -25.

Wi lliam, J. "Financi al Incenti ves for Heal thy Lifestyles: Accou ntabi li ty and Equ i ty," The

Challen ge of Fi nanci al Risk Rati n g: A Collecti on of Essays and Case Stud i

es (Washi ngton D.C.: Washi ngton Busi ness Group on Health. 1992): 21 -23.

Woolsey, C. ''E1nploycrs Moni tor Li festy les: Fi nancial Incent i ves for Wel l ness

Gain Favor,"

Busi ness Insu rance 1 7 (February 1 994): 3-6.

---. "Off-duty Conduct: None of Employer's Busi ness." Busi ness I nsu rance 1 7

(February 1 992): 1 1 .

Yen. L., Ed i ngton, D. And Witti ng, P. "Associations Between Heal th Risk Appraisal Scores and

E1nployee Medical Clai n1s Costs i n a Manufacturi ng Co1npany. American Journal of Health

Promotion 6 ( I ) ( 1 991 ): 46-54.




How to Cite

Milburn, S., Siehndel, R. D., & Singer, J. (1995). Lessons for Small Business: Incentive Health Care and Risk Rating Practices. Journal of Small Business Strategy, 6(2), 97–108. Retrieved from https://libjournals.mtsu.edu/index.php/jsbs/article/view/321