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Evaluation of the Healthy
Savings Program: A Novel Health
Insurance-Based Program to Incent Healthy
Food Purchases
Presenter: Xuyang Tang
Acknowledgements
Coauthors:
Angela Fertig
Simone French
Jean Abraham
Julian Wolfson
Melisa Laska
Mary Ann Honors
Lisa Harnack
Partners:
University of Minnesota
Medica Research
Institute
Solutran Inc.
INTRODUCTION
Background
 Food prices = barrier to choose healthier
foods
Calorie-
dense
Price
Background
 Previous literature
Price-
sensitive
people
Cheaper
healthy
foods
Buy more
healthy
foods
Background
 Policy implication
Price of
healthier foods
People’s
nutritional
quality
Purpose of This Study
 Evaluate a program that provides financial
incentives to program members to
purchase healthy foods.
Healthy Savings Program (HSP)
 Developed by Solutran Inc.
 Offers price discounts on healthy foods on
an ongoing basis
◦ Improve quality of grocery store purchases
 1st of its kind
 Potential to be distributed nationally
◦ Warrants thorough evaluation
Healthy Savings Program (HSP)
Members
receive
discounts
Food
manufactures
Grocery
stores
Health
insurers
Healthy Savings Program (HSP)
Weekly
discounts on
selected
items
$5-10 per
week
voucher on
fresh
produce
Totally
weekly
savings
Healthy Savings Program (HSP)
 HSP card
◦ To swipe at stores’ checkouts
 HSP website
◦ Weekly discounts/coupons
◦ Recipes
◦ Personal saving records
 HSP Emails
Research Objectives
• To determine HSP’s participation rate &
level of participation among those invited
to participate.
• To compare the demographic and health-
related characteristics of program
participants in comparison to non-
participants.
DESIGN & METHODS
Sample
 Randomly selected 400 Medica members
◦ Whose employers participate in HSP option of
providing $5/week discount on fresh produce
Recruitment
 Dillman method
◦ Initial mailing
 3 weeks
◦ 1st post card reminder
 3 weeks
◦ 2nd post card reminder
Web Survey
 140 respondents
◦ Completed by primary grocery shopper of the household
◦ Response rate: 35%
 62 questions
◦ Food shopping behavior
◦ HSP-related
◦ Technology use
◦ Health and nutrition
◦ Demographics and socioeconomic status
Telephone Interview
 40 participants were asked open ended questions
◦ Out of 74 survey participants who consented to participate
in the interview
 Regular HSP card users (n = 21)
◦ Use HSP card 2-3 times per month or more on average
 Limited HSP card users (n = 9)
◦ Use HSP care 1 time per month or less on average, or have
discontinued use
 Non-HSP card users (n = 10)
Telephone Interview
Regular & Limited Users
• General opinion on HSP
• Foods purchased with
HSP
• HSP’s effect on choice of
foods & frequency of
shopping
• Ease of using card
• Ease of finding out about
discounted foods
• Likes & dislikes about
HSP
Non-Users
• General opinion on HSP
• Why not use HSP
• Ideas to improve HSP to
increase future use
RESULTS
Demographic Characteristics
Table 1: Demographic characteristics & HSP card use of survey respondents (N = 140)
%
Female 77.1
Non-Hispanic White 92.1
Age (years)
25-34 21.4
35-44 20.0
45-54 25.0
55-71 31.4
Highest level of education
High school graduate or some college 14.3
Associate degree 9.3
Bachelor’s degree 36.4
Masters, professional or doctoral degree 37.1
Body weight
Normal or underweight (BMI < 25) 47.1
Overweight (25-29.9) 29.3
Obese (BMI > 30) 17.9
Ever used HSP card – Yes 69.3
Use of HSP Features
Table 2: Use of HSP card in past 6 months (N=140)
HSP card use – Yes 67.1 %
Ever receive emails from HSP – Yes 77.9 %
Visited HSP website – Yes 71.4 %
1.4%
13.6%
7.1%
20.7%
25.7%
Never 1-6 times About 1
time a month
2-3 times a
month
1 or more
times per
week
HSP Card Use of All Survey Participants
Figure 1. HSP card use categories, based on frequency of use
Use of HSP Features - Website
Access list of
products and
discounts
69%
Find nutritional
information
8%
Find recipes
11%
Check personal
savings records
12%
Figure 2. Purpose of using HSP website
HSP Users v.s. Non-Users
Table 3: Comparison of demographic and health characteristics of those who
have used the HSP card and those who have not
Users
(%)
Non-
Users
(%)
p
Demographics & SES
Female 82.5 65.0 0.03
Non-Hispanic white 91.8 92.5 0.88
Age < 45 38.1 50.0 0.2
Bachelor’s degree or higher 84.5 87.5 0.66
Annual household income > $75,000 71.1 62.5 0.32
Health-related characteristics
Weight status: overweight/obese 51.5 57.5 0.53
History of heart disease, hypertension, diabetes, or high
cholesterol
59.8 47.5 0.19
Shopping characteristics
Frequently (or all the time) use coupons for food shopping 55.7 30.0 0.006
Shop at participating stores at least once a month 95.9 67.5 <0.001
Dietary behavior, mean of frequency/day
Fruit and vegetable intake 3.9 2.5 0.003
Sugar sweetened beverage intake 0.2 0.2 0.47
Reasons for Not Using HSP Card
41.9%
37.2%
23.3%
14.0%
9.3%
4.7%
Cannot use card at stores I regularly shop at
Don’t usually buy the discounted products
Hard to know which items are discounted
Not enough of a discount
Never heard of HSP
Never received HSP card
Figure 3. Reasons for not using the HSP card among survey respondents in study who
reported not using the HSP card
Telephone Interview - Summary
 Most liked features
◦ $5 fresh produce discount
◦ Ease of using the card at check outs
 Need to improve
◦ Selection of participating stores
◦ Selection of discounted products
◦ Information of discounted items
DISCUSSION
What we learned from this study
 High participation rate for a voluntary
wellness program
◦ 69% reported using the program card
 Of whom 26% use the card at least once a week
What we learned from this study
Strengths
• Found what appeals
to people
• Rewards
• Savings
• Found areas to
improve for HSP
• Selection of stores
• Selection of products
Weaknesses
• Hard to know what
are discounted from
HSP
• Non-representative
population
• Caucasian
• Higher education
• Higher income
Recommendation and Next Step
Recommendations to HSP
• Keep fresh produce discount
• Increase the number of participating stores
• Provide hard copies (e.g. flyers) of discounted items at
stores
Next Step
• To evaluate HSP’s effect on behavioral change
• Select a more price-sensitive population
Thank you!

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Evaluation of the healthy savings program

  • 1. Evaluation of the Healthy Savings Program: A Novel Health Insurance-Based Program to Incent Healthy Food Purchases Presenter: Xuyang Tang
  • 2. Acknowledgements Coauthors: Angela Fertig Simone French Jean Abraham Julian Wolfson Melisa Laska Mary Ann Honors Lisa Harnack Partners: University of Minnesota Medica Research Institute Solutran Inc.
  • 4. Background  Food prices = barrier to choose healthier foods Calorie- dense Price
  • 6. Background  Policy implication Price of healthier foods People’s nutritional quality
  • 7. Purpose of This Study  Evaluate a program that provides financial incentives to program members to purchase healthy foods.
  • 8. Healthy Savings Program (HSP)  Developed by Solutran Inc.  Offers price discounts on healthy foods on an ongoing basis ◦ Improve quality of grocery store purchases  1st of its kind  Potential to be distributed nationally ◦ Warrants thorough evaluation
  • 9. Healthy Savings Program (HSP) Members receive discounts Food manufactures Grocery stores Health insurers
  • 10. Healthy Savings Program (HSP) Weekly discounts on selected items $5-10 per week voucher on fresh produce Totally weekly savings
  • 11. Healthy Savings Program (HSP)  HSP card ◦ To swipe at stores’ checkouts  HSP website ◦ Weekly discounts/coupons ◦ Recipes ◦ Personal saving records  HSP Emails
  • 12. Research Objectives • To determine HSP’s participation rate & level of participation among those invited to participate. • To compare the demographic and health- related characteristics of program participants in comparison to non- participants.
  • 14. Sample  Randomly selected 400 Medica members ◦ Whose employers participate in HSP option of providing $5/week discount on fresh produce
  • 15. Recruitment  Dillman method ◦ Initial mailing  3 weeks ◦ 1st post card reminder  3 weeks ◦ 2nd post card reminder
  • 16. Web Survey  140 respondents ◦ Completed by primary grocery shopper of the household ◦ Response rate: 35%  62 questions ◦ Food shopping behavior ◦ HSP-related ◦ Technology use ◦ Health and nutrition ◦ Demographics and socioeconomic status
  • 17. Telephone Interview  40 participants were asked open ended questions ◦ Out of 74 survey participants who consented to participate in the interview  Regular HSP card users (n = 21) ◦ Use HSP card 2-3 times per month or more on average  Limited HSP card users (n = 9) ◦ Use HSP care 1 time per month or less on average, or have discontinued use  Non-HSP card users (n = 10)
  • 18. Telephone Interview Regular & Limited Users • General opinion on HSP • Foods purchased with HSP • HSP’s effect on choice of foods & frequency of shopping • Ease of using card • Ease of finding out about discounted foods • Likes & dislikes about HSP Non-Users • General opinion on HSP • Why not use HSP • Ideas to improve HSP to increase future use
  • 20. Demographic Characteristics Table 1: Demographic characteristics & HSP card use of survey respondents (N = 140) % Female 77.1 Non-Hispanic White 92.1 Age (years) 25-34 21.4 35-44 20.0 45-54 25.0 55-71 31.4 Highest level of education High school graduate or some college 14.3 Associate degree 9.3 Bachelor’s degree 36.4 Masters, professional or doctoral degree 37.1 Body weight Normal or underweight (BMI < 25) 47.1 Overweight (25-29.9) 29.3 Obese (BMI > 30) 17.9 Ever used HSP card – Yes 69.3
  • 21. Use of HSP Features Table 2: Use of HSP card in past 6 months (N=140) HSP card use – Yes 67.1 % Ever receive emails from HSP – Yes 77.9 % Visited HSP website – Yes 71.4 % 1.4% 13.6% 7.1% 20.7% 25.7% Never 1-6 times About 1 time a month 2-3 times a month 1 or more times per week HSP Card Use of All Survey Participants Figure 1. HSP card use categories, based on frequency of use
  • 22. Use of HSP Features - Website Access list of products and discounts 69% Find nutritional information 8% Find recipes 11% Check personal savings records 12% Figure 2. Purpose of using HSP website
  • 23. HSP Users v.s. Non-Users Table 3: Comparison of demographic and health characteristics of those who have used the HSP card and those who have not Users (%) Non- Users (%) p Demographics & SES Female 82.5 65.0 0.03 Non-Hispanic white 91.8 92.5 0.88 Age < 45 38.1 50.0 0.2 Bachelor’s degree or higher 84.5 87.5 0.66 Annual household income > $75,000 71.1 62.5 0.32 Health-related characteristics Weight status: overweight/obese 51.5 57.5 0.53 History of heart disease, hypertension, diabetes, or high cholesterol 59.8 47.5 0.19 Shopping characteristics Frequently (or all the time) use coupons for food shopping 55.7 30.0 0.006 Shop at participating stores at least once a month 95.9 67.5 <0.001 Dietary behavior, mean of frequency/day Fruit and vegetable intake 3.9 2.5 0.003 Sugar sweetened beverage intake 0.2 0.2 0.47
  • 24. Reasons for Not Using HSP Card 41.9% 37.2% 23.3% 14.0% 9.3% 4.7% Cannot use card at stores I regularly shop at Don’t usually buy the discounted products Hard to know which items are discounted Not enough of a discount Never heard of HSP Never received HSP card Figure 3. Reasons for not using the HSP card among survey respondents in study who reported not using the HSP card
  • 25. Telephone Interview - Summary  Most liked features ◦ $5 fresh produce discount ◦ Ease of using the card at check outs  Need to improve ◦ Selection of participating stores ◦ Selection of discounted products ◦ Information of discounted items
  • 27. What we learned from this study  High participation rate for a voluntary wellness program ◦ 69% reported using the program card  Of whom 26% use the card at least once a week
  • 28. What we learned from this study Strengths • Found what appeals to people • Rewards • Savings • Found areas to improve for HSP • Selection of stores • Selection of products Weaknesses • Hard to know what are discounted from HSP • Non-representative population • Caucasian • Higher education • Higher income
  • 29. Recommendation and Next Step Recommendations to HSP • Keep fresh produce discount • Increase the number of participating stores • Provide hard copies (e.g. flyers) of discounted items at stores Next Step • To evaluate HSP’s effect on behavioral change • Select a more price-sensitive population