Do health insurer or health-system–sponsored gym memberships, fitness benefits, or personal training programs reduce overall healthcare utilization or total healthcare costs?

Health Insurer and Health System-Sponsored Fitness Programs: Impact on Healthcare Costs and Utilization

Comprehensive, multicomponent worksite and insurer-sponsored fitness programs that include physical activity programming can generate improvements in health, reduce absenteeism, and generate a positive financial return, though evidence for direct healthcare cost reduction remains mixed and depends heavily on program design and adherence. 1

Evidence for Cost Savings and Healthcare Utilization Reduction

Documented Cost Reductions

Systematic reviews demonstrate significant financial savings in terms of reduced absenteeism and medical costs among nonrandomized trials of physical fitness programs. 1 The magnitude of documented savings includes:

• Immediate return of $2 to $5 per dollar invested in exercise programs, particularly when implemented as part of comprehensive health promotion initiatives 2
• Average reduction of $344 per person per year in total healthcare costs associated with community-based comprehensive programs, driven by decreased health service utilization and improved health status 1
• Physical activity is associated with reduced medical costs, especially for women, with cost reductions becoming more significant with increasing age 1

Healthcare Utilization Outcomes

In South Africa's largest private health insurer study (n=948,974), participation in fitness-related activities within an incentive-based wellness program was associated with lower hospitalization costs and admission rates across all activity levels compared to inactive members. 3 The study demonstrated:

• Lower hospitalization costs per member in all activity groups (low, moderate, and high active) compared to inactive groups 3
• Reduced admission rates correlating with increased fitness activity participation 3
• Strong agreement between fitness participation levels and overall wellness program engagement 3

Pulmonary rehabilitation programs showed decreased inpatient hospital days, decreased home visits, and produced cost per quality-adjusted-life-year ratios within bounds considered cost-effective. 1

Critical Limitations and Caveats

Mixed Evidence on Direct Healthcare Expenditures

A major limitation exists: recent systematic reviews concluded that while health outcomes show sufficient evidence of effectiveness, little support was found for direct impact on healthcare expenditures, and productivity-related outcomes remain promising but inconclusive. 1 This represents a significant divergence in the evidence base.

The evidence for healthcare cost reduction is stronger in nonrandomized trials than in rigorous controlled studies, suggesting potential selection bias and confounding. 1

Participation Barriers

Fitness program participation rates are generally low, limiting population-level cost savings. 3 In the South African insurer study:

• 80% of members were classified as inactive (≤3 gym visits/year) 3
• Only 7.4% achieved high activity levels (>48 gym visits/year) 3
• 90% of those nominally engaged in wellness programs were also low active or inactive 3

Physicians recommend health clubs to only 41% of patients and personal trainers to only 21% of patients, despite favorable views of these venues, primarily due to concerns about expense and convenience. 4

Program Design Factors That Influence Effectiveness

Comprehensive Multicomponent Approach Required

Success depends on comprehensive, multicomponent programs that address multiple organizational levels—only 6.9% of worksites offer truly comprehensive programs. 1 Effective programs must include:

• Health education with supportive physical and social environments 1
• Integration into organizational structure 1
• Linkage to related programs and screening 1
• Leadership support, relevance to participants, and partnership integration 1

Cost-Effectiveness of Specific Models

Brief counseling, green prescription, and exercise-referral strategies have proven cost-effective. 1 For example:

• National exercise referral program in Wales showed cost-effectiveness ratio of £12,111 per quality-adjusted life-year gained 1
• Significant cost savings occurred in fully adherent participants (62% of sample) 1
• Programs were particularly cost-effective for participants with mental health and cardiovascular disease risk factors 1

Combined diet and physical activity programs cost approximately $400 per participant for structured programs like the YMCA Diabetes Prevention Program. 1

Implementation Considerations

Insurance Coverage Impact

Program uptake increases greatly when health insurers (private or public) cover participation costs. 1 Examples include:

• Montana's collaboration with Medicaid to reimburse program sites for enrolled participants 1
• Increasing numbers of private insurance companies reimbursing for program delivery 1
• Many employers providing programs as covered health benefits 1

Clinical-Community Integration

Clinical-community links for physical activity promotion can augment effectiveness and help promote maintenance of intervention effects. 1 However:

• Less than 50% of older adults report that physicians have recommended exercise 1
• Bridging the gap between clinicians and fitness professionals remains a significant implementation challenge 4

Evidence Gaps and Research Needs

More evidence based on actual data is needed on costs and benefits of programs implemented in community or primary care settings, including cost-effectiveness, cost-utility ratios, and cost-benefit ratios. 1 Specific gaps include:

• Relative effectiveness in different populations 1
• Long-term sustainability and maintenance effects 1
• Costs associated with recruiting eligible participants, which may be high 1
• Pragmatic implementation experiences for sustainable models integrated into modern healthcare delivery 1

Bottom Line for Clinical Practice

While fitness programs show clear health benefits and some evidence of cost savings, the magnitude of healthcare cost reduction varies substantially based on program comprehensiveness, participant adherence, and insurance coverage of participation costs. The most reliable evidence suggests immediate returns of $2-5 per dollar invested 2 and average annual savings of $344 per person 1, but these figures come primarily from nonrandomized studies with potential selection bias. Healthcare systems and insurers should prioritize comprehensive, multicomponent programs with insurance coverage of participation costs to maximize both health outcomes and potential cost savings. 1