I'll be gone, you'll be gone: why American employers underinvest in health.

It has become increasingly common to hear a business case for wellness that emphasizes the benefits of having a healthy workforce. This is essentially the same as the case for employers to train their workers; training a worker and investing in the health of the worker both represent a productivity-enhancing investment in the worker by the firm. The problem is that the employer frequently fails to capture the returns on the investment. A healthier or better-skilled worker can command a higher wage and threaten to leave the firm making the investment. This risk of failing to capture the gains from investment produces underinvestment in skills and, by the same mechanism, should produce underinvestment in workforce wellness. We further divide wellness into positive and negative policies: Positive wellness is an investment, expenditure on the workforce in expectation of future increased returns, or perhaps better recruitment and retention. Negative wellness is an effort to reduce the wage bills associated with ill health with, for example, co-pays. Most stable and meaningful employer wellness programs are likely to be negative wellness programs that reduce the effective wages of the sick.