A staff petition at Houston Methodist denouncing the healthcare system's move to "take this basic American right away" by threatening to fire staff who refuse the COVID-19 vaccine has attracted the support of more than 4,150 signatories, reflecting thin line payers and providers walk when thinking of how to promote vaccination among employees.
"Many employees are scared that they lose their job or be forced to inject the vaccine into their body against their will to keep their jobs and feed their family," the petition reads. "We just want the power to choose for ourselves and not take this basic American right away from us!"
Houston Methodist did not immediately respond to an interview request. But the hospital system was the first in the nation to require that all of its workers get shots, setting a deadline for its 26,000 employees to be vaccinated by June 7. As of Friday, 89% of Houston Methodist employees had received their vaccination; two employees had quit over the company's vaccine mandate, WNCT reported.
"They're free to not work in healthcare," said Dr. William Parker, assistant director of the Maclean Center for Clinical Medical Ethics at the University of Chicago. "Nobody has a constitutional right to work in healthcare. That's a privilege that's earned."
Houston Methodist's vaccine mandate should set an example for hospitals, home healthcare companies and nursing homes across the country, he said, reflecting a simple extension of the flu shot mandate these workers already face. Parker called their approach of initially offering employees a carrot—a $500 bonus—to get vaccinated and then following up with a stick—termination—ideal for healthcare systems. Other hospitals like Benefis Health System in Montana have also chosen to mandate vaccination among staff.
"From an ethical perspective, mandating vaccination is acceptable from an employer perspective, but that's contingent upon them compensating employees for their time, and making the experience at least cost neutral," Parker said.
Other healthcare organizations have taken the cash-for-vaccine route—PruittHealth in Georgia is offering its long-term care employees Waffle House giftcards, Oak Valley Hospital in California is offering $300 and Memorial Medical Center employees will be eligible to win a prize. These tactics are how most insurers are promoting vaccinations too.
Cigna Corp. could pay up to $13 million in staff bonuses, after offering every employee $200 to get vaccinated. Health Care Service Corporation might invest up to $4.8 million in individual bonuses to incentivize its 24,000-member team to be vaccinated. Anthem, which operates Blue Cross and Blue Shield plans in 14 states, is also offering a financial incentive to its more than 78,200 associates, although the Indianapolis-based insurer declined to specify how much it was paying people to get vaccinated. Insurers are clearly betting that these investments will pay for themselves in fewer sick days and more productive staff, said Arthur Caplan, a professor of bioethics at the NYU Grossman School of Medicine.
But Caplan said he believes gifts rather than cash offer a greater incentive to get vaccinated. As proof, he pointed to the failure of cash reward for companies' "healthy lifestyle" initiatives that generally do not gain much participation when it comes to convincing individuals to engage in healthy practices. Moreover, paying people could actually drive vaccine hesitancy and produce a natural level of skepticism among staff, he said, like "you literally have to pay me because you think there's danger here."
"While people respond to gifts and lottery tickets and sick days, that kind of thing isn't so clear that small monetary inducements really make them change their behavior," Caplan said.
But successful or not, he did say using the record profits insurers scored in 2020 to incentivize vaccines was a good use for their excess cash. He believes insurers can write these bonuses off as medical expenses under their medical loss ratios, or MLRs, which basically measure how much a payer spends its members' care. As utilization continues to remain below normal levels, commercial insurers could start offering members cash bonuses for vaccines as a way to avoid returning excess profits to members.
"It's a good use of that even though many people would say that is a bitter irony because it's built on the back of deferred care," Caplan said.