A pre-employment medical check: Is it required?

Pre-employment health screenings do little in the way of saving a company money, writes Stephen MacLaren



The issue of pre-employment health screenings always stirs up debate. The big question, of course, centres around the value of the exercise. In some cases it is obvious: certain jobs – particularly those involving physical labour – could be dangerous for someone with a certain condition. In such a scenario it is just as much about protecting the individual as it is about protecting the company.

And then there are pre-employment health checks carried out on white collar executives. Many questions must be put forth here. What, in particular, are we looking for? What do we do if we find something significant? What about the moral or legal aspects?

Pre-employment health screenings are in fact not allowed in many countries. Section 60 of the Equality Act 2010 in the United Kingdom, for example, makes it unlawful to even ask questions about health and disabilities prior to making a job offer. The only exceptions are if it is intrinsic to the work concerned, it is an occupational requirement of the job to be disabled, or the employer is asking in order to comply with law or best practice regarding recruitment of disabled people.

However, I am not looking at the moral or legal debate. I am instead looking at some of the research done around the issue to try and draw conclusions on whether pre-employment medical checks offer value to the companies carrying them out. The conclusions I drew are that they do not.

A barrier to talent

One problem, many researchers have found, is that rigid health screenings can be an unnecessary barrier to finding and employing talent. For example, a large prospective study of 270,000 employees of Bell, an American telecommunications company, revealed no excess in coronary heart disease in workers in higher management or with the greatest responsibilities (that is, jobs where stress levels are perhaps considered to be higher).

If, then, a health check revealed a prospective senior management candidate may be at risk from coronary heart disease, on what basis would he or she be disregarded when such studies imply that there is no link between coronary heart disease and job role.

It could be argued that the position is an important one and there would be concern about the person being unable to fulfil duties if their condition worsens, which could then have a significant impact on the company. But then we get into the “ifs” and the “scenarios” discussions, and that could, depending on the laws, put the organisation in a potential legal situation.

In theory, the goal of the pre-employment examination is to determine whether an individual is fit to perform his or her job without risk to him or herself or others. But despite this focused objective, a 2004 study by Harris et al found that testing often exceeds this scope. Indiscriminate testing inevitably yields findings that are not relevant to the job requirements, but which can nonetheless result in unnecessary rejection of otherwise suitable candidates or delay employment – and not to mention cause unnecessary expense.

The cost savings fallacy

Indeed, unnecessary expense is one thing employers want to avoid, and it’s another main reason that some companies carry out pre-employment health checks. But research has consistently indicated that these health screenings do little in the way of saving a company money.

A 1992 survey in the United States titled ‘Blood pressure and fitness for work’ found that 68 per cent of occupational physicians reported certifying candidates with hypertension as unfit because their inclusion in the workplace would “increase the company’s health insurance premium”. Yet the cost of this increase was far outweighed by the costs involved in screening and the subsequent renewed employment drive.

A study by Hessel & Zeiss examined the value of medical assessment examinations used for pre-employment and found that very little benefit was realised. Only 1.7 per cent of examinations resulted in diagnoses considered to be significant according to defined criteria. And there are question marks over this ‘defined criteria’ too.

Another study by Serra et al in 2006 analysed all published research relating to fitness-for-work examinations between 1996 and 2005 and concluded that “there were few to no validated criteria or research that would support the efficacy of screening”.

And yet another study, ‘The pre-employment examination – worth its cost?’, found that there was no difference in future rates of absenteeism as a result of pre-employment examination findings. A follow-up study using retrospective chart reviews also found no significant effect on employee longevity, workers’ compensation claims experience, or the utilisation of healthcare resources by those that had been deemed ‘potentially problematic’ in a healthcare context.

Similar findings abound for mental health issues, too. Certainly mental illness in the workplace is an important issue and is taking on an ever-increasing significance in today’s high stress work environment. But a 2000 study by Glozier et al concluded that screening for common mental disorders during a pre-employment process was “pointless”, and that even in the case of depression and anxiety there is no empirical evidence regarding variables that might predict successful employment.

Health screenings, not pre-employment health screenings

For many organisations, the ritualistic use of pre-employment examinations might occur because of an ingrained ‘compliance mentality’ – boxes must be ticked and papers filed away, regardless of context or purpose. Given what the research tells us about the apparent lack of effectiveness of these screenings, however, these are policies that should be reconsidered.

But this is not to say pre-employment health screenings serve no purpose. That is, if you are doing them for a different reason, then maybe there is a value to be had. For example, more forward-thinking companies are adopting pre-employment health screenings – or rather screening at the start of employment – not as a method of granting or denying employment, but as an indicator of future health outcomes and, subsequently, costs.

Understanding the employee’s health status upon entry to the company provides valuable data that can be used as part of the overall goal of working towards a healthier workforce. Knowing the general health of your company means you can initiate wellness programmes that focus on the common problem areas such as high blood sugar, high blood pressure, obesity, etc. There is nothing wrong with gathering such information at the start of employment.

But of course this shifts the argument entirely to where the focus should be – which is carrying out health screenings in general for all staff (or at least a representative sample), whether they are new to the company or not, and with the main purpose of improving the overall health situation of the organisation through targeted wellness initiatives.

From this viewpoint, we can even say that health screenings are in fact essential for companies. Using them to get a picture of the health of the company is a necessary first step in knowing what wellness initiatives make most sense.

And all of this is tied to what I have touched upon a number of times in my articles already: If companies do not work with their employees on improving overall health through wellness initiatives that lead to healthier lifestyle choices, we are unlikely to see any significant change for the better on the cost front.

We can talk about the rising costs of procedures or medicines all we want, but the reality is that only by reducing the need for these through healthier living will we fix this broken system.

Stephen MacLaren is head of regional sales employee benefits at Al Futtaim Willis