OBJECTIVE: To explore methodological refinements in measuring health-related 
lost productivity and to assess the business implications of a full-cost 
approach to managing health.
METHODS: Health-related lost productivity was measured among 10 employers with a 
total of 51,648 employee respondents using the Health and Work Performance 
Questionnaire combined with 1,134,281 medical and pharmacy claims. Regression 
analyses were used to estimate the associations of health conditions with 
absenteeism and presenteeism using a range of models.
RESULTS: Health-related productivity costs are significantly greater than 
medical and pharmacy costs alone (on average 2.3 to 1). Chronic conditions such 
as depression/anxiety, obesity, arthritis, and back/neck pain are especially 
important causes of productivity loss. Comorbidities have significant 
non-additive effects on both absenteeism and presenteeism. Executives/Managers 
experience as much or more monetized productivity loss from depression and back 
pain as Laborers/Operators. Testimonials are reported from participating 
companies on how the study helped shape their corporate health strategies.
CONCLUSIONS: A strong link exists between health and productivity. Integrating 
productivity data with health data can help employers develop effective 
workplace health human capital investment strategies. More research is needed to 
understand the impacts of comorbidity and to evaluate the cost effectiveness of 
health and productivity interventions from an employer perspective.