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Goleva, O.I., Goleva, L.I. (2024). Cognitive distortions in human self-preservation and health-saving behavior in the context of evaluating the economic effectiveness of an employer's investments in employee health. Finance and Management, 4, 268–293. https://doi.org/10.25136/2409-7802.2024.4.72696
Cognitive distortions in human self-preservation and health-saving behavior in the context of evaluating the economic effectiveness of an employer's investments in employee health
DOI: 10.25136/2409-7802.2024.4.72696EDN: ZYUGHLReceived: 12-12-2024Published: 27-12-2024Abstract: Modern approaches to assessing the effectiveness of investments are based on the theory of rational choice, and the same applies to investments in health. At the same time, a person’s real behavior differs from rational behavior. The purpose of the study is to propose scientifically based methodological approaches to taking into account the characteristics of health-saving behavior of workers to increase the effectiveness of measures to reduce health risks. The object of the study is the working population and the characteristics of its health-saving behavior as a factor in the economic efficiency of measures to reduce health risks. Based on Russian and foreign studies, the provisions on cognitive distortions that cause negative features of self-preserving and health-preserving behavior (including patterns of self-destructive behavior) are summarized. Approaches to identifying the characteristics of health-saving behavior of employees of an economic entity, as deviations from rational behavior, have been formed on the basis of cognitive distortions formulated in the scientific literature that are characteristic of making a person’s choice in matters of health. An algorithm is proposed for analyzing the characteristics of such behavior (as deviations from rational behavior) and taking into account their impact on assessing the economic effectiveness of preventive measures and developing measures to improve their effectiveness. Criteria for the effectiveness of measures to manage the effectiveness of preventive measures, developed taking into account the characteristics of the health-saving behavior of the organization's team of employees, are formulated (based on the calculation of the total effect and result per unit of invested funds, both in the organization of the event itself and in the implementation of measures to improve efficiency). Keywords: investing in health, investment efficiency, disease prevention, health risk management, reduce health risks, self-preservation behavior, health-saving behavior, behavioral economics, cognitive biases, behavioral patternsThis article is automatically translated. Introduction Evaluation of effectiveness and efficiency, including economic efficiency, of projects, measures, activities, etc. are based on the provisions of the theory of rational choice, where an individual's behavior and choice are determined by the principles of maximizing profits while minimizing costs and risks, choosing the optimal option from available alternatives, taking into account the time value of money in relation to the effects significantly delayed in time and others . Such an idea of human behavior leads to the fact that measures and measures (for example, to reduce health risks) with proven effectiveness for health depend on a person's choice (his decision to participate or not, openly or covertly sabotage proposed activities, etc.), and the implementation of corporate disease prevention programs is not always effective.. At the same time, modern scientific approaches to the analysis of human choice in conditions of risk and uncertainty (within the framework of behavioral economics) suggest that people are limited in their rationality by cognitive distortions. People act irrationally, but this irrationality is not individual, unidirectional and, most importantly, predictable. Cognitive distortions will be understood as repeated errors in perception and thinking that lead to deviations (from the rational model) in behavior (forming certain behavioral patterns). Thus, the issue of how to take into account the peculiarities of the health-saving behavior of a team of employees caused by cognitive distortions becomes relevant for the management of an economic entity in order to correctly assess the effectiveness of investments in employee health and develop measures to improve the effectiveness of preventive measures. Behavioral economics and health-saving behavior: points of intersection in foreign studies The founders of behavioral economics are D. Kanneman and A. Tversky [1, 2], who described irrationality in human decision-making as quite predictable. To date, there are from 100 to almost 200 variants of cognitive distortions that characterize certain patterns in human behavior. One of the most popular and visual attempts to present the variety of types of human cognitive distortions is made in the Code of Cognitive Distortions, which contains 151 paragraphs [3]. In the specified list of 151 items, all cognitive distortions are divided into 4 blocks.: 1) "When there is a lot of information" (Information: filtering information); 2) "When there is not enough meaning" (Meaning: connecting dots and filling in the gaps with what we think we know); 3) "When we remember and remember" (Memory: we can't remember everything so we have to use it efficiently); 4) "When we react quickly" (Speed: making decisions based on new information). The uniformity of such a classification is ensured through the individual's attitude to information: choosing information from a set for analysis, filling in missing information, "recording" and reproducing information in memory, using information for decision-making). The systematization of examples of cognitive distortions directly related to health in a systematic review by Reed K. L., Harvey E. M., Everly C. J. looks more concise [4]. The same authors note in later works that social and cultural factors cannot be excluded from the analysis: "When we are not sure, we tend to follow social norms, compare ourselves with others who are similar to each other, or respond to environmental signals" [5] (Table 1). Table 1 – Examples of Behavioral Economics Terms and Concepts in Health-Related Decision-Making [5]
Behavioral economics highlights how various unhealthy behaviors can be conceptualized in terms of behavioral choices, in which relatively unhealthy options are constantly chosen over alternatives that promote health. Two decision-making processes that behavioral economics research has shown are integral to understanding these suboptimal choice models: delay, discounting, and elasticity of demand"[6]. It is noted that more than half of health disorders occur due to the behavioral consequences of "unhealthy" choices [7]. This is explained by the importance of a healthy lifestyle (proper nutrition, regular physical activity, adherence to sleep patterns, quitting smoking and alcohol, etc.) in the formation of self-preserving and health-preserving behavior. It is these points that often become the basis for examples of cognitive distortions – when people prefer delicious food or other pleasures today to a healthy body "tomorrow", exaggerating the risk of vaccination against the background of the risk of disease, etc. [8]. In addition to the research area "on motivation and/or lack thereof for a healthy lifestyle", the topic of vaccination and the reasons for avoiding it before the Covid-19 pandemic [9, 10, 11] and especially after it [12, 13, 14] has become a significant scientific body. There are three groups of cognitive biases in relation to vaccination: cognitive biases caused by processing information related to the vaccine; cognitive biases caused by making a decision about vaccination; cognitive biases caused by previous beliefs about vaccination. In general, the high perceived risk of vaccination itself reduces the desire to get vaccinated. Of particular interest in this topic is the experience of the USA and Great Britain, where issues of behavioral patterns in relation to the health of the country's population have emerged from the sphere of scientific research only [15] (and a significant proportion of authors of scientific publications on this topic are from these countries [16]) and they formed the basis of the methods of "Nudging" applied at the national level. Realizing that "in the UK, behavioral and lifestyle factors are considered the main factors in about half of all deaths (smoking, unhealthy diet, excessive alcohol consumption and sedentary lifestyle, diabetes, organ donation problems)," a "nudge" method and a "guided choice" system were proposed and implemented in various areas of life. a human being [17]. Knowledge of the cognitive distortions present in the formation of self-preservation and health-preserving behavior makes it possible to "influence" human decision-making in such matters as donation, participation in health insurance programs with the participation of the state and private insurance plans [18]. There are also direct forms of impact, including financial ones, which is being actively studied by foreign authors, but the role of financial incentives "in reducing the burden of disease is potentially limited, given the available evidence that the effects dissipate after three months after the removal of incentives" [19]. Russian authors on human behavior in relation to their own health: research directions General behavioral practices of the population. Health care is of interest to researchers and managers, both at the level of individual companies and territories, and at the level of countries. For example, in 2019, the Public Opinion Foundation conducted a study aimed at studying the attitude of Russians to take care of their health and the relationship of this attitude to their health behavior, health status and other significant aspects of their lives [20]. There are "three main components for a healthy lifestyle.": cognitive (interest in information about how to take care of health), emotional (self-assessment of whether the respondent pays enough attention to his health and the desire to increase this attention) and behavioral (self-assessment of the extent to which the respondent pays attention to his health). Based on the materials of this FOM study, a study was conducted by I. V. Zhuravlev and E. S. Petrenko, who note a clear difference in the behavior of "independent" (in relation to their health) and "dependent" (on external factors) respondents, 31% and 20% of all respondents, respectively. "As for the motivation to take care of health, the main difference is observed in the leading motive – for the "independent" it is "to stay healthy longer", while for the "dependent" it is "to improve health" [21]. In general, Pokida A.N., Gazieva I.A., Zybunovskaya N.V. in the study of behavioral practices of the population in the field of health maintenance, they note: "Most of the respondents believe that they lead a healthy lifestyle ..., but some of them, despite classifying themselves as leading a healthy lifestyle, continue, for example, to smoke or drink alcohol regularly" [22]. Platova I.D. notes a number of factors that cause the appearance of cognitive distortions, such as: emotional, social, motivational [23]. Behavioral practices of various socio-demographic groups. A large number of works are devoted to the practices of health-saving behavior in different socio-demographic groups: youth (often students), men and women (in comparison), people of retirement and pre-retirement age, etc. So, in different cultures, the attitude of men and women to their health and the health of the family may differ. Domestic authors, as a rule, note the greater importance of health for women and attention to it (willingness to engage in disease prevention) than for men [24, 25]. It should be noted that this observation in domestic practice has led to the fact that in large companies that pay great attention to investments in human capital and in the health of employees, in particular, the "approach" to male employees in matters of health and disease prevention is often carried out through the involvement of wives (families), which increases the effectiveness of preventive measures. "Despite the importance of using behavioral change measures, the sustainable overcoming of gender stereotypes lies in the intersection of behavioral and socio-economic determinants of health and healthy behavior" [26]. At the same time, the behavioral patterns of young girls differ from the behavior of women. Mekhova G.A., Protsenko O.I. note "the discrepancy between the desire of girls to be beautiful and healthy and specific actions aimed at improving health" [27]. Researchers are also interested in the older generation. In the work of Vlasova E.M., the main patterns for the motivation of health and work longevity among workers of harmful industries of pre-retirement and retirement age are formulated. It is stated that "the main positive patterns of motivation for health and work longevity for workers of pre-retirement and retirement age were job stability, job satisfaction; negative patterns were lack of interest in life, fear of losing their jobs. The main positive health patterns for the workers in the comparison group (young workers) were the opportunity for self-realization and self-improvement, motivation for success; negative patterns were not pronounced. Health for employees of both groups has a low status in the hierarchy of values, the attitude towards illness is unconstructive; there is no pronounced internal motivational pole of health preservation" [28]. A particular interest in cognitive biases in making decisions about one's health in different gender and age groups arose against the background of the Covid-19 pandemic and the need to be vaccinated [29]. For example, Ryaguzova E.V. identified the following cognitive distortions in decision-making about vaccination among students: "exaggeration of personal awareness, the illusion of competence, imposed delusions, egocentric distortion, the illusion of control, illusory correlation, cognitive dissonance." [30]. In general, it is noted that "95% of the population has at least one element of a destructive nature in their behavior ..., 26% of young people do not take any measures to preserve and strengthen their health" [31]. Economic aspects of personal health and financial incentives. Life as the main value of a person (or one of the most important) and his health have been repeatedly evaluated, including in order to determine rational human behavior [32]. At the same time, the revealed cognitive distortions in the perception of short- and long-term effects, the illusion of control, and so on disrupt this perception. Although, "according to the majority, the most acceptable methods of financial encouragement, according to the survey results, include: reduction of the insurance premium for life insurance, reduction of the insurance premium for accident and disease insurance, addition of 2 days to annual leave, payment of sick leave with a coefficient of 1.2, sale of medicines at a 20% discount, preferential right, all other things being equal, to receive vouchers to sanatoriums and other places of treatment and recreation, etc." [33]. It is important to note that the ethical issues of using such incentives are not considered, unlike, for example, the work of foreign researchers [34, 35]. Behavioral patterns in health risk assessment (cognitive biases as a determinant of health). It is noted that "the assessment of the risk associated with the impact of behavioral factors on health can be performed using qualitative, semi-quantitative and quantitative methods. In cases where the necessary numerical data for expressing hazard factors and parameterizing their relationships with health responses are not available, qualitative and semi-quantitative assessment methods are used. Their main task is to substantiate strategies for transforming the behavior of individuals, to establish priority measures to inform the population about the risk associated with the implementation of a low level of self-preservation behavior" [36]. Mechanisms of "pushing". As a result of studying the features of health–saving behavior (a field of study for economists and managers in the field of public and corporate health), taking into account cognitive distortions and corresponding patterns of behavior in planning preventive measures to increase their effectiveness has become the next step for scientists and managers. At the same time, there is little experience in using such mechanisms – "a comparison of the results of a search query made in Russian and international scientific databases shows that in There are practically no scientific experimental studies conducted in Russia on the role of Nudge tools in popularizing vaccination, or at least they are not publicly available" [37]. Domestic publications, as a rule, are based on materials from foreign studies [38, 39]. So, among the main cognitive distortions noted by researchers in the health-saving behavior of employees of enterprises, the following are indicated: the effect of the illusion of control, ignoring a priori probability, selective perception, expectation of a positive result, emotional distortion, fundamental attribution error, short-term benefit versus long-term perspective. Thus, these deviations from rational behavior can manifest themselves in the behavior of employees of enterprises as follows: - "I note the high importance of health in the quality of life, but I do not pay attention to prevention", - "I know about preventive measures offered by the employer (and/or within the framework of compulsory medical insurance), but I don't use them", - "I note the threat, but I do not carry out appropriate prevention (viruses/ vaccines, stress/ psychological help, etc.)", - "I believe that I am engaged in prevention, but the actual behavior refutes this", - "I think that disease prevention measures are necessary (the employer should offer them), but I don't need them (or vice versa, only I need them)." The main approaches to the formation of the "architecture of choice" based on knowledge about cognitive distortions and patterns of behavior (caused by them), they are presented in the concept of "nudging" [4, 15]. "Nudges" is a general term for something that guides a choice without limiting it. The various forms of nudges include: frames, silences, reducing "friction" (easing efforts), reminders and checklists, rewards/penalties, simplification (reducing cognitive load in decision-making), decision-making tools, and other tools for understanding and explaining probabilities. So, according to research data, the features of self-preservation and health-saving behavior of employees (often caused by cognitive distortions and social factors) can have an impact on the economic effectiveness of measures aimed at reducing risks to the health of employees of the organization, but from a methodological point of view, this issue has not been sufficiently studied. Taking these features into account when planning and evaluating the expected effectiveness of measures aimed at reducing health risks (including economic efficiency) will lead to a more accurate prediction of the effects of such measures, which will make it possible to reasonably plan and manage their effectiveness. The specifics of the health-saving behavior of the team in assessing the expected economic effectiveness of the employer's investments in the health of employees and managing the effectiveness of these activities The analysis of the specifics of the health-saving behavior of employees of enterprises should become an important component of a correct assessment of the relevance of the measures proposed by the employer aimed at reducing the risks to the health of employees and, accordingly, a component of assessing the economic effectiveness of these measures. It should be noted that this analysis is necessary in the economic assessment of the effectiveness of planned measures (in assessing the expected effects and/or adjusting the effectiveness criteria). The assessment of the economic effectiveness of the implemented measures (based on actual data) does not require an adjustment of the calculation, since it already takes into account the actual health-saving behavior of the company's employees in the activities carried out. Expected effectiveness is usually assessed based on assumptions about the rational behavior of individuals in relation to one of the main values in their lives – health. That is, this approach rarely takes into account the subjectivity of a person in these events (including those initiated not by the person himself, but by the state and/or the employer). However, an employer can fully exclude human subjectivity in assessments (and base management decisions on the rational behavior of employees) only for those preventive measures that do not require active human participation in their implementation. Let's also pay attention to the fact that excessive measures to increase the effectiveness of measures aimed at reducing the risks to workers' health can lead to negative results (to a decrease in the effectiveness of these measures). Berinato S. notes: "Many wellness programs caused employees to feel guilty and anxious" [40]. Thus, an adjustment in the assessment of the economic effectiveness of measures aimed at reducing health risks will be required only for planned activities (expected effectiveness) and, at the same time, requiring active human participation in them (Table 2). Table – 2 Criteria for the need to adjust the calculation of the economic effectiveness of measures aimed at reducing health risks, taking into account the characteristics of the health-saving behavior of employees of the enterprise
The peculiarities of the health-preserving behavior of the company's staff (including those dictated by cognitive distortions) are manifested in the formation of groups that differ in the degree of rationality of self-preserving and health-preserving behavior (from completely rational to destructive). Such a quantitative assessment will make it possible to calculate the relevance of the proposed measures aimed at reducing the health risks of the company's employees, and, as a result, the expected economic effectiveness of these measures. A general algorithm for analyzing the features of health-saving behavior and their impact on the economic effectiveness of measures to reduce the risk to workers' health is shown in Fig. 1.
Fig. 1 Algorithm for analyzing the features of health-saving behavior and their impact on the economic effectiveness of measures to reduce the risk to workers' health Source: compiled by the authors. The main methods in determining the characteristics of the health-saving behavior of employees of the enterprise are sociological methods. Depending on the size of the team, different methods of sociological research can be used (observation, questionnaires, in-depth interviews, or combinations thereof). Thus, the survey is usually conducted anonymously (using remote technologies). The goal is to interview all employees of the organization (or to form the necessary representative sample [41, 42]). It is necessary to take into account the specifics of the enterprise itself when preparing for the analysis of the health-saving behavior of employees of the enterprise (in the selection of methods of sociological research and the formation of the content of questionnaires / questionnaires).: - the size of the enterprise (for the choice of methods of sociological research), - the level of education of the staff (to assess the general background of health–saving behavior in the formation of the questionnaire - "educated people take more careful care of their health, strive to lead a healthy lifestyle") [43, 44, 45], - income/salary level (large financial resources provide great opportunities to seek paid medical care and follow a healthy lifestyle) [46, 47], - industry and/or type of activity (special health requirements are typical for certain industries or types of activities, that is, attention to one's own health may be dictated by professional requirements) [48, 49], - the company's established behavioral practices in relation to health, including among different groups of employees (active adherence to a healthy lifestyle, ignoring proposed preventive measures, practices of self-destructive behavior, etc.). The content and general context of the questionnaire or questionnaire are largely determined by the purpose and initiator of the survey formulated for the respondents. For example, employees may be interviewed to evaluate the work of the relevant department of the organization (whose functions include planning and organizing preventive measures) or an outsourcing company, to find out how well employees are informed about the employer's proposals in caring for the health of employees, or to get an opinion on which information channels are most preferable in this matter and ave. In the general list of questions about the awareness and/or needs of employees, questions are formulated that reveal people's choices other than "rational behavior" in a format that allows the respondent to remain in the field of socially acceptable answers. These may be responses that confirm a deviation from rational choice, but contain a "valid" reason for such behavior [50, 51]. The content of the questionnaire or questionnaire includes several basic blocks "a – z" (or individual questions) necessary for the study (used in Table 3): a) information about the respondents (department, gender, age, etc.); b) self-assessment of health and assessment of the importance of health for a person; c) self-assessment of lifestyle and adherence to the principles of a healthy lifestyle; d) identification of significant threats and risks to one's own health; e) awareness of preventive measures (including the context of a particular enterprise and industry); f) the relevance (lack of demand and its causes) of measures proposed by the state and the employer for the prevention of diseases; g) requests and needs (in preventive measures) for the organization's staff; h) requests and needs (in preventive measures) for yourself personally. These blocks of information make it possible to study the features of the health–saving behavior of employees of the enterprise according to the main deviations ("1-4") (used in Table 3): 1. The importance of health and the relevance of preventive measures. 2. Deviations from rational behavior in relation to health. 3. Awareness of preventive measures and their relevance. 4. Collective needs and personal needs (in health care). The analysis of the survey results will allow us to examine deviations in the following parameters: - the importance of health and the relevance of preventive measures; deviations from rational behavior in relation to health – to quantify the correction factor in the economic assessment of the effectiveness of measures aimed at reducing the risk to the health of employees of enterprises; - awareness of preventive measures and their relevance; collective needs and personal needs (in health care) – for qualitative analysis and development of measures to improve the effectiveness of measures aimed at reducing risks to the health of employees. Table 3 – Comparison of information blocks (indicated by letters)b in the study of the characteristics of the health-saving behavior of the company's employees according to the main deviations (indicated by numbers)
When comparing information blocks (Table. 3) deviations in the specified parameters and the proportion of respondents demonstrating behavior that differs from rational behavior are determined. Further, the groups of respondents are distinguished by the proportion of employees subject to cognitive distortions from the total number of respondents (minimum, maximum, average levels), taking into account the self-assessment of the importance of health for a person. The more important health is to a person, the more effective measures can be to increase the effectiveness of measures aimed at reducing the health risks of employees of an enterprise [52, 53]. Schematically, the distribution of the company's employees according to the specified parameters can be presented in Table 4. Table 4 – The ratio of groups of employees of the enterprise by the nature of activity in rational health-preserving behavior and the importance of health for humans, as a percentage of the total number
In the table. The 4 main groups of employees in their attitudes towards self-preservation and health-saving behavior are highlighted in color and labeled. Collectively, there are three main groups: Group A – "high degree of rationality": employees not only use everything that the employer (and the state) offers, but also take the initiative themselves and are conscious of their health (they highly exhibit rational behavior towards their own health and a high level of self-preservation and health-saving behavior). Group B is an "average degree of rationality": people who are dependent on their close environment, accept individual offers from the employer and the compulsory health insurance system and do not accept others, agree to measures that do not require their own initiative, actions and medical intervention (for example, the creation of certain working conditions). Group C – "low degree of rationality": workers who ignore or reject preventive measures, in some cases, adhere to a point of view that contradicts official medicine (example: "anti-vaccinators"). The sum of employee shares for each category is 100%. For Group A, adjustments in the assessment of expected economic efficiency are not required, and the organization of events does not require additional measures (and costs) to increase the effectiveness of measures aimed at reducing the risk to workers' health. The preventive measures proposed by the employer for this group are in demand and potentially effective (they do not require additional costs on the part of the employee himself). Group B will be less responsive to the proposals of the employer and the state, and there will be more variables in their decision-making. The effectiveness of measures aimed at reducing risks to their health will be lower than that of Group A, which must be taken into account when evaluating the effectiveness of such measures when planning them. At the same time, it is for this group that measures and methods of pushing, stimulating, informing and "bypassing or removing" cognitive distortions may be most effective. Group "C" explicitly or implicitly ignores the proposed preventive measures, and in some cases may influence the members of group "B" (if there are opinion leaders). In this group, the effectiveness of measures aimed at reducing health risks will be the least. The methods of managing the effectiveness of preventive measures in this group are extremely limited. The calculation of the correction coefficient for the indicators of the effect and result of measures aimed at reducing the health risks of the company's employees is based on the ratio of the considered groups of employees in the company's team. The impact of the number of different groups of employees on the expected economic effectiveness of measures aimed at reducing health risks and their effectiveness can be expressed through a correction factor.:
where: K is a correction factor for indicators of the effect and result of measures aimed at reducing the health risks of employees of the enterprise, depending on the ratio of groups of employees of the enterprise in terms of the degree of rationality of health–saving behavior and the importance of health for humans, in fractions; d A, d B, d C, – the shares of groups of employees of the enterprise A, B and C (according to the degree of rationality of health-saving behavior and the importance of health for humans), in shares; k B, k C is the correction coefficient of the effect and result of measures aimed at reducing the health risks of employees of the organization, calculated as the proportion of employees deviating from rational behavior in groups B and C (as the average deviation in the results of respondents' responses to the information blocks of the questionnaire: gw, ge, gj, gz). This coefficient is used in assessing the economic effects of measures aimed at reducing health risks (to the cumulative sum of effects in the forecast and post-forecast period before the discounting procedure, if applicable). Thus, the expected effect will be reduced, taking into account the peculiarities of the health-saving behavior of the enterprise's staff (the expected efficiency will also be adjusted downwards). As part of the qualitative analysis, special attention is paid to the answers to the questions "why am I not doing something" (from among the necessary preventive measures or factors of a healthy lifestyle). A variety of refusals ("for a good reason") From such events, it will be possible to identify the main cognitive distortions underlying the decisions of the company's employees (illusion of control, short-term benefit, selective perception, etc.). This information provides the necessary basis for correcting the behavior of the organization's employees in matters of disease prevention and following the principles of a healthy lifestyle (changing the channels, form or content of information, choosing methods of stimulation and/ or coercion, etc.). In accordance with the classification of cognitive biases, the recommended measures to form an "architecture of choice" and, accordingly, increase the expected economic effectiveness of measures aimed at reducing health risks to employees of enterprises may look like this: - "excess information" – frames, simplifications (cognitive load reduction), reminders and checklists; - "lack of information" – additional information (including frames), reminders and checklists; - "information selection" – simplification, easing efforts, reducing friction; - "quick solutions" – omissions, facilitation of efforts, rewards and fines, the formation of formal and informal internal health-saving policies at the enterprise and maintaining a high level of self-preservation and health-saving behavior (including involving formal and informal leaders). In calculating economic efficiency, it will be necessary to take into account the impact of the proposed measures on increasing the cost of preventive measures and increasing economic effects (in the part of group "B", which has a high management potential). Thus, a quantitative analysis of the health-saving behavior of employees of an enterprise allows us to adjust the calculation of results and effects in assessing the expected economic effectiveness of measures aimed at reducing health risks, and a qualitative analysis of the types of cognitive distortions (based on employee responses) forms the basis for developing measures to improve the effectiveness of these preventive measures. The lack of an economic assessment of the effectiveness of measures aimed at reducing health risks, or the incorrect conduct of such an assessment for an enterprise leads to a discrepancy between the result and the planned indicators. The quality of forecasting economic efficiency indicators is determined by how accurately they describe the actual result. A significant excess of the expected efficiency over the actually achieved indicators is a reason to reconsider approaches to the implementation of measures aimed at reducing risks to the health of employees at the enterprise. This becomes especially relevant for regularly recurring events. As a rule, the repetition cycle is 1 year. The general management scheme for the implementation of measures aimed at reducing risks to the health of employees of enterprises is shown in Fig. 2. The classical management scheme for the main functions (analysis, planning, implementation, accounting and control) is applicable to measures aimed at reducing the risk to the health of employees at the level of a particular enterprise.
Fig. 2 The management cycle for the implementation of measures aimed at reducing the health risks of the company's employees Source: compiled by the authors. The availability of data on the specifics of the health-saving behavior of the company's employees and the actual results of the implementation of preventive measures (for previous periods) allows us to optimize the work and not repeat this stage every time for each individual event. Also, if the part of employees that can be influenced by measures to increase the effectiveness of preventive measures is small, then the implementation of additional measures to increase economic efficiency is impractical. The criteria for the economic efficiency of the total costs (for measures aimed at reducing the health risks of the company's employees and measures to increase efficiency) are shown in Fig. 3.
Fig. 3 A general scheme for assessing the cost-effectiveness of managing the effectiveness of measures aimed at reducing health risks Source: compiled by the authors. Not all actions aimed at managing the economic effectiveness of preventive measures can be considered effective and efficient. It is important to separate the expected medical effectiveness of measures (and the increase in this effectiveness) and the expected cost-effectiveness of preventive measures and, consequently, the increase in expected cost-effectiveness. An increase in the economic efficiency of the preventive measures under consideration can be expected only if the cost of performance management does not exceed the effect of them (or the cost-per-unit ratio of the result is acceptable to the organization). An indicator of effective management of the effectiveness of measures aimed at reducing health risks is also a reduction in the cost-per-unit ratio of the result after the implemented management actions. Conclusion The proposed approach to the analysis of cognitive distortions that form negative behavioral patterns in self-preservation and health-saving behavior will allow the employer not only to take these features into account when evaluating the effectiveness of measures taken by the employer himself and to develop measures to increase their effectiveness; but also to participate more effectively (for the employer) in activities proposed by the state, having developed an appropriate system of information and motivation of employees, as well as "reducing friction" (for the opportunity to participate in these events). ___________________________________
a. The basic tools for assessing the economic effectiveness of investments in the health of employees of enterprises are presented in the monograph "Health risk analysis in the strategy of state socio-economic development", 2024 (§ 4.2) [54] b. See the notation and numbering in the table above. c. Information about the respondents makes it possible to make the comparisons under consideration in the analysis of the characteristics of the health-saving behavior of employees by individual gender and age groups or structural divisions of the enterprise. d. For example, the proportion of respondents who identify viral infections as a significant danger and do not use vaccination as a preventive measure. e. The gradation according to the level of importance (value) of health for a person is proposed taking into account the results of scientific research, which show that two thirds of respondents (in various surveys) note a high and very high importance of health in their lives (9-10 points out of 10) and, as a rule, no one evaluates the importance of health on at the level of 4 points or less [55, 56, 57]. f. Respondents indicating one or more patterns of destructive behavior (refusal of vaccination, refusal to follow the principles of a healthy lifestyle, refusal of medical examinations, etc.) are taken into account. g. Respondents who do not demonstrate patterns of destructive behavior are taken into account, indicate a desire to follow the principles of a healthy lifestyle, but formulate barriers preventing this from happening; they prefer preventive measures, participation in which does not require difficulties (can be carried out at their place of work). h. Respondents who demonstrate fully conscious behavior regarding their own health are taken into account (implementation of preventive measures proposed by the state and/or enterprise, desire to follow the principles of a healthy lifestyle); absence of patterns of destructive behavior. i. See Table 3. References
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