I know several doctors and hear stories of their non-compliant patients. Those who know their behaviors will cause more sickness or even death, but they do nothing. There was even one case of a man who 3 times was scheduled for a life saving surgery (Medicaid so free to him) and never showed up. Some people just commit slow suicide.
Well, that was kind of my point. For some reason, people respond less to incentives* with respect to health habits than in many other domains.
*Not just monetary ones like the medical bills. You would think that people would not want to subject themselves to the misery of lung cancer, bypass surgery, vision degradation, loss of mobility, etc…
How about neither. People who smoke should pay more because statistically they have more health problems and more expense than people who don’t.
The problem is the linkage between the incentives and expenses. The more direct link, the more likely change. But for some, nothing will make them change.
Frightening that they are amassing so much data on each of our personal habits and awful that rates are perhaps raised because of it.
Well, of course, the answer is, Yes, but just not by many… And that is great for the (rare?) individual that undergoes a behavior change. However, the collective costs of such wellness programs far exceeds the medical expenses reduced/saved by those rare individuals that undergo behavior change. In other words, on a cost-benefit analysis, the costs exceed the benefits. Moreover, since the wellness/preventive benefits are priced into the Insurance Plans, everyone pays more so a few will benefit. (Maybe that’s ok, but just clarifying.)
I’m not so sure about that. What are the incentives a fat person has to lose weight? She faces social scorn and sometimes outright abuse. She faces discrimination in employment. She has more trouble finding on trend clothing to fit her. She is more at risk for many serious health conditions. Perhaps she has health conditions related to her fat, that could be ameliorated or eliminated if she lost weight. If she lost weight she could climb Old La Honda Road faster on her bike. And yet, she has not lost weight.
Now you say she will face social scorn and abuse, discrimination in employment, difficulty finding fashionable clothing, higher risk of health dangers, slow Old La Honda time, AND she will have to pay $200. You haven’t increase her incentive very much, because her incentive was already enormous and yet it wasn’t enough.
I foresee a not too distant future where insurers first offer an an incentive for constant wearing of a watch-like monitor for health stats and soon afterwards come to require it for coverage or use it to determine cost. High tech companies are all over medical monitoring devices, seeking non-invasive ways of tracking as much as possible. While I can see how helpful it could be to an individual for self-monitoring, it raises my blood pressure to contemplate how this is could be utilized by insurers, particularly as consumer protections are diminishing.
Not sure why it looks like you are trying to contradict what I wrote, since you just gave a confirming example of a rather enormous (not necessarily monetary) incentives for someone to make a particular health-related choice, but the person does not make such a choice. (Yes, employee wellness incentives are typically piddly in comparison to such existing incentives.)
Oh my. It’s called elastic vs inelastic behaviors (or needs.) You think raising the price of gas keeps people from driving? Maybe some. Not all.
I protect my privacy as best I can and advised the kids to. But for heavens sake, being on CC or other media or buying online leaves your behaviors open to scrutiny, too. Or, I bought a freaking product that’s a little hard to find, in person, and the ads started showing up on my devices two days later. I paid with a credit card and it linked my purchase to my device. I don’t get a receipt at the market and it comes to my email. You don’t think they can use that purchase info?
Protect what you can. There aren’t yet fully laws to control this. If there ever will be.
In some (most?) states, a higher premium for smokers is allowed. But here’s the catch: to eliminate that higher premium, the insured simply has to sign up for a smoking cessation program. That’s it! Doesn’t have to succeed at it! I’m not even sure if they have to complete it.
And as for the wellness programs…our city employees had a wellness program where they had to use a city recreation center for lower premiums. One high ranking employee was caught faking it. And who thinks there isn’t LOTS of cheating in these wellness programs?
Our benefits broker, a long-time expert in healthcare benefits, calls wellness benefits as low costs “feel good” for the employer, as a way to show some concern for ee’s wellbeing.
But, from a purely actuarial perspective, they make little sense. Even if that obese person in Fang;s example starts to lose weight, the benefits may be years away. But, as we all know, most folks will have multiple careers/jobs over a lifetime. So, the current employer won’t see any benefits. Perhaps the next or the next-next employer will. (Or, even Medicare if that now-obese person keeps their future weight down to more healthier numbers.)
The ACA allows states to allow higher premiums for individual insurance for smokers. For individual insurance, there is no provision to eliminate the penalty by signing up for smoking cessation programs. This penalty has had the effect of discouraging young smokers from signing up for insurance. We want to encourage young people to sign up for insurance (basically, to subsidize older people) and young smokers have about the same health costs as young non-smokers, so this is a bad effect.
The data collection power of the insurance companies is frightening. We have even paid for certain prescription drugs full pay cash and not thru insurance, for example we did this when one of our kids had a short term need (thankfully) for anti-anxiety meds. I was too afraid that this diagnosis could come back to haunt her because as much as the companies (insurers and employers) tell you these things are confidential, they are not always. Lastly, if you go full-pay cash, some pharmacies will give you their lowest negotiated (via insurers) rate, but you have to ask, push and negotiate too. Always ask them to search for coupons as well.
I certainly don’t believe we be able to reign in all of this tracking data, across the many companies and industries. For now, I try to limit programs I sign up for at my insurance company/employer, minimize facebook use and utilize incognito windows in my search engine often. Still isn’t 100% but I don’t get as many pop-up ads as I used to.
I was speaking about my state, and this is a small group plan. The point was that the higher premium for smokers is easily eliminated by enrolling in a smoking cessation program, with no results required.
"uwalummom: Our company was sold in February. We had excellent insurance, low premiums, low copays, low max out of pocket. Well, no more! When we switch in January, we will have huge premiums, huge deductible and huge max out of pocket. Worst of all, drugs come out of your deductible - no copay drug plan.
Anyway, back to the topic - the premiums are huge, but you can consent to health screening and for each “health goal” you meet, they will lower your premium by a step. Tobacco use, blood pressure, cholesterol, glucose, and BMI.
They may not be calling it a penalty, but it sure seems like one… "
I agree that you are being penalized for not being willing to share your personal medical information with your insurer. They cannot use penalties but they can use “incentives”. So, what they are doing is redefining “incentive”. If it is really a penalty, which this is, if they call it an incentive, they are able to either extract more money or get you to cough up your personal medical information. This “incentive” can be used to lower the premium for the company if they have enough lower risk people in a category. Employers are stepping up the demands. At first it was a questionnaire, then medical tests, now it is becoming outcomes (i.e. you must lose X pounds, or drop X points in cholesterol, etc).
So we are actually much worse off now than years ago, when we had lower premiums AND retained complete medical privacy in the workplace. Premiums are still skyrocketing AND we are all being data-mined and categorized as desirables and undesirables. No one will insure or even hire those “higher risk” (which could be solely a risk, never realized) people as this continues.
But wait. I was told the ACA was going to solve all of that.
People who buy individual insurance and who have pre-existing conditions are better off now than they were. This could change with new legislation or regulations, but being able to buy insurance is better than not being able to buy insurance.
But we already had protections for pre-existing conditions in Maine. And it’s frustrating that when you follow the rules and work hard, you’re penalized. We buy individual insurance and are worse off. We’ll be over $2,000 a month in premiums for three people next year. It’s absurd.
The most expensive, sickest people cost a fortune. If insurers can exclude them, premiums will be a lot lower for everyone else, but the sick people won’t get health care. It’s a trade off.
Reinsurance can save a bit. States should adopt it.