Under reform, insurers will still do their best to shun the sick. Over at AlterNet, health care editor Adele Stan points to one way they may do it: by using “wellness programs” to penalize those who can’t meet health targets. If the financial penalties are high enough, some employees just won’t sign up for insurance.
Stan explains: “A little-discussed provision of the Senate bill allows insurers to expand so-called wellness programs that let insurers penalize subscribers by hundreds—and even thousands—of dollars for not meeting certain ‘wellness targets,’ such as a particular cholesterol number, blood sugar measurement or body-weight target.
“Remember all those Democrats pleading plaintively, in the face of Republican accusations that the GOP had been cut out of the health care debate, that actually they included many Republican ideas in their health care bills? Well, this is one of them. One of the pro-business innovations of the Bush administration was to introduce into health insurance regulations a provision allowing employers to offer loosely defined "wellness" programs that carry incentives for employees meeting certain standards of premium reductions of as much as 20 percent. Sounds like a pretty good deal, right? Sure, until you realize that there's no baseline for the original premium, meaning that, in reality, people who don't meet the standards are really carrying the burden of others' discounts and then some—paying as much as 20 percent more for a policy in which a family member's failure to meet a wellness target forces up the entire premium for that family's policy. . .
“‘Insurers can spot profits a mile away, and this is a loophole they will drive right through on day one,’ said Andrew Kurz, the former chief financial officer of Wisconsin Blue Cross-Blue Shield on a recent conference call with reporters convened by the advocacy group, Health Care for America Now. ‘We got into this mess because insurers unfairly targeted sick people and charged higher premiums based on illness status. To now charge lower premiums based on wellness status can lead to the same result. Like the water glass, half full or half empty, it is still the same amount of water.’
“In other words,” Stan writes, “while insurers may no longer be able to drop your coverage for a preexisting condition such as high blood pressure, under the Senate bill they will be able to charge you and your employer as much as 50 percent more for your total premium cost if you fail to meet a targeted blood pressure or cholesterol measurement.
“‘Although described as incentives, this practice actually allows employers to raise costs across the board for everyone, and then lower them selectively for those who meet certain targets,’ Nelson told reporters. ‘So incentives quickly become penalties for those who do not meet the targets, and therein lies our concern.’
“And we're talking real dollars here,” Stan adds. “Current regulations allow companies that offer wellness programs to vary costs per family policy by as much as $2,675, based on the average cost of a family plan derived from the 2009 Kaiser/HRET annual survey of health plans. Under the Senate bill, those cost differentials climb to $4,013 at the 30-percent level, and $6,688 at the 50-percent level, which would kick in later in the implementation schedule. (Find the American Heart Association’s (AHA’s) fact sheet here.”
Obesity
I would add that as regular HealthBeat readers know, obesity is a particularly complex disease. In November of 2008, I wrote about an excellent documentary film titled Fat, which introduces viewers to patients and doctors battling the disease. The idea that obesity is caused by eating too much and not exercising enough, is too simplistic,” explains Dr Robert Lustig, of the Division of Pediatric Endocrinology at the University of California, San Francisco. An expert in the field, he knows that obesity is “a chronic condition.” And we don’t have a cure.
This is why, even when patients enter medically supervised weight-loss programs, and stick with the rules, Lustig explains, “95 percent” regain whatever pounds they lose.
“Obesity doesn’t seem like a subtle disease,” adds Dr. Lee Kaplan, who heads the Weight Reduction Program at Mass General Hospital. “But it is. If something is off kilter by just 1 percent in your system that can lead to a 100 pound weight gain. More than 400 genes are involved in weight regulation. And that doesn’t include the environmental factors.”
In part 2 of that post, I quote Dr. Michael Rosenbaum, a Columbia University researcher working on an NIH-funded study on weight control who points out that “Obesity is the one disease where your body fights the cure.”
By and large, the body is programmed to help you heal. But not in this case. People think that dieting is “a matter of choice,” says Arthur Frank, medical director of the George Washington University Weight Management Program. But in fact, losing weight requires overcoming powerful brain signals that are working against you.
If you have ever dieted you may already know that, once you lose some weight, your metabolism slows down and you burn fewer calories. For all your body knows, you are stranded on a desert island, starving to death. So it tries to “help.” The brain is wired to eat and store fat to protect against starvation. In fact, when you lose weight, the human body has redundant systems to try to save you. That’s how the human species has survived.
Meanwhile, as a public health nurse points out; “Fat prejudice is the primary impediment to understanding—or wanting to understand what obesity is all about.” Physicians still know little about what causes obesity—in part because, “blaming the victim has stood in the way of understanding.” Here, I am reminded of how, in the past, we blamed patients suffering from depression and other forms of mental illness. For centuries, this prejudice stood in the way of understanding that mood disorders are caused by a flaw in chemistry, not character.
Under the wellness programs Stan describes, employees suffering from such a flaw in body chemistry would be punished.
Penalizing Employees for a Genetic Flaw
Let me be clear: the American Heart Association does not object to employer-sponsored wellness programs per se, but only to financial penalties imposed on those who don’t participate in “voluntary” wellness programs or cannot meet wellness targets. As the AHA points out; “the causes of obesity, hypertension, and high cholesterol are many, and vary between individuals.” For instance, genetic predisposition is an important factor in many conditions. Therefore, penalizing individuals for their risk factors sometimes means penalizing them for their genetic makeup which is beyond their control.
As Stan observes: “Certain ethnic and racial groups, such as African Americans and Native Americans, face genetic predispositions to diabetes and hypertension, making it far less likely that they can meet targets.”
Moreover, the AHA points out, “Even health factors that are theoretically controllable in the best of circumstances may be vastly more difficult to control for those who are: (1) low income; (2) working more than one job; (3) working parents; (4) dealing with chronic mental or physical conditions; or (5) caring for sick parents, children or other family members. There are also important environmental influences that may impose barriers to healthy lifestyles. For example, living in a neighborhood with poor public transportation, no safe walking or other exercise areas, and a food supply dominated by fast-food outlets and/or high-priced convenience stores creates significant barriers to healthy living.”
Stan concludes that what is most troubling is how the penalties zero in on “people least likely to be able to contro
l the circumstances that lead to their inability to meet wellness targets—the poor and those with genetic predispositions to certain conditions. ‘Poor people are faced with a double whammy', explains Harold Schmidt of the Harvard School of Public Health. ‘Firstly, they have to live in circumstances that make it much more difficult for them to be healthy and, secondly, it’s likely that health insurance will become less affordable for them….’"
So, unless regulators intervene, insurers will continue to discriminate against those who most need high quality, affordable care.
This is a complex issue, with the “devil” in the proverbial details. Wellness programs with unachievable goals may indeed be a gimmick to discriminate on the basis of health status, and it will be imperative to ensure the programs only provide discounts for methods that actually show themselves to work in practice rather than merely in theory, and that the premium differentials are not excessive.
On the other hand, the principle is a valid one in general, and particularly valid in a system that requires us to reduce unnecessary health expenditures by means of more than a single approach. Andrew Kurz is quoted above as stating, “To now charge lower premiums based on wellness status can lead to the same result. Like the water glass, half full or half empty, it is still the same amount of water”, but that’s inaccurate. If the wellness efforts succeed, health costs will diminish, saving the insurer money, which in principle can be passed on to the subscriber without raising premiums for those who don’t participate or meet goals.
On balance, I favor these programs because they encourage individuals to engage in health-promoting behaviors, and because they can reduce excessive healthcare costs. Rather than delete them from proposed legislation, the obligation of reform packages and their implementation will be to ensure that the programs operate as intended – rewarding healthy behaviors rather than penalizing those whose health risks are not amenable to reasonable remediative steps. This will require close monitoring, but also, of course, the operation of a competitive marketplace as well as appropriate risk adjustment measures to ensure that insurance plans that attempt to profit from discrimination against higher risk individuals do not gain an advantage over those that operate wellness programs in an appropriate manner.
Fred wrote:
“that the programs operate as intended – rewarding healthy behaviors rather than penalizing those whose health risks are not amenable to reasonable remediative steps.”
———————
I can see a lot of trouble here especially if the drug effectiveness transparency issues continue tainted and hidden as it has been. Look at all the drugs that have been advertised as safe, but later they are found dangerous. Take the statin drugs for instance. They are now touted as manna from heaven with few side effects, but I have my doubts. All these rare muscle problems do not seem so rare anymore. So what if lowering cholesterol via statins is mandated for someone who just does not trust these drugs with the current ?? evidence or that person gets a premium penalty. Should that patient be automatically penalized because of this mistrust and no obvious bad health symptoms?? I think our research criteria better be stepped way up and become totally transparent before we institute this kind of mandate/penalties.
I have no problem with employers offering incentives to their employees in the form of healthcare contribution discounts for meeting a wellness goal, so long as those who do not meet the goal outright can also receive the same discounts if they participate in a wellness program (at no monetary cost to the employee) to at least attempt to move toward a goal.
In this scenario, employees fall into one of three categories:
1) they meet the goal, get a premium discount
2) they fail to meet the goal, but choose to work towards wellness, get same premium discount
3) they fail to meet the goal, and choose not to participate in any program to work toward wellness, do not get a premium discount.
This is the setup in my workplace, and it has proven to be very popular with little pushback. The wellness programs to support those that do not meet the goal are varied and robust, from web based tools to phone counseling with certified health and wellness professionals.
Those that can’t be bothered, or choose not to participate, do so freely and pay the freight (meaning they pay the baseline employee contribution toward premiums – others receive a discount off the base premium).
I can understand that not all wellness issues such as obesity, or even smoking cessation are open to simple remedies. And in some cases, improvements may be near unachievable due to genetic, socio-economic or other factors. However, I have little sympathy for those that claim to not have the time to at least make some attempt at personal wellness improvement.
Fred–
Ideally, wellness programs would reduce costs, resulting in lower costs for everyone.
But we do have a tendency to want to punish people for being fat, smoking, etc–rather than helping them.
You write that it will be important to “ensure that hte programs don’t penalize those whose health risks are not amendable to reasonable remediative steps.”
Here, I am afraid, there would be much disagreement as to whether a depressed 50-year-old’s weight problem is “amenable to reasonable remediative steps.”
A combination of depressoin, genetics, ethnicity and poverty might well make it impossible for this individaul to lose the 40 pounds they need to lose.
While not clinicallly obeses, he or she is going to find weight loss much harder than 28-year-old affluent person who can afford to join a gym or lives in a neighborhood where it’s safe to job after work.
I’m all for trying to help people stop smoking. We can that smokign cessatoin clincs can work for many (not all) patietns, particularly if there is no co-pay and if there are free nicotine patches.
The vast majority of US adults who still smoke are poor. Many suffer from some form of mental illness–anxiety, depression, etc.
Bottom line: I’m happy to see insurers and employers use financial carrots to encourage wellness–as long as there are no
financial sticks used to punish those who can’t or won’t meet the targets.
Postiive reinforcement yes; negative reinforcement no.
But–as Adele points out– since there is no baseline for premiums I don’t quite see how we can be sure that the “bonus” for one employee isn’t really raising premiums for the less healthy employee.
Terence–
If I’m a single mother cleaning office buildilngs at night, there is a very good chance that I don’t have the time to participate in a wellness program.
I also probably don’t have a computer, or access to the Internet.
When I get home I have to get my kids ready for school, feed them breakfast–do the dishes get some sleep, pick them up after school, give them some attention, dinner, and get ready for my night shift.
If I’m a low-income male working 1 1/2 jobs, I probably don’t have time to participate in a wellness program.
There are a great many reasons why life circumstances might might this difficult–or impossible.
For a clinically depresed person, it’s often all they can do to get out of bed in the morning and get dressed.
I think it’s great if employers offer wellness programs, but once you begin tying them to financial incentives, those who can’t participate are almost certain to wind up paying higher premiums.
Hi Maggie:
That certainly would be a loophole which would be aggressively exploited if it remains wide open for such actions by companies as well as the insurance industry. The practical matter is people not realizing they too will age, have a disorder, suffer a slowing of metabolism, have depression, etc., which will affect how they are in the work place and impact their behavior. Targeting them for higher costs goes against what healthcare reform is supposed to accomplish.
regards,
NG, run 75441
You make a good point.
I, too, am concerned about the side effects that we see from statins–particularly with older patients.
I wouldn’t want my company to tell me that I have to go on statins, or wind up paying more for my insurance.
My employer is not a physician. Some of these “wellness” programs are created by consultants who may mean well, but are not medical reserachers or physicians.
run 75441–
Good to hear from you.
Yes, it seems that this is a loophole that could be exploited, and would be difficult to regulate.
IF the legislation set premiums (varying by location) then it would be easy to see whether employees who couldn’t meet the targets were being penalized when others received bonuses.
But since, as Stan points out, there will be no “baseline” for premiums, it is going to be hard to tell . . .
This is about a mature a discussion on this subject that I have seen. Worth reading if you wish to engage in this debate.
http://content.healthaffairs.org/cgi/content/abstract/28/3/845
For the record, so long as there is equal treatment and appropriate substitutes are offered, I am fully for this. If you are depressed, your employer should assist. Too busy…well, join the rest of America (and if there are real issues, you should get a waiver btw). To say you cant engage in wellness, if, and a big if, it is put in front of you on company time, on company property, then we get a grade F on changing the health trajectory of this country.
Most surveys, especially in HA (look em up) all seem to show employer support for wellness, with mostly employee satisfaction.
Brad
In my view, wellness programs are potentially of substantial value, and that value cannot be realized without financial incentives, but as Maggie has pointed out, these programs must be monitored to ensure that they are not used to penalize those who are unable to benefit from them.
The proposed legislation is a reasonable step in the right direction, but will require constant monitoring. This means, as the Senate bill proposes, that the HHS Secretary must monitor the programs to determine their effects on health status, heatlhcare costs, and affordability for those who participate and those who don’t. Plans with or without wellness programs or with differing programs must be compared in terms of effects on premiums, healthcare costs, and actuarial values, with the expectation that costs will diminish (in a relative sense), premiums will not change for non-participants, and actuarial values will not decline due to a failure of insurers to pass cost savings on to subscribers. This type of monitoring may not be perfect but until proven otherwise, should be expected to prevent egregious abuses.
Monitoring also requires that the bill’s provisions be enforced, including those that demand that all program goals be reasonably achievable for the individuals targeted rather than used “as a subterfuge” to raise rates, and that waivers be available for individuals who are not in a position to participate or meet goals.
In other words, these are provisions whose value or lack of it should be determined empirically based on performance rather than judged in advance. For most of the conditions listed, the requirements should not be unduly onerous (with waivers available, as mentioned, for exceptional cases). Blood pressure management generally requires taking a few pills and avoiding too much salt. It’s doubtful that any program would pass muster that insists on a specified weight loss level, and so that stikes me as possibly a “bogeyman” describing a hypothetical worst case scenario. I would predict that no-one is going to be compelled to take statins, because again, such restrictive demands would violate the principles of “reasonable” approaches to risk reduction (although for some individuals, statins are known to be the best measures available). What I’m saying is that it’s possible to construct a nightmare scenario in which every legitimate goal of wellness programs is subverted, but it should also be possible to be sure that doesn’t happen. The benefits of successfull wellness programs will be substantial in containing rising healthcare costs. Even though these cost excesses predominantly involve excessive use of unnecessary interventions, lifestyle factors amenable to individual control are not insignificant and should be addressed.
Finally, the “50 percent” discount would only pertain if the HHS Secretary, based on empirical data, determined that such a figure was appropriate.
It would be a shame if wellness programs were diverted to insurer profits instead of serving their purpose. In my view, however, it would also be a shame not to attempt to make them work the way they are designed to.
Brad, you write:
“If you are depressed, your employer should assist. Too busy…well, join the rest of America (and if there are real issues, you should get a waiver btw). ”
Brad– Most employers don’t “assist” if employees are depressed –unless those employees are executivs. . .
The depressed single mom cleaning office buildings at night that I mentioned on this thread? No way..(This is not a sentimental fantasy. When I was at Barron’s/Dow Jones, I often worked very late and met the cleaniing women with pictures of their kids on their carts.)
And yet, there are so many more low-income and often depressed,low-income workers at most major corporations– they way outnumber the exectuives. These workers aren’t jsut cleaning at night; thye’re in the in the mailroom, servicing the building in other ways-
Of course, the execs may also be depressed but can afford therapy, meds, a gym where exercise can lift their spirits while someone else takes care of their children.
As for “too busy, well join the rest of America,”–the problem for the poor, and many minorities, is that they have not been asked to join the rest of America.
They are underpaid and may work 1 1/2 jobs. They are trying to care for children or sick spouses and parents without help. .
By conrast, more affluent Ameircans are “too busy” because they’re running form a meeting at work to dinner out with friends.
Meanwhile, the maority fo Americans are running very, very ing hard to try to stay in place.
I’m sure that you, and most of HealthBeat’s readerse, know all of this.
But sometimes,it’s easy to respond in a quick and breezy way to something like Adele’s post, without stopping to remember what we all know. ,
Regarding ; “getting a waiver to be exempted if you have ‘real issues'” — what do you think getting a wavier would do to an employee’s job prosects in terms of getting a raise, a promotion–or just keepng his job?
Maggie
I made the assumptions under a 2.0 health environment:
1) Mental health parity laws which will begin to phase in (which still can be bypassed–not perfect). Additionally, with ramped up primary care, PCMHs, etc., access to psych treatment will improve. See #2 as well.
2) Most wellness plans will begin in large, self-insured companies. Low income worker phenomena less problematic in this sphere, as most of these types of folks wont be at the whim of a less than sympathetic <50 employee worker mill boss. Yes, you are right though, the person pumping gas and flipping burgers will be screwed. This slice of America will not get the access to programs they deserve, but conversely, many will who never had access to wellness plans will get them for the first time.
3) Obesity, HTN, DM, not a "poor persons dx," even though prevalence higher in that population. Wellness programs will benefit ALL workers, from all financial strata. Obesity and overweight afflict 2/3 of USA, and you have written extensively on that subject.
4) Once again, time is tough. Two worker households, single moms, two jobs, etc. This is America now. This problem may go beyond health care, but so long as it exists, to give all a pass is akin to saying paths to ameliorating chronic dx are hopeless. If we cant do it through structured, regulated programs, I certainly am not more optimistic with self-initiated attempts. We need to try, and benevolent programs are worthwhile first attempts.
Anyway, we probably agree more than we disagree, ie, we have to look out for the "little guy" in a big way. However, for the 100 million plus individuals who are "in play," so long as programs are ethically sound, i feel it is a reasonable approach.
Maggie, a few initial thoughts, since I became overwelmed about halfway through and needed to set some things down:
1. Your first sentence assumes something it shouldn’t. Health insurers will continue to shun the sick only if there is no risk-adjustment of premium out of a larger, multi-payer pool. Already in Medicare, and through the SNP program in Medicaid, insurers are being paid more (actuarially sustainable amounts) to provide coverage for those with chronic conditions. Insurers are seeking out these sick people. I know, because I work for a company that does this. You can argue that insurers are still seeking to increase revenue or profit, but you can’t argue that they are shunning the sick in these cases. If the US adopts a model more like the Netherlands, risk-adjusted premiums will become ubiquitous and insurers will have no reason to avoid the sick. In fact, since there will be more opportunities to save money on the sick through more efficient care and behavior modification, insurers will have an incentive to seek out the sick.
2. Wellness programs need not be, and often are not, part of an effort to avoid the sick. Now, I should disclose that some of what I do specifically involves workplace wellness programs, so you may regard me as doubly-suspicious here, but there are a few uncontroversial facts in my favor. First, most private insurance is group insurance, and wellness programs are generally for groups, not individuals. Insurers who insure a group (full-replacement) get everyone, and so their incentive is to keep costs down for the group as a whole, not to stop insuring the sicker people in the group since they don’t have control over that. The sick people, as you know, are among the most determined to have insurance in a group setting. They are much less likely to turn down employer-sponsored insurance than the healthy.
So, I really do think it is off base to say that insurers will use wellness programs to “penalize” those who can’t meet health targets, with the goal of creating penalties so high that some of these sick employees just won’t sign up for insurance. That’s not the way it works.
It’s different in the individual market, where an insurer could promote wellness reward programs or wellness perks like gym memberships as a way to entice those who are healthy. This has occured in the past for Medicare Advantage, and insurers would look very closely at what they could do similarly in the Exchange. The framing in the individual market would be to emphasize the carrot and not the stick, since people don’t like sticks and are unlikely to voluntarily choose a plan that has them. Of course, carrots and sticks can often amount to the same thing financially when you look at the amount of cost-sharing, so this is a psychological difference more than a “real” one. But as Kahneman and Tversky, Thaler and many others have shown, perceived differences make a real impact on behavior and people behave in reliably irrational ways.
OK, now I’ll read the rest.
One-half to two-thirds of the savings from improved health accrue not to insurers, but to employers and individuals (mostly to employers in the form of improved productivity). If a wellness program works to move the needle, it is a win-win-win situation. Total healthcare costs go down, which means total premiums are very likely to go down, which obviously relieves some of the pressure on wages and/or increased cost sharing for health care. Employees, obviously, are healthier on average.
Large employers like Safeway and IBM are reporting significant improvements in health despite the obstacles to moving the needle that you cite. I don’t see evidence that they could do this without financial incentives. Do you think that these cases do more harm than good?
You mention three reasons why wellness programs may not be successful due to reasons that are not the fault of the individual: subtle physiological or neurological barriers to changing behavior enough to impact health (obesity, depression), genetic causes of poor health that are difficult or impossible to overcome through behavior change, and social factors such as poverty that limit the options for exercise and nutrition or cause psychological problems which are their own barriers to change.
I’m quite sympathetic to the reference to poverty, poor education and poor living conditions. People in such conditions are not equally situated when it comes to changing behavior and improving health. At least thus far, most wellness programs are for the fully employed middle-class and upper-middle-class so those issues have been reduced thus far. But if wellness becomes ubiquitous that won’t continue. For those in socio-economic dire straits, financial incentives can’t take the form of deprivations (more cost sharing) but must instead primarily take the form of increased benefits or just cash payments. For example, Medicaid in New York allows incentives for things like getting preventive health screenings. There is no reason that model couldn’t be expanded, though we don’t yet really know what works enough to be worth doing in a cost-effective manner. I am assuming that the present bill would not allow increased cost sharing for Medicaid and Medicare, but only commercial insurance.
The genetic case and other similar cases of bad luck are real, and wellness programs do need to accommodate them to be fair in extreme cases, but I don’t see why they always need to.
For example, I am predisposed to have high cholesterol and as I reach middle-age it is very hard to change this through diet and exercise. I’m not overweight and eat a little better than most Americans, but have cholesterol in the danger zone. Not to say it would be impossible to change. If I were to exercise an hour every day, it would be a big help. If I were to cut out all refined sugars and simple carbohydrates, it would also be a big help. Together, they could probably get me back to normal without drugs, which I really don’t want to take. It isn’t “fair” that I can’t control my cholesterol doing the same things that others do. However, should I or millions of others be treated as unable to change because of this? Should I feel no responsibility to change? Are financial incentives useless? I don’t think so. I, for one, want additional carrots and sticks to help me do what is in my best interest and what I want to do, but have been unable to motivate myself to do thus far. Financial incentives can have a place in motivation. Massive cultural change to bring us closer to a European way of life would be great, but I’m more optimistic about making those changes with the acceptance of wellness programs than without it.
jd:
I like the idea of increased cash payments for preventive care, in lieu of no co-payments.
In addition, premium savings should generate additional savings either for medical expenses, retirement, or an inheritance.
Using cash in lieu of co-pays is easy.
If that will not be done, how can we expect people to live healthy lifestyles, which is more difficult?
Don Levit
Being that I am some who supports a single payer health care system,I am opposed to insurance corporations having the right to charge people more money for not participating in wellness programs. However even when or if the day comes that we get single payer, I would favor a system where those people who refuse to follow their doctor’s recommendations to stop smoking or drinking, and at least try to adhere to a better diet and exercise, would pay more for visits to their doctors. Many of these people simply don’t give a care and this would cost a universal health care system a ton of money, not to mention how these peoples second-hand smoke impacts the health of other people. I do want to mention that I am opposed to doctors over prescribing statins because they can cause muscle problems. Too many doctors aren’t familiar with other natural cholesterol reducing remedies such as Red Yeast Rice.
All of the conversation aside, the issue is that looking for loopholes = gaming the system. If not this loophole, then another. If not a loophole, then a secret collusion or an “honest mistake” made by design, or strongly influenced studies or suppression of results….
The problem is the motivation to game the system and the lack of consequences if caught gaming the system.
Nothing I have seen so far in the current reform addresses this basic problem.
Hi Gays,
I’m a single man work in office buildilngs at night, there is a very good chance that I don’t have the time to participate in a wellness program.
I also probably don’t have a computer, or access to the Internet.
jd. and Brad F.
Very good to hear from both of you.
J.D. —
I have to say that research indicates that you over-rate how effective financial incentives can be.
According to the American Heart Association:
“In a comprehensive analysis of financial incentives to encourage healthy behaviors commissioned by
the Agency for Health Care Research and Quality (AHRQ), Dudley and colleagues found that by far
the most widely studied areas are programs related to incentives to quit smoking or lose weight. In
studies of such programs, the report found that the impact of smoking cessation and weight loss
incentives has been small. Although they do boost participation, according to the report, they usually
have little lasting impact on actual smoking cessation rates or weight loss.”
The truth is that these problems are: a complicated combinaton of genetics, body chemistry, current environment, environment while growing up .. . For patients, financial carrots and sticks often aren’t the answer. . .
Also, you are a very intelligent person, but don’t work to lower your cholesterol.
You are not overweight and not in poor health. Unless you begin to experience symptoms which suggest that you are in trouble,
I doubt that a financial incentive would cause you to change your behavior, long-term.
(Also , see my posts on the Cholesterol Con. High cholesterol may not be as dangerous as you have been told.)
Brad F.–
Thank for your reply.
I think we do agree more than we disagree.
Just a oouple of comments:
In very large corporations
a surprising number of employees are low-income:
they are the clerks and adminsitrative assistants, the folks in the mail-room, and in some cases the people who clean the building (though in many cases this service is contracted out.)
They would be effected by these wellness programs–wouldn’t have the time or the incentive to participate, etc.
Secondly, more access to treatment for depression is good, but it doesn’t mean that people dont’ remain depressed. We have no cure for chronic clinical depression and treatments that sometimes work for a while don’t work long term. . .
Although I am all for wellness and prevention becoming more a part of our national health care, being that I’ve been a professional wellness/holistic therapist for 31 years, but I feel angry that the insurance companies are now trying to use it as just another excuse to take people’s money and not give them the product they are paying for.