Infuse Incentives in Insurance Markets That Promote Wellness and Better Outcomes for Chronic Diseases: Health insurance must be redefined to cover wellness as well as sickness. In conjunction with recommendations from doctors and nurses, Rudy will propose new initiatives to promote healthy lifestyles and wellness programs, and tie Medicaid payments to a state’s success in promoting preventative care and tracking obesity for children.
(PS. sorry for the typos in the title)
I’m going to disagree. Health insurance is not a free market, it’s so regulated that I’m not sure a total govt takeover would really make much difference in the short term. I don’t think “rational economic decision” means the same thing to a regulated industry as it does to the rest of us.
Also, group health insurance in the US is not insurance, it’s prepaid health care and group discounts. They essentially promise to cover most of your health care costs for a monthly fee on the bet that spread across a large enough group, in any given year most of us won’t consume what we paid in.
On second thought, that sounds exactly like insurance! Maybe that is the crux of the problem? They sell it like insurance, but we don’t consume it like insurance.
What you say is possible, and I agree that a total government takeover wouldn’t make much difference. The way things are going it is inevitable anyway.
But I still think “wellness programs” are probably too bottomless and undefinable to make a rational business model. It just sounds too much like self-confident posturing on the part of candidates.
What would actually make sense is for insurance companies to require customers to take part in wellness activities. If the insurance company is contractually bound to cover breast cancer treatment, it’s in the insurance companies best interest (as well as the patient) to catch it early. So require mammograms each from age 40 or whatever. Same thing with physicals, etc. There are certain activities we know will lead to early detection and reduced cost, as well as better patient outcomes. There is no excuse for not getting an annual physical, especially when you’ve already paid for it anyway.
But what does it mean to “require?” Deny coverage to conditions that arise later, for those who don’t avail themselves of the wellness programs? Or cut off the insurance of those who don’t provide regular documentation of their participation in preventive care?
That’s all well and good until you realize that when those people get sick, a few of them will be paraded up to Capitol Hill and some emergency relief bill will get passed to cover all those poor souls who got their healthcare coverage cut off by heartless insurance companies. Then we’re directly funding even more healthcare from taxes, that could have been covered by private insurance had that system not been in place.
OTOH, a simple incentive in rate for regular participation in preventive care would be a good idea. But anything that actually “requires” individual action (as opposed to providing incentives) raises the question, “Whatcha gonna do when people don’t go along with it?”
By require I meant negative consequences for not playing along – which might be as you suggest best implemented as a rate decrease for those in compliance.