Monday, July 01, 2013

Employers Adopt Rewards And Penalties In Healthcare Coverage

The Future of Getting Paid to Be Healthy, The Atlantic, 3 June 2013

I don't like this. For several reasons ...
  1. It appears to place blame for skyrocketing healthcare costs upon the individual, and not where it should be ... on profit-driven corporations.

  2. There is a fine line between a penalty and a reward, as this article pointed out. Giving someone $100 to stop smoking appears to be penalizing those who don't smoke.
    "But when GE rolled these financial incentives to quit smoking to the rest of their workforce, employees complained about rewarding smokers to do something they should be doing anyway. From their perspective, GE turned the program into a penalty rather than reward program."
  3. Who defines "healthy behavior"? Say your employer has you fill out a form detailing your behaviors. (You may be penalized if you don't comply, or if you are not truthful). You might expect to be penalized if you smoke, but what if you choose not to eat whole grains or dairy foods? Or if you eat low-carb, Paleo, vegan - which all fall outside of a conventional healthful diet, say, the government's DASH Plan)? Should you be penalized if you spend more of your free time in prayer or meditation than in aerobic exercise? Or vice versa? Both of these have a positive impact on health. (How will they know? "[Outsource companies] might track your gym visits, activity using pedometers and accelerometers and attendance at Weight Watchers meetings.") Is it fair to base penalties related to obesity on BMI when this measurement does not account for body composition? Will you be penalized for not getting colonoscopies, mammograms, prostate exams, immunization shots, bone density scans, and a multitude of blood tests ... even though health organizations vary on their recommendations?

  4. You have to change the environment before you can ask someone to change their behavior. For example, you have to offer a safe, accessible place to exercise before you can ask someone to exercise. You have to address barriers like childcare and adultcare. You have to address external costs like transportation, day care centers, and home health aides. You have to make "healthy" food accessible. You have to get bosses on board...
    "Without the other pieces to facilitate behavior change -- healthy cafeterias, opportunities to exercise, flexible work hours, supportive leadership and middle managers, and health risk assessments and coaching -- incentive programs will only penalize, not change, those who are least healthy."
  5. You must employ a failsafe security program to protect private data (mental health assessments and treatment, genetic tests, health diagnoses, drug schedules, medical histories, private behaviors) from being accessed by third parties. Recent revelations about government surveillance of citizens' private electronic records and correspondence place security effectiveness into question.

Related: Final Rules On Employment-Based Wellness, News Release: Department of Health and Human Services, 29 May 2013


Bix said...

I originally said, for No. 1, that getting people to change their behaviors places the burden for rising healthcare costs upon individuals. I meant to say it places the blame, not burden. Individuals will be, are, carrying the burden of rising costs regardless of health assessments.

Bix said...

The more I think about this, the more I see how discriminatory it is.

The ability to engage in health-promoting behaviors depends on a health-promoting environment, a physical and social infrastructure that is lacking in those lower on the socioeconomic ladder, who then find themselves in poorer health. I agree with the article when it says:

"An annual premium adjustment isn't likely to change behavior, and will just end up penalizing those with poorer health."

Creating tiers based on conformity to health behaviors ("The difference between the Bronze and Gold tiers can make a difference of as much as $2,400 per year for a family of four.") that are not uniformly within reach is discriminatory.

How does a single mother who lives in a food desert manage to take time away from her child to go to the gym? To eat fresh produce that her local stores don't sell? What if you spend your at-home time caring for an ailing parent? Is it more difficult to stop smoking when you live in a household of smokers?