Commentary: Office Visit: Should Personal Health Affect Your Premiums?

Article excerpt

Conversations on health care reform cover many topics, but there is one subject that has not been widely addressed. America's health care problems have been blamed on insurance companies, pharmaceutical companies, physicians and the government. But little has been said about the one person who, in many cases, has the control - the patient.

More than half of Americans consider it fair to ask people with unhealthy lifestyles to pay higher insurance premiums and higher deductibles or copayments, according to an online survey conducted by the Wall Street Journal in July 2006. Many employers, like my own, enforce surcharges on employees who smoke. This voluntary activity has damaging effects on the human body and increases the health care costs of the entire group. Perhaps financial incentives would encourage personal responsibility. This thought process is much like automobile insurance, which rewards drivers for keeping a safe driving record and increases their insurance rate when accidents or speeding tickets arise.

In 2005, Safeway, a self-insured employer, designed a plan that has kept per capita health care costs flat for both the grocery retailer and its employees. Most other American companies' health care costs have increased 30 percent since then. The Wall Street Journal reports that about 70 percent of all health care costs are the direct result of patient behavior. Seventy-four percent of all costs are due to four chronic conditions - cardiovascular disease, cancer, diabetes and obesity. These four costly conditions are preventable at least 60 percent of the time. Employer-sponsored health plans are permitted to establish wellness programs that provide premium discounts, rebates or other incentives in return for adherence to programs of health promotion and disease prevention. With this in mind, Safeway began rewarding healthy behavior, focusing on tobacco usage, healthy weight, blood pressure and cholesterol levels. These employees have pronounced differences in premiums that reflect each covered member's behaviors.

Another concept that incorporates financial incentive for patients is value-based design, one of the newest emerging trends designed to help insurers control medical costs by increasing the focus on the value of care. Such programs offer rewards, such as waiving copayments when patients participate in and adhere to wellness programs.

Lowering health care costs is key. …