Human Limits

Several posts ago I wrote about the idea that people with certain controllable risk factors might be charged higher health insurance premiums.   This issue has come to a head at Penn State University where a comprehensive wellness program, with financial incentives/penalties is being implemented.   The obvious motivation for such programs is to reduce the cost of health care borne by large employers.  A couple of things stand out related to the news reports on this topic:

Who Runs It?

From what I can tell Penn State is using a third party contractor to administer the program.  In addition to focusing on the obvious stuff like smoking, diabetes, blood pressure, obesity, and physical activity; the third party contractor seems to be taking a deep dive into all sorts of behaviors that might or might not be linked to health and health care spending.   Why?   My guess is that over time the vendor can match answers to their surveys with health insurance claims data and use this data for all sorts of purposes.   These might include things like even more granular rate structures or perhaps helping companies determine who to hire or not hire based on projected future health care costs.    Like all big data some of it is about efficiency, but how easy and tempting will it be to hijack this information for other purposes?  How do we ensure that such data really is being used to make people healthier vs. mostly making the bottom line healthier?  Recent revelations in many areas of life make it pretty clear that privacy guarantees should be viewed with skepticism.

Focus on Fundamentals

If you take a big picture look at behavior and health data only a few things stand out.  Don’t smoke, be active, watch your weight, eat a bit better and avoid excessive drinking.  Also if your lipids, blood pressure or blood glucose is out of whack get it treated. I am all for ideas about controlling stress and health.  However, there is pretty good evidence that people who are able to follow basic health guidelines are protected from many of the stresses of life .  The fact that so-called third party wellness programs apparently want so much information has me scratching may head and tends to reinforce the idea that they want the data for other reasons.

Other Options?

Penn State is located in a relatively isolated area of central Pennsylvania and it seems to me that there are other less invasive options to improve the health of the university community.  Is the community biking and walking friendly?  Are highly effective smoking restrictions in place?  My guess is the University serves a lot of meals every day, have the choices in the cafeterias and eateries been cleaned up?  Is there a community wide public health approach to issues like exercise, blood pressure, cholesterol and diabetes?  Why not partner with the local health care providers and go after these big ticket items?  There are experts in all aspects of nutrition, exercise, public and behavioral health on the faculty of the University.  Have these experts been engaged to design and evaluate a comprehensive program and share the results with others so we all learn?  Why outsource this to a third party vendor who can monetize it?

My Take

I think it is a good idea to charge different health insurance rates based on a few simple things that people have control over.  I would start with smoking, obesity, lipids, blood pressure and diabetes.   Physical activity and physical fitness are harder to assess (there is no blood test), but they should be included as well.   However, I think charging different insurance rates for controllable health risks needs to be part of a comprehensive approach that makes it easier for people to change their behavior.   Using third party vendors and letting them capture the data, crunch the numbers, repurpose it and monetize it is not the way to go.   We all own the problem of public health and high health care costs and we need to develop inclusive local and regional solutions.  An “Us vs. Them” approach needs to be avoided