Incentives as motivation: do they work?



How much would you do for lower health care premiums?
How much would you do for lower health care premiums?

Recently there have been articles in the news about the proposed health care reform, the effects of people being un-healthy and insurance companies looking for ways to reduce costs.  One of the proposals from the insurance folks is to incentivize health.  What they are proposing is charging everyone higher premiums, then, if you submit to a physical examination, you have the potential of getting a reduced rate.  However, if you have any medical conditions that are controllable according to some standard (such as obesity, diabetes, high blood pressure or high cholesterol) you will be charged a higher rate.  If you show a reduction in these un-healthy factors you will get a bonus: a reduction in your rate.  They are calling this an incentive program.

A few things we all agree on: 1. it is not healthy to have high cholesterol, high blood pressure, diabetes and the like; 2. having all of these things put you at risk for more problems down the road; 3. you will have higher medical costs than someone who does not have these conditions. 

In the current system of group insurance if one person uses the medical system a lot everyone’s rates go up.  The system they are proposing would make it so that people with the conditions pay more than the people without conditions.  I use the term “conditions” lightly, I’m not all together sure where they will put the cut off or what scale (no pun intended) they will use.  In essence, with this proposed incentive system, people who are generally healthy will have the opportunity to pay less: use less = pay less.  That seems like a pretty fair system when you are on the healthy side of the equation.

But let’s take a look for a moment at what happens if you don’t fall on the healthy side.  The insurance company has just raised your premiums and told you to lose weight or stop smoking or fix your cholesterol levels — or else we’ll keep raising your rates.  If you control these things we’ll lower the rate.  My question then becomes — how?  How am I to quit smoking, lower my cholesterol and lose weight? 

Let’s just take weight loss.  Well, my company offers a once a year health fair.  I go to that health fair and learn that eating more vegetables is healthy and helps you lose weight.  It doesn’t work.  I go to my doctor and say: “doctor, I have to lose weight” and the doctor says: “reduce your calorie intake and exercise more”.  It doesn’t work.  What do most people do at this point?  They say, well nothing I do is working so I’m just going to have to pay more.  Or, I lose a little weight and they take pennies off my bill.  Is that enough to keep me on a weight loss program?

Research says that no, incentives don’t work by themselves to help promote weight loss, stop smoking, change eating habits or keep people safe at work.  People don’t make long term decisions based on financial gain.  Really if money were all there were to it, many people would have stopped smoking when the price of cigarettes got higher than their gas bill.  Incentives do work to get people in the door.  They increase the likelihood that the person is going to sign up for a program — that’s great!  Once you get them in the door, what are you going to do with them?

The best programs need to treat the whole person.  Research is showing that people need one-on-one counseling for many of these issues, they need follow up, they need peer support, they need consistent messages at home and at work.  Good wellness programs include all of these things and more.  And, you know what, you don’t even have to include an incentive if you have all of these components.  These components don’t cost as much as health care premiums and you can impact more people.  

Let’s talk for a minute about those factors that don’t respond to diet and exercise.  There is a large portion of the population that have a genetic predisposition to high blood pressure.  They have to be on medication to keep this under control.  Would a change in diet help? Possibly.  However, you can be very religious about eating healthy and exercising frequently and still have highblood pressure.  What would the insurance companies do with this person?  They have to use the medical system to get their medication and with their medication their issues are under control.  Do they get the “incentive”?  They don’t need to participate in wellness classes, they are already eating right and exercising and watching their stress levels and all that…  But they are still in a high risk category because of their history.  How much should they pay?

There are incentive programs that work to get people in the door.  It helps motivate them to listen to the experts and get the begining stages of help.  They can help motivate a group to do better and reach a goal.  For example a walking club could have a goal of 100,000 collective steps in one month.  When they reach that goal everyone who participated gets a t-shirt “I walked for the team” or gets a gift card to a local store.  That kind of incentive helps get a program off the ground.  People get excited about what they accomplished.  Management praises them for a job well done.  Support is available all around.  The program can gain momentum and try to out do itself for the next competition. 

Would you get the same reaction to a larger or smaller chunk taken out of your paycheck every month?

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