Monday, June 21, 2010
The numbers have been repeated many times over, according to the Henry J. Kaiser Family Foundation, the United States spends over 16% of its Gross Domestic Product (GDP) on health care costs annually. Over the next several years, this country will attempt to bring that cost under control by increasing the numbers of insured individuals through a variety of efforts. Many of those efforts are directed at employer sponsored health care plans. However, key to health care cost savings is the role played by the enrolled employee and their covered family members. Until recent times, only modest attention has been paid to the pro-active role employee engagement and commitment plays in altering the rate of health care cost trend. Anyone familiar with patient compliance can attest to the challenges providers face in even simple treatment regiments. The Patient Protection Act hopes that by increasing the role of covered employees in their own health care with informed provider selection; value based care delivery systems, and coordinated treatment plan development cost savings can be achieved. The outcome of this effort will only be known in time.
In prior years, many employees had little or no incentive to be concerned with their health care plan. Premiums, deductibles, co-pays, co-insurance rates, and employee out of pocket expenses were comparatively low. After all, it was mainly the employer’s money. With many employers picking up 60%, 70%, 80% or more of the plan costs, employee out of pocket expenses were little more than an annoyance. Yes, carriers and employers tried limiting benefits, prior authorizations, concurrent review, post procedure reviews, restrictive networks, audits, nurse lines, and mandatory generics and mail order. Were employers, carriers, and the government successful in slowing the rate of health acre trend? No, they were not. The Henry J. Kaiser Family Foundation reports that between 1980 and 2008, health care costs rose from $253 billion to $2.3 trillion.
Therefore, what is going to make the current health care reform any different from any of the prior attempts over the last 20 years? There is more focus on employee involvement, education, and information availability. Some of the restrictions around employee wellness plan designs have been relaxed allowing employers to offer greater monetary incentives for employee participation in wellness plans. However, fundamental to employee wellness is participation and the commitment to sustain that participant overtime. Participation on not only the employee but also family member participation, encouragement, and support as well. We have all tried to stop smoking, lose that extra 10 pounds, increase the amount we exercise, switch to decaffeinated coffee or develop better sleep habits. The true test is the outcome and that comes from long-term commitment and goal attainment. Trying to lose 10 pounds is not the goal; actually losing the 10 pounds is the goal.
What motivates an employee to commit to actually losing those 10 pounds? Is there some leverage that we can apply to engage the employee to commit to losing 10 pounds? Can it be so simple as to reward the desired behavior? Lose 10 pounds and your employer will pay you X dollars? Can employers appeal to the employee’s basic needs? No matter what employers desire to do, true health care cost savings will require the engagement and commitment of employees to make it happen.
Like Bob, I am a lifelong nonsmoker. And, in these times, where both employers and employees are facing higher premiums for medical coverage, anything we can do to contain costs is worthy of consideration.
ReplyDeleteThe question, as I see it, is how far we take things, particularly if we’re talking about any kind of perceived “sinful” behavior. Effective yesterday, July 1, a 10 percent tax is imposed on the use of tanning beds. This consumer "tan tax" is expected to raise nearly $3 billion over the next decade. If that revenue from a tan tax can directly affect and reduce healthcare costs, then I'm all for it.
For this apparent sin and the person who wants the UV rays, there's the sun (yes, presently free and untaxed). For those who want a UV-free tan without the tax, get sprayed! There's an airbrush tan that is not subject to the tax. Then, add a little vitamin D supplement to potentially enhance the mood of a person who will eventually come to realize that underneath the spray is still a hideously lighter-complected person. It's a trade-off, yes. There's a tax savings and possibly a longer life in exchange for luxurious, sun-kissed color along with those pesky carcinomas and misshapen and multicolored moles.
Do we impose a similar "sin tax" on tobacco smokers? The equivalent here would be smokers switching to smokeless cigarettes which are free of tar and carcinogens and perhaps, well, some of the glamour of really smoking. But, if a person needs either the nicotine or the presence of a white stick between the fingers, this may be the sinless or at least less-sinful solution.
I think we need to see if a sin-tax such as this tax on tanning can truly be directed toward healthcare savings. If it is successful, let's impose an increased tax on some other sins in addition to cigarettes: alcohol (if consumed in excess only), pornography (again, for excesses), fast food sold to the obese and those with elevated blood pressure, workplace computer-solitaire abusers, anyone who talks on a cell phone in the grocery checkout, etc. Not all of these are true sins as defined by any church or our by our government. Some are simply annoyances to me and, as such, should probably be taxed.
On the other hand, if the tax simply enters the government coffers and becomes payment toward some unpopular war or more pork barrel spending, it will become Internet-listed on dumblaws.com and provide fodder for generations to come until it is repealed or until someone invents a safer way for those of us who are pale to become less pale.
Smoking is dangerous, yes. Do we make life decisions based on the risk of danger? Not always. If we did, there’d be no NASCAR or bungee jumping, and nobody wants that.
Yes, there probably are some things we just cannot fix.
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ReplyDeleteYou could not be more correct. The key is participation. Actually it is participation in programs that measurably improve the health of the workforce. You can have high participation in a health risk assessment, but that alone is unlikely to change people's health.
ReplyDeleteSimply throwing money at employees is not likely to work. So, the increased ability to incent is great; however, incentives alone are not likely to actually improve the quality or impact that such programs have on employee health.