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by Donald B. Ardell, Ph. D.
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Wellness in the Headlines
(Don's Report to the World)

Creating A Health Care System With Incentives for Wellness

Tuesday May 20, 2003

Early last week (5/12/03), the Congressional Budget Office released data showing that almost 60 million Americans, not 41 million as often reported, lack health insurance. My guess is that none of these people is a member of Congress, a Bush administration official, a health care executive or a Republican! The uninsured figure represents about a quarter of the non-elderly population in this country. Oddly, as things continue to get worse in this respect, the prospects for health care reform get better, as the crisis eventually will require action by the national powers that be. The real challenge will be crafting a wise course of action that not only addresses insufficient access to medical care, but leads to significant advances in the health status of the population. The latter can only be done by creating a medical care system that encourages people to exercise, become and stay fit and otherwise shape approaches to wellness lifestyles.

A colleague of mine in Florida is an expert in health insurance reform and has spent a considerable amount of time, energy and money devising a plan for a better system. He wants to deal with gaps in coverage on a local and national level. Recently, he forwarded an outline of his ideas for reform to me for comment. Some of his key ideas, and my reactions, might be of some interest to you. I hope so -- I'll summarize the basics of his plan and my suggested reforms.

The key feature of his plan, proposed to legislative officials as a demonstration project to try out in Florida, would entail a ten percent tax on wages. Employers would pay into a health insurance pool that would be used to fully compensate doctors for care of all Floridians. It would completely eliminate co-pay provisions that exist today with standard health insurance. He notes that the ten percent figure is what employers currently pay for conventional insurance. However, at present, up to a third of that goes to non-medical expenses, management and profits. Since employers would pay the ten percent to doctors from employee salaries, the employees would end up paying ten percent less than they do now for Social Security and Medicare taxes. Under this demonstration plan, an estimated "windfall" to the state would exceed $.6 billion. My policy wonk friend also claims that his plan is endorsed by Nobel Laureate Milton Friedman. (This is a neat trick. Next time I run for office, I think I'll get Milton Friedman or some such luminary to endorse me.)

I offered two sets of comments over the course of a single day. In the first, I asked if he could craft incentives for healthy lifestyles, noting that it is the failure to exercise, eat wisely and learn basic self-management that causes so much of the illnesses for which funds are needed to pay for mostly avoidable illnesses. One specific suggestion I made was to offer a percent discount if one demonstrates, via wellness testing, that he/she is meeting lifestyle standards (to be devised and put in place.) He was quite responsive, and asked how to test for wellness or, better yet, score wellness.

This was my (second) response.

Thanks for the invitation to comment further on the notion of adding incentives for proactive, wellness-oriented initiatives that would reduce illness and attendant needs for expensive care.

I am NOT talking about annual physicals. Nor am I suggesting more risk reduction or prevention activities of a testing for disease/illness nature. There is too much of this already. I am NOT interested in reimbursements for "toothpaste, soap and hygiene products." Or "herbs, proven or otherwise or salad eating," as you noted. Web pages won't do it, either. How can I get your attention away from the sickness system -- and away from such things as "diagnostic related groups" or "treatments may be better for a patient" or "medications that might be best?" Even providing, as you suggest, "patient accolades" or "complaints about bedside manners" does not interest me. Enough, already! Please try to think of wellness as a lifestyle. The activities encompassed under such an umbrella of initiatives would require no doctors, nurses, drugs, etc. I have written about this elsewhere -- and rather than go on and on here, let me note that, if interested, you can check the Archives for relevant articles on wellness-based health system reform.

Here's the basic idea. Use ONLY positive incentives. Do NOT penalize for anything (smoking, being fat, supporting weird politicians, for examples.) Instead, reward wellness initiatives. On the simplest level, consider three stages of steps for rewards. You could offer discounts at each step in the process, and let these incentives be ever larger to reward lifestyle accomplishments.

  1. A wellness assessment. A testing of how FIT FOR WELLNESS one is and could become in six months. Just having this done at an approved center (where a standard wellness base protocol will be applied) makes one eligible for the bonus.
  2. Ability to demonstrate advances with regard to objective indicators. Examples: Improved body composition levels and similar changes of a physical nature. Another bonus kicks in.
  3. Annual check-offs rendering eligibility for a third level bonus. This entails mastery of skill levels. See the 14 skill areas in the three dimensions of wellness for the kind of skill areas envisioned for inclusion.

The dollar savings that would be returned to individuals from the basic ten percent contributions could be the motive driver to encourage positive lifestyle advances. A final note -- be sure to keep participation in such wellness initiatives voluntary -- that's the only way they will ever take hold. Good luck with this.

What do you think? Am I steering my policy friend in the right direction (s)? Be well, and always look on the bright side of life. Domain: purpose
Subdomain: applied wellness

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