May 21, 2013

How Far Would You Walk to Save on Health Insurance?

There’s one way to get people exercising: Threaten to charge them higher insurance premiums.

The obesity epidemic and its ugly cousin, the inactivity crisis, are on everybody’s minds, including those of healthcare officials and insurance companies. But one insurance company turned everybody’s heads when it rolled out a new strategy for getting obese people to become more active: the threat of higher insurance premiums.

Overweight people could avoid the rising cost by enrolling in a fitness program. The big surprise was that it actually seemed to work very well.

Obesity and being sedentary have been linked to a laundry list of chronic and acute health problems, not to mention early death. There’s been a lot of debate in recent years about how to address the rising problem in the U.S., with some strategies more successful than others.

One insurance company turned everybody’s heads when it rolled out a new strategy for getting obese people to become more active: the threat of higher insurance premiums.

A program by Blue Care Network gave obese people the choice of paying 20% more for their premiums or enrolling in a program like Weight Watchers or WalkingSpree, in which participants tried to walk at least 5,000 steps per day, monitored by a pedometer that registered their daily distance remotely.

A study that analyzed the WalkingSpree option found that after one year, 97% of the 6,500 people enrolled met or exceeded the 5,000 step-per-day goal. In fact, the average was about 6,500 steps/day, and many people walked more than the goal. Even the people who were fundamentally opposed to the strategy or found the method to be “coercive” — about one-third of the study group — were also successful.

“Wellness interventions like this clearly hold significant promise for encouraging physical activity among adults who are obese, ”said study author Caroline R. Richardson in a statement.

That said, Richardson also mentions an important issue the program raises, Is it ethical to threaten higher premiums unless certain conditions are met? One could argue that whether one exercises or not is a person’s prerogative, and to threaten higher premiums is, well, “coercive,” as many of the participants felt.

But because of the success rate of the program and the health value of even gentle forms of exercise in reducing America’s healthcare burden, Richardson expects to see more of these “incentivized wellness programs” in the future. And when the Affordable Care Act goes into full swing, health and wellness programs by both employers and insurance companies are likely to expand.

People with health conditions that prevented them from being able to meet the requirements were, of course, allowed to opt out. More research certainly needs to be done to understand how incentivized programs help or hinder an individual’s health goals and quality of life. In the meantime, the logic behind the program is certainly valid: getting in as many steps as possible is certainly a benefit to health, whether you’re running, walking, or just puttering about the house.

The study was carried out by researchers at the University of Michigan and Stanford University, and published in Translational Behavioral Medicine.

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