Generally, people will work harder or make more of an effort at a given task if it is in their best interest. That, I believe, is part of human nature. While maintaining a healthy lifestyle is in our best interest and that of our families by itself alone, sometimes we need a small (or large) extra push. Incentives come in many forms, however, money may create the most significant results since it enables additional positive reinforcements (e.g. a nice vacation, new clothes, etc).
Pay for performance is a concept that continues to be discussed as far as our U.S. health delivery system. The idea is that physicians and hospitals should be paid for providing quality care, not necessarily quantity. For example, physicians that demonstrate improved diabetes control in their patient population may receive a higher reimbursement, etc. As for hospitals, those that reduce inpatient associated infections or blood clots may receive additional compensation. The specifics regarding these types of incentives are still mostly under discussion on a national level but certain hospital systems have enacted this principal with success. Fundamentally, I have always thought this idea makes sense from a patient-physician-health care system perspective. We all want the same thing, in theory, which is for the people of this country to live healthy and long lives.
Since the insurance companies, and the employers who pay for benefits, want their customers/employees to remain healthy (for many reasons) a few pioneers have adopted a similar pay for performance health incentive. An article on March 28th in the NY times business section "Carrots, Sticks and Lower Premiums by Steve Lohr described the success of some of these programs including General Electric and Safeway. One of the models used for these companies is based on the Virgin formula which focuses on promoting physical activity. Personal physical activity is measured using pedometers, accelerometers or heart-rate monitors and the data is uploaded into an individual account on the web. One of the participants interviewed in the article stated that the financial reward of a $100 decrease/month in health insurance premiums for her and her husband if she maintained her activity goal was a huge selling point (50-80% of eligible employees participate). Currently, she has lost 40 pounds and intends to lose 14 more.
Executives in these companies believe that the "carrot works better than the stick." The article explains that there are no penalty payments, only encouragement to convert to healthy habits. Some companies are offering cash carrots to smokers, some paying up to $500 for smokers to quit. It is not hard to fathom that there may eventually be "cash carrots" for participants who give up sodas, excessive alcohol and fast food. Sean Forbes, president of Virgin Health-Miles stated, "We're trying to create the good-driver discount for health but one reason that's been so difficult is there's never been a way to really measure things before, but that is changing because of technology."
One of the take home points for me is that we need objective information regarding our health to have lasting effects. I recently started using a polar heart-rate monitor (thanks to my wife, Alexis) that tracks my heart rate and calories burned during exercise. I know I need to achieve about 85% of my maximum heart rate during exercise for beneficial results and now I can keep track. Also, it has been rewarding to see that in a 1 hour spin class I have burned over 500 calories. While these devices are helpful, they are not essential. Find objective ways to track your health such as weighing yourself once per week, have your cholesterol checked and then re-checked, monitor your blood pressure at home, etc.
Opponents of health care reform have made the argument that we all should be responsible for our own individual health on some level. Many have asked why they should pay for others health care if they don't take it upon themselves to remain healthy. Well, I hope with wellness education and objective data we can all reach our individual health goals so we can continue to live fulfilling and productive lives.
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Excellent entry! I just love to watch the calories burn but my problem is that I always think of it as an extra glass of good wine I can drink or the rich meal I can eat without impact ;-) rather than using it for weight loss. However, that's not all bad since its not all about the calories, its also about cardio health and other benefits.
ReplyDeleteIt is true that there are a huge number of health problems that can be kept at bay by keeping up your fitness level. There is a lot to be done on that level in this country. Nevertheless, it still makes sense to take care of everyone's health. If only from the perspective of decreasing the impact of catastrophic illness on the overall healthcare system. If people can't understand why we should just maintain a level of humanity for the sake of humanity, then at least they should be able to understand the impact on the natiional economy!
Thanks for your thoughts.
As always Curt, thanks for your comments. I agree that it is usually challenging not to rationalize that extra food/beverage after working out. I have reached my weight goal plateau and my goal is to now maintain both my cardiac fitness and continue to use the exercise as a great stress release.
ReplyDeleteI read an interesting perspective by Dr. Donald Berwick the new head of Medicare and Medicaid that maybe hospitals should be paid for keeping beds empty rather than full. This was essentially a point that with the current system hospitals, insurance companies and physicians are in financial conflict. A new structure whereby everyone is rewarded for keeping people healthy and in /out of the hospital quickly seems to make sense.