Beware of the Preventive Health Care Bogeyman

Written by: pinetrees on Feb 16, 2008 10:48 AM EST

I work for a large state university system, which has recently initiated a large preventive health care benefit program.  If this is what prevention programs will be like, such a policy move should be reconsidered.  I view this program as a gigantic waste of money.  Some of the PR around this program bases it support on the assumption that what people need to take care of themselves is a "nudge."  The allocation of money for this "nudge", however, takes away money from health care rather than encouraging it.  Employees have been asked to voluntarily take part in a health assessment questionnaire.  This questionnaire includes questions on why certain steps have not been taken to improve one's health.  The questionnaire introduces statistical bias and is invalid; there is nowhere on the questionnaire where a person can state that one cannot afford the cost of the copays.   So, for example, if a person wants to lose weight and can't afford the copays for visits to the primary care physician, specialist and nutritionist, there is nowhere on the form where this becomes apparent.  The person is assumed to need a "nudge," whereas the real need is lower copays.  Upon completion of the questionnaire, the employee is given a $75 gift certificate.  The employee chooses from a list of vendors participating in the program.  Most of these vendors are large chains selling discretionary items.  Target is the only business on the list that sells food.  Although this is a preventive health program, there are no health food stores on the list.  There is also no vision care chain, dental group or hearing aid company on the list, so the employee cannot use the $75 towards the copays for these health care needs.  The $75 can be used towards university gym fees, but since it doesn't cover the full  amount, it will not help staff members afford the fee.  There is no provision for the employee to use the $75 to pay for the copays for 5 office visits.  Also, there is no provision for employees to use the $75 for necessities such as housing, gasoline or car repairs.  There is no way a person can direct the money into paying for child care or elder care.  There are some pharmacies accepting the card, but it is already cheaper to use the university pharmacy in many cases.  This means that a huge amount of money allocated as a health care benefit is actually being diverted for employees to purchase discretionary items at large chain stores that do not provide any health-related products or services at all.  Most people I know are choosing Target in the hope that the gift card can be used toward the purchase of food (if there is no exclusion in fine print).  Another "benefit" offered by the prevention plan is access to health coaches 24 hours per day by phone.  There is no way a person call and get a counselor 24 hours a day if one has an argument with one's spouse or experiences workplace stress or is exhausted from caring for an elderly parent.  But there are those health coaches 24 hours a day for all of those preventive "emergencies."  When our society is being told that there is not enough money to provide people with health care, I think we have to very careful about what the money is being spent on and whether the existing funds are being directed to where the real needs are.

Tags: