Some people don’t have an exercise routine and eat what they want, others are very conscious of what they eat and how active they are. In the United States, there is great concern about containing the soaring costs of health care, which are constantly outpacing inflation. One method that has been adapted is that of Health Maintenance Organizations, widely known as HMO’s. In capitation plans, members pay a fixed amount for a given year of coverage, with the provider bearing any additional costs if services exceed that amount.
Another common practice is charging copays for health care visits. Denying coverage to patients with existing illnesses, such as cancer or AIDS, is another way for individual companies to keep their costs down.
Health Accountability Act (HIPAA) mandated that all workers covered by an employer-sponsored health plan pay the same premiums regardless of their health status. However, federal authorities finalized the rules in July 2008 granting HIPAA exceptions for certain wellness programs, where employers can now offer rewards or penalties of up to 20% of an employee’s total cost of coverage. Is this practice correct?
Charging more for unhealthy behaviors is a form of cost shifting. Copays apply universally and unconditionally and no matter what the patient’s problem or symptoms are.
Copays are intended to discourage unnecessary use of medical services. One option is no-fault health insurance. Fees should be based on the principle of merit, charging people based on what they deserve or have earned.
Promoting healthy behaviors reduces suffering, prevents social exclusion and shows that the person knows what is good for them.
Being fair is examining whether a patient is abusing drugs, alcohol, cigarettes, or prescription medications, because it costs more to treat if a patient is suffering from these things. On the other hand, is it fair to charge more for a patient who has a life? threatening disease such as cancer, heart failure, diabetes, or high blood pressure. People may argue that they may need to take a prescription medication to deal with anxiety or stress. Should the medical community avoid or penalize those people with a higher rate for their insurance premiums?
It is a debate that will always continue. Hopefully insurance companies realize that their best interest should always be the patient and that goes for the doctor as well. Whatever the patient’s problem is, a good doctor would look beyond the reason for a patient’s problem and try to help the patient get better and live a healthy rest of their lives. This can be a sacrifice for the doctor, but for most, helping people was what brought them to this profession in the first place.
