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20/20 InSights

Insurance...for treatment or prevention?

Back in 1999, I had a brief 3-month stint in cardiac rehab, working a lot with coronary artery bypass graft (CABG) patients.

We had a Phase II and Phase III to our treatment.  Phase II was for clients soon after their discharge from the hospital, and typically lasted for 12 weeks.  It involved closely monitored aerobic exercise, along with some weight training and flexibility training.

Phase III was a maintenance program for patients that had graduated from Phase II, and again involved closely monitored exercise, although at a lower frequency.

Phase II was often covered by insurance, but Phase III wasn't.  I remember discussing with my colleagues about this how the insurance companies would save themselves money in the long run if they covered Phase III.  The importance of exercise in the prevention of future cardiovascular events (like heart attacks) is well documented in scientific studies.  But the insurance companies would only pay for the post-surgery rehab, which only gets patients "back on their feet" so to speak.  Often, the patients who did not continue to exercise after Phase II ended back up in the hospital at some point down the road, which obviously cost the insurance companies more money...probably more than they would've payed for an on-going prevention program.

The reason I bring this up is because a colleague recently emailed me an article in the New York Times about weight loss camps for kids, and how they usually weren't covered by insurance.  Unfortunately, when they weren't covered by insurance, the families couldn't afford the programs.

It's been well-established that childhood obesity leads to a host of health problems, and that more and more children are experiencing type 2 diabetes, a disease that only middle-to-older aged adults used to get.  The burden that these problems will place on our health-care system and on employers is tremendous.  For example, it's been estimated that a type 2 adult diabetic's health-care costs are 2.3 times greater than a person without diabetes.  In the long-run, insurance companies probably would save more money by paying for preventive programs rather than paying for the problems after they've already occurred.

I'm interested in hearing your thoughts.  What do you think?  Do you think insurance companies should cover preventive programs?  If not, why not?  If so, what types of coverage would be fair?

 

Comments

 

cbuck said:

They should most definitely cover preventive programs. As someone who just barely qualified for the 20-20 program, I had been frustrated for years with being borderline unhealthy. Fortunately (or unfortunately) I crossed over that line this spring, and was able to enter into the program. Less than 9 weeks later, I am 30 lbs lighter and in better shape than I was at age 21. If not for this program (and Microsoft's financial support), I know I would have struggled -- just like many of my family members -- for much of my life. Now with this knowledge and through development of healthy habits, I I know life is going to be different, and future health costs will be dramatically lower.

August 18, 2008 6:22 PM
 

hrischar said:

I think they should cover preventive programs, or at least offer partial support. If only partial support is provided, then things such as scholarships, grants and comfortable payment options should be put into place as well.  Combating obesity, and promoting healthy lifestyles is so important, why not tackle it while people are young, more able bodied and acceptable to change.

August 19, 2008 1:40 PM
 

jkrieger said:

That's a good point, hrischar.  People are generally more acceptable to change at younger ages.  Much better chance of success with a preventive program at a younger age

August 20, 2008 11:12 AM

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