Incentivizing health in an unhealthy population

Medicare may be where the budget debate resides (See Paul Krugman’s “Who’s Serious Now?” for an education about the political battles waging this week), but Medicaid is getting a wellness check that many believe may be long overdue.

On April 11th, MSNBC.com ran an article published by the Kaiser Family Foundation detailing an incentive program within health care reform that offers states 00 million to reward healthy behaviors to Medicaid recipients.  There is good reason to focus on this population: Medicaid enrollees smoke more than the broader population, and obesity is strongly tied to poverty. Cigarette smoking is the leading preventable cause of death in the US and chronic disease accounts for approximately .8 trillion the US spends annually on health care, according to HHS.

A few states have used health incentives (with mixed results), but by and large the Medicaid population remains untested when it comes to preventive measures on the part of the patient. Critics argue that incentives are too small, and that there isn’t enough evidence to base any major incentive models for wide-spread behavioral change.

Although this article is an interesting glimpse into the government’s plans for changes around healthy behaviors in Medicaid, even more interesting were the comments posted by readers at the end.

Instead of wasting tax dollars bribing people who are already getting something for free, why don’t we cut them off if they don’t comply with or make efforts towards certain standards?” says BD-540164.

Rewards? How about they do not get coverage until they attempt to be healthy?” writes vegasj.

There is a very real possibility that any attempt at incentivizing healthy behaviors may fall short (the Florida program pays 25 per year to the folks who get their flu shot, but that amount likely won’t be enough to sway eating behaviors over the course of 12 months for the same population).

Tossing aside the limited scope those commenters may be using as a platform (after all, with no coverage, the hospitals and our tax dollars will pick up the tab of these potential non-compliant and therefore non-Medicaid recipients), is this the future of government sponsored programs for the needy? You’ll need to earn your way to play? The most vulnerable population in our society has already suffered major funding cuts because of the Great Recession. On the other hand, who would make the argument that early childhood education should take another cutback while an overweight, smoking, and sedentary population remains unchecked? This is probably the tip of the iceberg…

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