Health Plan Support

Fifty-Plus Fitness Library

Library : Year 2 | Session 2: Myths of Aging

Dear Dr. Bortz –

I am baffled and more than a little upset that my expensive health plan has no provision to support or encourage my participation in an exercise program. Everything I read and know deeply in my heart is that exercise is much better medicine, is much stronger and effective medicine, than a lot of the trash which is covered by my plan, but it isn’t covered. I conclude that the health plans are either stupid, or insensitive, or both to miss this vital point. What do you think?__Jan Dobins, Chicago

Dear Jan,

As a physician who has worked in a fine medical group for several decades with much daily encounter with health plans, I share your exasperation. I will let you in on a dirty little secret that explains this huge defect. What the health plans want is enrollment, and this is tightly tied to cost, so anything they can curtail such as health promotion education is redlined. Further, they state "why should we invest in your long-term health profile when we know you are likely to change your plan next year for a cheaper plan which has even less preventive medicine provisions than ours does?" Short sighted! How can we improve community and individual health when the insurers of health have such a cynical and self-serving perception?

In the December 1999 issue of the AMA Journal, an article from Health Partners Research Foundation in Minneapolis reported on a survey of nearly 6000 health plan members over 40 years of age. A 60-item questionnaire was submitted to these persons, and the results of their health behavior were related to medical costs over an 18-month period. The authors of the article report that a slim, physically active, non-smoker had bills that were 49 percent lower than overweight, physically inactive smokers. Ten percent of the group accounted for 71 percent of total charges, and in these the adverse behaviors were concentrated. The paper concludes, "Payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks." I would agree with this conclusion except that I would substitute the verb "must" for "may wish to".